Form 57.116 Denominators for Neonatal Intensive Care Unit (NICU)

The National Healthcare Safety Network (NHSN)

57.116_DenominatorNICU_BLANK.ppt

57.116 Denominators for Neonatal Intensive Care Unit (NICU)

OMB: 0920-0666

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  1.  Facility ID:

  1. *Location Code:

  1. *Month:

  1. *Year:

  1. Birth Weight Categories

  1. Date

  1. <750 gm

  1. 751-1000 gm

  1. 1001-1500 gm

  1. 1501-2500 gm

  1. >2500 gm

 

  1. *Pts

  1. **U/C

  1. **CL

  1. **VNT

  1. *Pts

  1. **U/C

  1. **CL

  1. **VNT

  1. *Pts

  1. **U/C

  1. **CL

  1. **VNT

  1. *Pts

  1. **U/C

  1. **CL

  1. **VNT

  1. *Pts

  1. **U/C

  1. **CL

  1. **VNT

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  1. *Total

                    

  1. Pts=number of infants        U/C=number of infants with umbilical catheter        CL=number of infants with 1 or more central lines
    VNT=number of infants on a ventilator      *If infant has both a U/C and CL, count as U/C infant only for the day

  1. Label

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  1. Data

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File TitleSlide 1
AuthorCDC
Last Modified Byano3
File Modified2010-08-04
File Created2004-07-27
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