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*Facility ID #: ____________ *Event #: _____________
*Event Type: MDRO *Location: ______________ *Month: ____ / ______ (mm/yyyy)
*MDRO______
# of Patient Days_____
# of Admissions______
# of incident MDRO patient isolates from clinical cultures_____
# incident MDRO patient isolates from surveillance cultures_____
# MDRO isolates from clinical cultures that are not attributable to the unit_____
# MDRO isolates from surveillance cultures that are not attributable to unit_____
# of patients for whom admission surveillance cultures were indicated_____
# of patients who had admission surveillance cultures performed _____
# of patients for whom follow-up surveillance cultures were indicated_____
# of patients who had follow-up surveillance cultures performed_____
# of observed healthcare worker-patient interactions during which hand hygiene was indicated____
# of observed healthcare worker-patient interactions during which hand hygiene was performed____
# of observed healthcare worker-patient interactions during which contact precautions were indicated____
# of observed healthcare worker-patient interactions during which contact precautions were performed____
