Form 57.75Z Implementation of Engineering (safety devices) Controls

The National Healthcare Safety Network (NHSN)

Z_ImpEngrControls.ppt

Implementation of Engineering (safety devices) Controls for Sharps Injury Prevention

OMB: 0920-0666

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  1. Device Type

  1. **Your Code

  1. **Safety Feature

  1. **Manufacturer and Model

  1. **Device Implementation

  1. **Device Discontinuation

  1. Qtr

  1. Yr

  1. Scope of Use

  1. Qtr

  1. Yr

  1. Reason

  1. Arterial blood collection device

         
         
         

  1. Hypodermic needle attached to syringe

         
         
         

  1. Unattached hypodermic needle

         
         
         

  1. Prefilled cartridge syringe needle

         
         
         

  1. IV-delivery system

         
         
         

  1. IV catheter - peripheral

         
         
         

  1. IV catheter – central line

         
         
         

  1. Huber needle

         
         
         

 

  1. Device Type

  1. Your Code

  1. Safety Feature

  1. Manufacturer and Model

  1. Device Implementation

  1. Device Discontinuation

  1. Qtr

  1. Yr

  1. Scope of Use

  1. Qtr

  1. Yr

  1. Reason

  1. Winged-steel (Butterfly™-type) needle

         
         
         

  1. Vacuum tube collection holder with needle

         
         
         

  1. Blood culture adapter

         
         
         

  1. Lancet

         
         
         

  1. Hemodialysis needle

         
         
         

  1. Dental aspirating syringe/needle

         
         
         

  1. Suture needle

         
         
         

  1. Scalpel

         
         
         

  1. Capillary tubes

         
         
         

  1. Blood collection tubes

         
         
         

 

  1. Device Type

  1. Your Code

  1. Safety Feature

  1. Manufacturer and Model

  1. Device Implementation

  1. Device Discontinuation

  1. Qtr

  1. Yr

  1. Scope of Use

  1. Qtr

  1. Yr

  1. Reason

  1. Catheter securement device

         
         
         

  1. Other

         
         
         

 
File Typeapplication/vnd.ms-powerpoint
File TitleSlide 1
AuthorJasie L. Jackson
Last Modified Byrfp9
File Modified2007-07-26
File Created2007-01-19
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