Form 57.117 Denominators for Specialty Care Area (SCA)

The National Healthcare Safety Network (NHSN)

57.117_DenominatorSCA_BLANK.ppt

57.117 Denominators for Specialty Care Area (SCA)

OMB: 0920-0666

Document [ppt]
Download: ppt | pdf

  1.  Facility ID:

  1. *Location Code:

  1. *Month:

  1. *Year:

  1. Date

  1. *Number of patients

  1. **Number of patients
    with 1 or more
    central lines
    (if patient has both, count as Temporary)

  1. **Number of patients
    with a
    urinary catheter

  1. **Number of patients
    on a
    ventilator

  

  1. Temporary

  1. Permanent

  

  1. 1

     

  1. 2

     

  1. 3

     

  1. 4

     

  1. 5

     

  1. 6

     

  1. 7

     

  1. 8

     

  1. 9

     

  1. 10

     

  1. 11

     

  1. 12

     

  1. 13

     

  1. 14

     

  1. 15

     

  1. 16

     

  1. 17

     

  1. 18

     

  1. 19

     

  1. 20

     

  1. 21

     

  1. 22

     

  1. 23

     

  1. 24

     

  1. 25

     

  1. 26

     

  1. 27

     

  1. 28

     

  1. 29

     

  1. 30

     

  1. 31

     

  1. *Totals

     
 

  1. Patient-days

  1. Temporary CL-days

  1. Permanent CL-days

  1. Urinary catheter-days

  1. Ventilator-days

  1. Label

  1. __________

  1. __________

  1. __________

  1. __________

  1. __________

  1. Data

  1. __________

  1. __________

  1. __________

  1. __________

  1. __________

 
File Typeapplication/vnd.ms-powerpoint
File TitleSlide 1
AuthorCDC
Last Modified Byano3
File Modified2010-08-04
File Created2004-07-27
© 2024 OMB.report | Privacy Policy