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FORMULIR SURVAILENS BULANAN INFEKSI

UPTD RSUD SIMPANG LIMA GUMUL

BULAN / TAHUN : APRIL 2019


RUANGAN : PERKUTUT
SURVEYOR :
DEPARTEMEN :

JUMLAH TINDAKAN INFEKSI RUMAH SAKIT TIRAH


TGL
PASIEN UC IVL CVL ETT VAP HAP ISK IAD BARING
1 6 1 6
2 5 1 5
3 8 2 8
4 8 2 8
5 5 5
6 6 6
7 4 4
8 2 2
9 3 3
10 2 2
11 1 1
12 0 0
13 0 0
14 0 0
15 1 1
16 1 1
17 1 1
18 2 2
19 2 2
20 3 3
21 2 2
22 2 2
23 1 1
24 3 3
25 3 3
26 3 3
27 3 3
28 2 2
29 2 2
30 3 3
84 6 84
AN INFEKSI
GUMUL

HASIL
PLEBITIS ANTIBIOTIK
KULTUR
FORMULIR SURVAILENS BULANAN INFE
UPTD RSUD SIMPANG LIMA GUMUL KED

BULAN / TAHUN : APRIL 2019


RUANGAN : PERKUTUT
SURVEYOR :
DEPARTEMEN :

TINDAKAN
TGL NAMA PASIEN UMUR JK DX. MEDIS
UC IVL CVL ETT
1 Citra Heri 26 TH P GEA 1
Yuliani 41 TH P Vertigo 1
Sukarti 64 TH P ISK 1 1
Kasmali 60 TH L NSTEMI 1
Arviansyah 10 TH L OF 1
Sumiati 54 TH P NSTEMI 1

2 Citra Heri 26 TH P GEA 1


Yuliani 41 TH P Vertigo 1
Sukarti 64 TH P ISK 1 1
Arviansyah 10 TH L OF 1
Sumilah 55 TH P Dispepsia 1

3 Emery Hermes 3 TH L Vomiting + Dehidrasi 1


Yuliani 41 TH P Vertigo 1
Eko Harianto 73 TH L NSTEMI Inferior 1
Arviansyah 10 TH L OF 1
Sumilah 55 TH P Dispepsia 1
Sugeng 77 TH L CHF dd PPOK 1 1
Auristella 2 TH P Leukositosis 1
Sukarti 64 TH P ISK 1 1

4 Emery Hermes 3 TH L Vomiting + Dehidrasi 1


Yuliani 41 TH P Vertigo 1
Eko Harianto 73 TH L NSTEMI Inferior 1
Arviansyah 10 TH L OF 1
Sumilah 55 TH P Dispepsia 1
Sugeng 77 TH L CHF dd PPOK 1 1
Auristella 2 TH P Leukositosis 1
Sukarti 64 TH P ISK 1 1

5 Emery Hermes 3 TH L Vomiting + Dehidrasi 1


Arviansyah 10 TH L OF 1
Azzam 2 TH P Brochopneumonia 1
Shofia 30 TH P DHF 1
Laily Mar'atus 20 TH P OF 1

6 Emery Hermes 3 TH L Vomiting + Dehidrasi 1


Arviansyah 10 TH L OF 1
Azzam 2 TH P Brochopneumonia 1
Shofia 30 TH P DHF 1
Laily Mar'atus 20 TH P OF 1
Nina Quddiawati 36 TH P Post MOW 1

7 Satriya 10 TH L OF 1
Azzam 2 TH P Brochopneumonia 1
Laily Mar'atus 20 TH P OF 1
Nina Quddiawati 36 TH P Post MOW 1

8 Satriya 10 TH L OF 1
Laily Mar'atus 20 TH P OF 1

9 Satriya 10 TH L OF 1
Laily Mar'atus 20 TH P OF 1
M. Arvino Bachtiar 2 TH L OF 1

10 Laily Mar'atus 20 TH P OF 1
M. Arvino Bachtiar 2 TH L OF 1

11 M. Arvino Bachtiar 2 TH L OF 1

12 0
13 0
14 0

15 Sastriono 11 TH L Gastritis + Vomiting 1

16 Sastriono 11 TH L Gastritis + Vomiting 1

17 Sastriono 11 TH L Gastritis + Vomiting 1

18 Sastriono 11 TH L Gastritis + Vomiting 1


Irfa Ayunda 2 TH L Dyspepsia Syndrome 1

19 Irfa Ayunda 2 TH L Dyspepsia Syndrome 1


Riko Pambudi 23 TH L Intoksikasi Alkohol 1

20 Irfa Ayunda 2 TH L Dyspepsia Syndrome 1


Riko Pambudi 23 TH L Intoksikasi Alkohol 1
Najwa Nur 10 TH P OF 1

21 Riko Pambudi 23 TH L Intoksikasi Alkohol 1


Najwa Nur 10 TH P OF 1

22 Riko Pambudi 23 TH L Intoksikasi Alkohol 1


Najwa Nur 10 TH P OF 1

23 Najwa Nur 10 TH P OF 1

24 Najwa Nur 10 TH P OF 1
Hasna Qonita 8 TH P Glumerulo nefritis 1
Siti Cholifah 66 TH P DM + Vomiting 1

25 Hasna Qonita 8 TH P Glumerulo nefritis 1


Siti Cholifah 66 TH P DM + Vomiting 1
Elvito Paramaditya 4 TH L Orchidectomy 1

26 Hasna Qonita 8 TH P Glumerulo nefritis 1


Siti Cholifah 66 TH P DM + Vomiting 1
Elvito Paramaditya 4 TH L Orchidectomy 1

27 Hasna Qonita 8 TH P Glumerulo nefritis 1


Siti Cholifah 66 TH P DM + Vomiting 1
Elvito Paramaditya 4 TH L Orchidectomy 1

28 Hasna Qonita 8 TH P Glumerulo nefritis 1


Siti Cholifah 66 TH P DM + Vomiting 1

29 Hasna Qonita 8 TH P Glumerulo nefritis 1


Siti Cholifah 66 TH P DM + Vomiting 1

30 Hasna Qonita 8 TH P Glumerulo nefritis 1


Siti Cholifah 66 TH P DM + Vomiting 1
Maharani 16 TH P CKR 1
VAILENS BULANAN INFEKSI
PANG LIMA GUMUL KEDIRI

INFEKSI RUMAH SAKIT TIRAH HASIL


PLEBITIS ANTIBIOTIK
VAP HAP ISK IAD BARING KULTUR

Ceftriaxone

Cefotaxime

Ceftriaxone

Intermoxil
Ceftriaxone

Ceftriaxone

Ceftazidime

Ceftriaxone
Cefterizine

Ceftazidime + Gentamycin

Ceftriaxone

Ceftriaxone