KOMITE PENCEGAHAN

DAFTAR CATATAN HARIAN IPCLN DA

ALAT KESEHATAN YANG DIGUNAKAN
JUMLAH
TGL PASIEN NAMA ETT CVL IVL Jumlah Tusukan UC IV-PLUG
NGT
B L B L B L tusukan >2X B L B L
1/1/2019 3 Ny. Hartini √ √
An. Lami'un Niam √ √
Tn. Isnanto √ √

1/2/2019 2 Ny. Hartini √ √

Tn. Isnanto √ √

1/3/2019 3 Ny. Hartini √ √

Tn. Ainul Akhiar √ 1
Tn. Sudarsono √ √

1/4/2019 3 Ny. Hartini √ √

Tn. Ainul Akhiar √
Tn. Sudarsono √ √ 4 √

1/5/2019 1 Tn. Sudarsono √ √ 4 √

1/6/2019 1 Tn. Sudarsono √ 2 √

1/9/2019 1 Ny. Khozinatul Aniqoh √ √ √ √

1/10/2019 1 Ny. Khozinatul Aniqoh √ √ 2 √ √

1/11/2019 1 Ny. Khozinatul Aniqoh √ √ √ √

1/13/2019 1 Tn Sunawi √ √ √

1/14/2019 1 Tn Sunawi √ 2 √ √

1/15/2019 2 Tn Sunawi √ √ √
Sdr Eko Joko Saktiono √ 1

1/16/2019 2 Tn Sunawi √
Sdr Eko Joko Saktiono √
 1/17/2019 3 Sdr Eko Joko Saktiono √ 2
Nn Innayatul Fitriyah √ √
Tn Sudarsono √

1/18/2019 2 Nn Innayatul Fitriyah √ 2 √

Tn Sudarsono

1/19/2019 1 Nn Innayatul Fitriyah √ 2 √

1/20/2019 1 Nn Innayatul Fitriyah √ 1 √

1/21/2019 1 Nn Innayatul Fitriyah √ 1 √

1/22/2019 1 Nn Innayatul Fitriyah √ √

1/24/2019 1 Ny Paerah √ √

1/25/2019 2 Ny Paerah √ 1 √
Tn Sarno √ √

1/26/2019 1 Nn Nurul Qomariyah √

1/27/2019 2 Nn Nurul Qomariyah √

An Muna Angelikha Maulana √

1/28/2019 1 An Muna Angelikha Maulana √

1/31/2019 1 Tn Muhammad Abusiri √ √

JUMLAH TOTAL 39 1 2 0 3 7 29 5 8 0 17 0 0 17

KOMITE PENCEGAHA
Alkes Terpasang Jenis
Pamasangan 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BARU 1
ETT
LAMA 2
BARU 0
CVL
LAMA 3
BARU 7
IVL
 IVL
LAMA 29
BARU 0
UC
LAMA 17
BARU 0
IV - PLUG
LAMA 0
BARU 10
BEDREST
LAMA 29
NGT 17 0
DRAIN 0 0
IMPLAN 0 0
PASIEN OPERASI 0 0
Fisiologis 0 0
Aspirasi
Patologis 0 0
Tusukan > 2 X 8 35

H.A.I`s 1 2 3 4 5 6 7 8 9 10 11 12 13 14
V.A.P 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IADP 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ISK/UTI 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PHLEBITIS 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ILO 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DEKUBITUS 0 0 0 0 0 0 0 0 0 0 0 0 0 0
H.A.P 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SEPSIS 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1
PRESENTASE KEJADIAN INFEKSI 0.9
V.A.P 0.00 0.8
IADP 0.00 0.7
ISK/UTI 0.00 0.6
PHLEBITIS 0.00 0.5
ILO 0.00
0.4
DEKUBITUS 0.00
0.3
H.A.P 0.00
SEPSIS 0.00 0.2
0.1
0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
TE PENCEGAHAN DAN PENGENDALIAN INFEKSI
AFTAR CATATAN HARIAN IPCLN DALAN SURVALENSI PER PERIODE DALAM SATU BULAN
H.A.Is
BEDREST Pasien Aspirasi
OPERASI ANTIBIOTIK
DRAIN IMPLANT VAP IADP ISK/UTI PHLEBITIS ILO
B L Fisiologis Patologis
√ Cefixime
√ Ceftriaxone
√ Ceftazidine

√ Cefixime
√ Ceftazidine

√ Cefixime
√ Cefotaxime
√ Cefotaxime

√ Cefixime
√ Cefotaxime
√ Cefotaxime

√ Cefotaxime

√ Cefotaxime

√ Meropenem

√ Meropenem

√ Meropenem

√ Ceftriaxone

√ Ceftriaxone

√ Ceftriaxone
√ Cefotaxime

√ Ceftriaxone
√ Cefotaxime
 √ Cefotaxime
√ Ceftriaxone
√

√ Ceftriaxone
√

√ Ceftriaxone

√ Ceftriaxone

√ Ceftriaxone

√ Ceftriaxone

√ Ceftriaxone

√ Ceftriaxone
√ Ceftriaxone

√
√ Ampicilin

√ Ampicilin

√ Kalfoxime

0 0 0 10 29 0 0 35 0 0 0 0 0

MITE PENCEGAHAN DAN PENGENDALIAN INFEKSI

Hari Ke-…/Tanggal Ke-…
15 16 17 18 19 20 21 22 23 24 25 26 27
 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
Tanggal
15 16 17 18 19 20 21 22 23 24 25 26 27
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0

0.00 0.00
 CATATAN
DEKUBITUS HAP SEPSIS

tranfusi PRC 1 kolf

tranfusi PRC 1 kolf

tranfusi FFP 2 kolf

 0 0 0 0

28 29 30 31 TOTAL
1
3
2
0
3
3
7
36
 36
29
0
17
17
0
0
0
10
39
29
0 0 0 0 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 43

28 29 30 31 TOTAL
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
 KOMITE PENCEGAHAN
DAFTAR CATATAN HARIAN IPCLN DA
ALAT KESEHATAN YANG DIGUNAKAN
JUMLAH
TGL PASIEN NAMA ETT CVL IVL Jumlah Tusukan UC IV-PLUG
NGT
B L B L B L tusukan >2X B L B L
2/1/2019 1 Tn Muhammad Abusiri √ √

2/5/2019 1 An Muhammad Iqbal Pratama √

2/6/2019 1 An Muhammad Iqbal Pratama √

2/7/2019 1 Ny Siti Zumrotu N √ 1

2/8/2019 1 Ny Siti Zumrotu N √ 3 1

2/9/2019 2 Ny Siti Zumrotu N √ 1 1

√ √

2/10/2019 1 Tn Subarda √ 1 √

2/11/2019 2 Tn Subarda √ 4 √
Tn Warsito √ √

2/12/2019 1 Tn Subarda √ √

2/13/2019 2 Tn Subarda √ √
Tn Komiko √ √

2/14/2019 2 Tn Subarda √ √
Tn Komiko √ 1 √

2/15/2019 1 Tn Komiko √ 2 √

2/16/2019 1 Tn Komiko √ √
 JUMLAH TOTAL 17 0 0 0 0 3 14 3 3 0 12 0 0 3

KOMITE PENCEGAHA
Alkes Terpasang Jenis
Pamasangan 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BARU 0
ETT
LAMA 0
BARU 0
CVL
LAMA 0
BARU 3
IVL
LAMA 14
BARU 0
UC
LAMA 12
BARU 0
IV - PLUG
LAMA 0
BARU 2
BEDREST
LAMA 13
NGT 3 0
DRAIN 0 0
IMPLAN 0 0
PASIEN OPERASI 0 0
Fisiologis 0 0
Aspirasi
Patologis 0 0
Tusukan > 2 X 3 16

H.A.I`s 1 2 3 4 5 6 7 8 9 10 11 12 13 14
 V.A.P 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IADP 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ISK/UTI 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PHLEBITIS 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ILO 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DEKUBITUS 0 0 0 0 0 0 0 0 0 0 0 0 0 0
H.A.P 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SEPSIS 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1
PRESENTASE KEJADIAN INFEKSI 0.9
V.A.P 0.00 0.8
IADP 0.00 0.7
ISK/UTI 0.00 0.6
PHLEBITIS 0.00 0.5
ILO 0.00
0.4
DEKUBITUS 0.00
0.3
H.A.P 0.00
SEPSIS 0.00 0.2
0.1
0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
TE PENCEGAHAN DAN PENGENDALIAN INFEKSI
AFTAR CATATAN HARIAN IPCLN DALAN SURVALENSI PER PERIODE DALAM SATU BULAN
H.A.Is
BEDREST Pasien Aspirasi
OPERASI ANTIBIOTIK
DRAIN IMPLANT VAP IADP ISK/UTI PHLEBITIS ILO
B L Fisiologis Patologis
√ Kalfoxime

Ceftriaxone

Ceftriaxone

√ Ceftriaxone

√ Ceftriaxone

√ Ceftriaxone
√ Ceftriaxone

√ Ceftriaxone

√ Ceftriaxone
√

√ Ceftriaxone

√ Ceftriaxone
√ Cefotaxime

√ Ceftriaxone
√ Cefotaxime

√ Cefotaxime

√ Cefotaxime
 0 0 0 2 13 0 0 16 0 0 0 0 0

MITE PENCEGAHAN DAN PENGENDALIAN INFEKSI

Hari Ke-…/Tanggal Ke-…
15 16 17 18 19 20 21 22 23 24 25 26 27

0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
Tanggal
15 16 17 18 19 20 21 22 23 24 25 26 27
 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0

0.00 0.00
 CATATAN
DEKUBITUS HAP SEPSIS
 0 0 0 0

28 29 30 31 TOTAL
0
0
0
0
0
0
3
17
14
0
12
12
0
0
0
2
15
13
0 0 0 0 3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 19

28 29 30 31 TOTAL
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0