Form 57.118 Denominator for Intensive Care Unit (ICU)/Other location

The National Healthcare Safety Network (NHSN)

57.118_DenominatorICU_BLANK.ppt

57.118 Denominators for Intensive Care Unit (ICU) Other Locations (not NICU or SCA)

OMB: 0920-0666

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  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

  1. **Number of patients
    with a
    urinary catheter

  1. **Number of patients
    on a
    ventilator

  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. Central-line 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
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