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F.01.K.

PPIRS
FORMULIR SURVEYLANS HARIAN INFEKSI RUMAH SAKIT
RUMAH SAKIT : RSBP Batam

BULAN/TAHUN : JUNI 2018
RUANGAN : ICU
SURVEYOR :
USIA PEMAKAIAN ALAT TIRAH DEKU
TGL NO NAMA/MR DX.MEDIS Plebitis KULTUR ANTIBIOTIKA KET
JK ETT CVL IVL UC BARING BITUS
1/6/2018 1 Nurhayati 402718 4/4/1954 DM, Strok 1 1 0 1 1 0 0 0 v
2 Rosmaida 256160 25/06/1950 Stroke infack 1 1 0 1 1 0 0 0 v
3 Wang Hong Hui 408887 8/1/1971 hematothorak 1 1 0 1 1 0 0 0 v
4 wira armani fauzi 004985 9/1/2000 CKB 1 0 1 1 1 0 0 0 v

2/6/2018 1 Nurhayati 402718 4/4/1954 DM, Strok 1 1 0 1 1 0 0 0 v
2 Rosmaida 256160 25/06/1950 Stroke infack 1 1 0 1 1 0 0 0 v
3 Wang Hong Hui 408887 8/1/1971 hematothorak 1 1 0 1 1 0 0 0 v
4 wira armani fauzi 004985 9/1/2000 CKB 1 0 1 1 1 0 0 0 v

3/6/2018 1 Nurhayati 402718 4/4/1954 DM, Strok 1 1 0 1 1 0 0 0 v
2 Rosmaida 256160 25/06/1950 Stroke infack 1 1 0 1 1 0 0 0 v
3 Wang Hong Hui 408887 8/1/1971 hematothorak 1 1 0 1 1 0 0 0 v
4 wira armani fauzi 004985 9/1/2000 CKB 1 0 1 1 1 0 0 0 v

4/6/2018 1 Nurhayati 402718 4/4/1954 DM, Strok 1 1 0 1 1 0 0 0 v
2 Rosmaida 256160 25/06/1950 Stroke infack 1 1 0 1 1 0 0 0 v
3 Wang Hong Hui 408887 8/1/1971 hematothorak 1 1 0 1 1 0 0 0 v
4 wira armani fauzi 004985 9/1/2000 CKB 1 0 1 1 1 0 0 0 v

5/6/2018 1 Nurhayati 402718 4/4/1954 DM, Strok 1 1 0 1 1 0 0 0 v
2 Rosmaida 256160 25/06/1950 Stroke infack 1 1 0 1 1 0 0 0 v
3 Wang Hong Hui 408887 8/1/1971 hematothorak 1 1 0 1 1 0 0 0 v jam 12 evakuasi ke cina

4 wira armani fauzi 004985 9/1/2000 CKB 1 0 1 1 1 0 0 0 v
5 Muhammad S 409343 14/10/2011 lap explo 0 0 1 1 1 0 0 0 merofenem 3x 600 PB R.Melati jam19.30
peritonitis diffuse Mtz 3x250 mg

6/6/2018 1 Nurhayati 402718 4/4/1954 DM, Strok 1 1 0 1 1 0 0 0 v
2 Rosmaida 256160 25/06/1950 Stroke infack 1 1 0 1 1 0 0 0 v
3 wira armani fauzi 004985 9/1/2000 CKB 1 0 1 1 1 0 0 0 v jam 19 rujuk ke RSBK
4 Muhammad S 409343 14/10/2011 lap explo 0 0 1 1 1 0 0 0 v
peritonitis diffuse

7/6/2018 1 Nurhayati 402718 4/4/1954 DM, Strok 1 1 0 1 1 0 0 0 v
2 Rosmaida 256160 25/06/1950 Stroke infack 1 1 0 1 1 0 0 0 v
3 Muhammad S 409343 14/10/2011 lap explo 0 0 1 1 1 0 0 0 v
peritonitis diffuse
4 M.Ali Berma 409125 12/4/1950 VATS 1 0 1 1 1 0 0 0 Ceftriaxon 2x1 gr PB jam 13,20 Rg OK
Px awal Rg Teratai

8/6/2018 1 Nurhayati 402718 4/4/1954 DM, Strok 1 1 0 1 1 0 0 0 v (+) jam 03.35 wib
2 Rosmaida 256160 25/06/1950 Stroke infack 1 1 0 1 1 0 0 0 v
3 Muhammad S 409343 14/10/2011 lap explo 0 0 1 1 1 0 0 0 v
peritonitis diffuse
4 M.Ali Berma 409125 12/4/1950 VATS 0 0 1 1 1 0 0 0 v

Keterangan
DX.MEDIS : Diagnosa Medis
ETT : Endotracheal Tube (+) : Meninggal Dunia
CVL : Central vena line

IVL : Intra vena line/ vena perifer UC : Urine Catheter .

Strok 1 1 0 1 1 0 0 0 v 2 Mariani 17/03/1948 Hipertensi ER 0 0 1 1 1 0 0 0 v . Strok 1 1 0 1 1 0 0 0 v 2 Mariani 17/03/1948 Hipertensi ER 0 0 1 1 1 0 0 0 v 3 Muhady 408234 28/09/1948 Stroke H 0 0 1 1 1 0 0 0 v 5/5/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v 2 Abdul Jalil 407696 7/7/1975 SDH 0 0 1 1 1 0 0 0 v 3 Anis S.Ningsih 405534 4/4/1962 tumor meningioma 0 0 1 1 1 0 0 0 v (+) jam 15 wib 4 saniah 293253 10/11/1940 stroke nh 1 0 1 1 1 0 0 0 ceftriaxon 1x1gr PB jam 15.PPIRS FORMULIR SURVEYLANS HARIAN INFEKSI RUMAH SAKIT RUMAH SAKIT : RSBP Batam BULAN/TAHUN : Mei2018 RUANGAN : ICU SURVEYOR : USIA PEMAKAIAN ALAT TIRAH DEKU TGL NO NAMA/MR DX.01. F.K.DM 0 0 1 1 1 0 0 0 PB jam 20 wib IGD 3/5/2018 1 Nurhayati 402718 4/4/1954 DM.30 wib IGD (+) Jam 21wib 5 Tjuan kim 390629 23/07/1955 ALE.MEDIS Plebitis KULTUR ANTIBIOTIKA KET JK ETT CVL IVL UC BARING BITUS 1/5/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v 2 Mariani 17/03/1948 Hipertensi ER 0 0 1 1 1 0 0 0 ceftriaxon 2x1gr PB jam 18 wib IGD 3 Tjuan kim 390629 23/07/1955 ALE. Strok 1 1 0 1 1 0 0 0 v 2 Abdul Jalil 407696 7/7/1975 SDH 0 0 1 1 1 0 0 0 v jam 19 pindah teratai 3 Anis S.45 wib IGD 4/5/2018 1 Nurhayati 402718 4/4/1954 DM.Ningsih 405534 4/4/1962 tumor meningioma 0 1 1 1 1 0 0 0 v 2/5/2018 1 Nurhayati 402718 4/4/1954 DM.DM 0 0 1 1 1 0 0 0 ceftriaxon 2x1gr PB jam 20 wib IGD (+) jam 03 wib 4 Muhady 408234 28/09/1948 Stroke H 0 0 1 1 1 0 0 0 Moxifloxacin 1x400 PB jam 12.

18 wib Melati 6/5/2018 1 Nurhayati 402718 4/4/1954 DM.15 wib Teratai (+) 00.Aggrek . Strok 1 1 0 1 1 0 0 0 v 2 Mariani 257360 17/03/1948 Hipertensi ER 0 0 1 1 1 0 0 0 v 3 Muhady 408234 28/09/1948 Stroke H 0 0 1 1 1 0 0 0 v jam 15.CKD 1 0 1 1 1 0 0 0 sulbacef 2x1 gr PB jam 01. Strok 1 1 0 1 1 0 0 0 v 2 Mariani 17/03/1948 Hipertensi ER 0 0 1 1 1 0 0 0 v 3 Muhady 408234 28/09/1948 Stroke H 0 0 1 1 1 0 0 0 v 4 Enik Soehartini 404408 17/10/1956 Ca Tyroid 1 0 1 1 1 0 0 0 v 11/5/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v 2 Mariani 17/03/1948 Hipertensi ER 0 0 1 1 1 0 0 0 v 3 Muhady 408234 28/09/1948 Stroke H 0 0 1 1 1 0 0 0 v 4 Kastia 398473 20/05/1953post op residif acinic cell1 0 1 1 1 0 0 0 v jam 11 wib Pindah melati 8/5/2018 1 Nurhayati 402718 4/4/1954 DM.11wib pdh melati 4 Enik Soehartini 404408 17/10/1956 Ca Tyroid 1 0 1 1 1 0 0 0 v 5 Herwan 404491 10/10/1962 CHF.20 wb R. Strok 1 1 0 1 1 0 0 0 v 2 Mariani 17/03/1948 Hipertensi ER 0 0 1 1 1 0 0 0 v 3 Muhady 408234 28/09/1948 Stroke H 0 0 1 1 1 0 0 0 v 4 Kastia 398473 20/05/1953post op residif acinic cell1 0 1 1 1 0 0 0 v 7/5/2018 1 Nurhayati 402718 4/4/1954 DM.45 wib 9/5/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v 2 Mariani 17/03/1948 Hipertensi ER 0 0 1 1 1 0 0 0 v 3 Muhady 408234 28/09/1948 Stroke H 0 0 1 1 1 0 1 0 v 4 Enik Soehartini 404408 17/10/1956 Ca Tyroid 1 0 1 1 1 0 0 0 Merofenen 3x1gr PB jam 10. Strok 1 1 0 1 1 0 0 0 v 2 Mariani 17/03/1948 Hipertensi ER 0 0 1 1 1 0 1 0 v 3 Muhady 408234 28/09/1948 Stroke H 0 0 1 1 1 0 0 0 v 4 Deky Mulyono 408332 28/8/1980 Ca Paru Metastase 0 0 1 1 1 0 0 0 cefirom 2x1gr PB jam 11.50 wib OK 10/5/2018 1 Nurhayati 402718 4/4/1954 DM. 3 Muhady 408234 28/09/1948 Stroke H 0 0 1 1 1 0 0 0 v 4 Kastia 398473 20/05/1953post op residif acinic cell1 0 1 1 1 0 0 0 Cefoperazon 2x1 gr PB jam 16.

Strok 1 1 0 1 1 0 0 0 v 2 Mariani 257360 17/03/1948 Hipertensi ER 0 0 1 1 1 0 0 0 v 3 Enik Soehartini 404408 17/10/1956 Ca Tyroid 1 0 1 1 1 0 0 0 v jam 12 wib pdh R. Strok 1 1 0 1 1 0 0 0 v 2 Roswini 025697 2/12/1941 ALE 1 0 1 1 1 0 0 0 v 3 Aditya 408780 29/03/1992 post op SDH 1 0 1 1 1 0 0 0 imipenem 3x1 gr PB jam 18.15 Rg.10 wib (+) 5 Roswini 025697 2/12/1941 ALE 1 0 1 1 1 0 0 0 levo 1 x 500 mg jam 23.30 wibPB R. Strok 1 1 0 1 1 0 0 0 v 2 Herwan 404491 10/10/1962 CHF.Melati 3 Herwan 404491 10/10/1962 CHF. Strok 1 1 0 1 1 0 0 0 v 2 Roswini 025697 2/12/1941 ALE 1 0 1 1 1 0 0 0 v 3 Musnidar 406975 31/12/1967 post op Tumor Re 1 0 1 1 1 0 0 0 v jam 14 pindah R teratai 4 widya C 041830 22/07/1990 Pos sc Atoni uteri 1 0 1 1 1 0 0 0 Ceftriaxon 2x1 gr PB jam 15.convulsif 0 0 1 1 1 0 0 0 v PB jam 16.Aggrk 14/5/2018 1 Nurhayati 402718 4/4/1954 DM.12/5/2018 1 Nurhayati 402718 4/4/1954 DM.CKD 1 0 1 1 1 0 0 0 v 13/5/2018 1 Nurhayati 402718 4/4/1954 DM.CKD 1 0 1 1 1 0 0 0 v (+) jam 15.Aggrk jam 18.50 wib Rg IGD 17/5/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v 2 Mariani 257360 17/03/1948 Hipertensi ER 0 0 1 1 1 0 0 0 v jam 14.30 wib.pdh mawar .50 pdh R.CKD 1 0 1 1 1 0 0 0 v 4 Shell Indrawati 408339 8/10/1961 DM.30 Ok --Mawar MTZ 3x500 mg 5 Rosmaida 256160 25/06/1950 Stroke infack 1 0 1 1 1 0 0 0 merofenem 4x0.Melati 4 Herwan 404491 10/10/1962 CHF.40 wib OK 4 widya C 041830 22/07/1990 Pos sc Atoni uteri 0 0 1 1 1 0 0 0 Ceftriaxon 2x1 gr jam 12.30 wibR. Strok 1 1 0 1 1 0 0 0 v 2 Roswini 025697 2/12/1941 ALE 1 0 1 1 1 0 0 0 v 3 Musnidar 406975 31/12/1967 post op Tumor Re 1 0 1 1 1 0 0 0 v 16/5/2018 1 Nurhayati 402718 4/4/1954 DM.25 wib 3 Roswini 025697 2/12/1941 ALE 1 0 1 1 1 0 0 0 v 4 Musnidar 406975 31/12/1967 post op Tumor Re 1 0 1 1 1 0 0 0 Timipenem 3x1gr PB jam 13.Teratai 15/5/2018 1 Nurhayati 402718 4/4/1954 DM.5 gr PB jam 18.

Strok 1 1 0 1 1 0 0 0 v 2 Roswini 025697 2/12/1941 ALE 1 0 1 1 1 0 0 0 v 3 Aditya 408780 29/03/1992 post op SDH 1 0 1 1 1 0 0 0 v 4 Rosmaida 256160 25/06/1950 Stroke infack 1 0 1 1 1 0 0 0 v 19/5/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v 2 Rosmaida 256160 25/06/1950 Stroke infack 1 0 1 1 1 0 0 0 v .55 wb pdh melati 6 Munasih 339679 12/8/1967 post op meningioma 1 0 1 1 1 0 0 0 cefirom 2x1 gr PB jam 17. Strok 1 1 0 1 1 0 0 0 v 2 Roswini 025697 2/12/1941 ALE 1 0 1 1 1 0 0 0 v 4 Rosmaida 256160 25/06/1950 Stroke infack 1 0 1 1 1 0 0 0 v 5 Dedi.05 wb Rg HCU 23/5/2018 1 Nurhayati 402718 4/4/1954 DM. Teratai 4 Rosmaida 256160 25/06/1950 Stroke infack 1 0 1 1 1 0 0 0 v 5 Dedi.50 wb OK 21/5/2018 1 Nurhayati 402718 4/4/1954 DM. MTZ 3x500 mg 5 Rosmaida 256160 25/06/1950 Stroke infack 1 0 1 1 1 0 0 0 v 18/5/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v 2 Roswini 025697 2/12/1941 ALE 1 0 1 1 1 0 1 0 v 3 Rosmaida 256160 25/06/1950 Stroke infack 1 0 1 1 1 0 0 0 v 4 Munasih 339679 12/8/1967 post op meningioma 1 0 1 1 1 0 0 0 v jam 15 wib Pdh Rg Aggrk 22/5/2018 1 Nurhayati 402718 4/4/1954 DM. S 408810 30/04/1981 post op Removal 1 0 1 1 1 0 0 0 Timipen 2x1 gr PB jam 19.45 wb Rg HCU 5 wartoyo 408916 21/05/1948 Stroke H 1 0 1 1 1 0 0 0 Timipen 3x1 gr PB jam 23. Strok 1 1 0 1 1 0 0 0 v 2 Roswini 025697 2/12/1941 ALE 1 0 1 1 1 0 0 0 v (+) 21.32 wib 3 Rosmaida 256160 25/06/1950 Stroke infack 1 0 1 1 1 0 0 0 v 4 Zahri 408736 1/6/1971 SOL 1 0 1 1 1 0 0 0 moxifloxacin 1x400 PB jam 11.25wb Ok-melati 20/5/2018 1 Nurhayati 402718 4/4/1954 DM. S 408810 30/04/1981 post op Removal 1 0 1 1 1 0 0 0 v jam 13. Strok 1 1 0 1 1 0 0 0 v 2 Roswini 025697 2/12/1941 ALE 1 0 1 1 1 0 0 0 v 3 Aditya 408780 29/03/1992 post op SDH 1 0 1 1 1 0 0 0 v Jam 11 wib pdh R.

Strok 1 1 0 1 1 0 0 0 v 2 Rosmaida 256160 25/06/1950 Stroke infack 1 0 1 1 1 0 0 0 v 3 Zahri 408736 1/6/1971 SOL 1 0 1 1 1 0 0 0 v (+) 02. 3 Zahri 408736 1/6/1971 SOL 1 0 1 1 1 0 0 0 v 4 wartoyo 408916 21/05/1948 Stroke H 1 0 1 1 1 0 0 0 v 24/5/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v .30 wb Rg Teratai 26/5/2018 1 Nurhayati 402718 4/4/1954 DM.Ali Berma 409125 12/4/1950 Pneumonia 0 0 1 1 1 0 0 0 v Jam 20. Rg Ok px asal rg teratai 29/5/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v 2 Rosmaida 256160 25/06/1950 Stroke infack 1 1 0 1 1 0 0 0 v 3 Wang Hong Hui 408887 8/1/1971 hematothorak 1 0 1 1 1 0 0 0 v 4 M . Strok 1 1 0 1 1 0 0 0 v 2 Rosmaida 256160 25/06/1950 Stroke infack 1 1 0 1 1 0 0 0 v 3 wartoyo 408916 21/05/1948 Stroke H 1 0 1 1 1 0 0 0 v (+) 05.30 wib 4 Wang Hong Hui 408887 8/1/1971 hematothorak 0 0 1 1 1 0 0 0 Extimon 2x1gr PB jam 12.30.Ali Berma 409125 12/4/1950 Pneumonia 0 0 1 1 1 0 0 0 Ceftriaxon 3x1 gr PB jam 11. Strok 1 1 0 1 1 0 0 0 v 2 Rosmaida 256160 25/06/1950 Stroke infack 1 1 1 1 1 0 0 0 v 3 Wang Hong Hui 408887 8/1/1971 hematothorak 0 0 1 1 1 0 0 0 merofenem 3x1gr extimon stop 28/5/2018 1 Nurhayati 402718 4/4/1954 DM.10 Pdh Rg Teratai 30/5/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v 2 Rosmaida 256160 25/06/1950 Stroke infack 1 1 0 1 1 0 0 0 v 3 Wang Hong Hui 408887 8/1/1971 hematothorak 1 1 0 1 1 0 0 0 v 4 M .15 wib 4 wartoyo 408916 21/05/1948 Stroke H 1 0 1 1 1 0 0 0 v 25/5/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v 2 Rosmaida 256160 25/06/1950 Stroke infack 1 1 0 1 1 0 0 0 v 3 Wang Hong Hui 408887 8/1/1971 hematothorak 0 0 1 1 1 0 0 0 v 27/5/2018 1 Nurhayati 402718 4/4/1954 DM.

30 wib Rg IGD Keterangan DX. 2 Rosmaida 256160 25/06/1950 Stroke infack 1 1 0 1 1 0 0 0 v 3 Wang Hong Hui 408887 8/1/1971 hematothorak 1 1 0 1 1 0 0 0 v 31/5/2018 1 Nurhayati 402718 4/4/1954 DM.MEDIS : Diagnosa Medis ETT : Endotracheal Tube (+) : Meninggal Dunia CVL : Central vena line IVL : Intra vena line/ vena perifer UC : Urine Catheter . Strok 1 1 0 1 1 0 0 0 v 2 Rosmaida 256160 25/06/1950 Stroke infack 1 1 0 1 1 0 0 0 v 3 Wang Hong Hui 408887 8/1/1971 hematothorak 1 1 0 1 1 0 0 0 v 4 wira armani fauzi 004985 9/1/2000 CKB 1 0 1 1 1 0 0 0 ceftriaxon 2x1 gr PB jam 08.

03.PPIRS FORMULIR SURVEYLANS BULANAN INFEKSI RUMAH SAKIT RUMAH SAKIT : BP Batam BULAN/TAHUN : Mei 2 RUANGAN : ICU SURVEYOR : PEMAKAIAN ALAT INFEKSI RS INFEKSI LAIN HASIL KULTUR ANTI TGL JLH PS ETT CVL IVL UC VAP ISK IADP IDO PLEBITIS DECUB TB DARAH SWAB SPUTUM URINE BIOTIKA 1/5/2018 3 1 2 1 3 0 0 0 0 0 0 3 0 0 0 0 v 2/5/2018 5 2 1 3 5 0 0 0 0 0 0 5 0 0 0 0 v 3/5/2018 4 1 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 4/5/2018 3 1 1 2 3 0 0 0 0 0 0 3 0 0 0 0 v 5/5/2018 4 2 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 6/5/2018 4 2 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 7/5/2018 4 2 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 8/5/2018 4 1 1 3 4 0 0 0 0 1 0 4 0 0 0 0 v 9/5/2018 4 2 1 3 4 0 0 0 0 1 0 4 0 0 0 0 v 10/5/2018 4 2 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 11/5/2018 5 3 1 4 5 0 0 0 0 0 0 5 0 0 0 0 v 12/5/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 13/5/2018 5 3 1 4 5 0 0 0 0 0 0 5 0 0 0 0 v 14/5/2018 4 4 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 15/5/2018 3 3 1 2 3 0 0 0 0 0 0 3 0 0 0 0 v 16/5/2018 4 4 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 17/5/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 18/5/2018 4 1 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 19/5/2018 5 5 1 4 5 0 0 0 0 0 0 5 0 0 0 0 v 20/5/2018 6 6 1 5 6 0 0 0 0 0 0 6 0 0 0 0 v 21/5/2018 4 4 1 3 4 0 0 0 0 1 0 4 0 0 0 0 v 22/5/2018 5 5 1 4 5 0 0 0 0 0 0 5 0 0 0 0 v .K. F.

23/5/2018 4 4 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 24/5/2018 4 4 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 25/5/2018 4 3 2 2 4 0 0 0 0 0 0 4 0 0 0 0 v 26/5/2018 3 2 2 1 3 0 0 0 0 0 0 3 0 0 1 0 v 27/5/2018 3 2 2 1 3 0 0 0 0 0 0 3 0 0 0 0 v 28/5/2018 4 2 2 2 4 0 0 0 0 0 0 4 0 0 0 0 v 29/5/2018 4 3 3 1 4 0 0 0 0 0 0 4 0 0 0 0 v 30/5/2018 3 3 3 0 3 0 0 0 0 0 0 3 0 0 0 0 v 31/5/2018 4 4 3 0 4 0 0 0 0 0 0 4 0 0 0 0 KETERANGAN ETT : Endotracheal Tube VAP : Ventilator Associated Pneumonia v : Pakai Antibiotik CVL : Central vena line ISK : Infeksi Saluran Kemih IVL : Intra vena line/ vena perifer IADP : Infeksi Aliran Darah Primer UC : Urine Catheter IDO : Infeksi Daerah Operasi TB : Tirah Baring .

PPIRS FORMULIR SURVEYLANS BULANAN INFEKSI RUMAH SAKIT RUMAH SAKIT : BP Batam BULAN/TAHUN : April RUANGAN : ICU SURVEYOR : PEMAKAIAN ALAT INFEKSI RS INFEKSI LAIN HASIL KULTUR ANTI TGL JLH PS ETT CVL IVL UC VAP ISK IADP IDO PLEBITIS DECUB TB DARAH SWAB SPUTUM URINE BIOTIKA 4/1/2018 3 2 1 2 3 0 0 0 0 0 0 3 0 0 0 0 v 4/2/2018 3 2 1 2 3 0 0 0 0 0 0 3 0 0 0 0 v 4/3/2018 3 2 1 2 3 0 0 0 0 0 0 3 0 0 0 0 v 4/4/2018 3 2 2 1 3 0 0 0 0 0 0 3 0 0 0 0 v 4/5/2018 3 3 3 0 3 0 0 0 0 0 0 3 0 0 0 0 v 4/6/2018 3 3 3 0 3 0 0 0 0 0 0 3 0 0 0 0 v 4/7/2018 4 4 3 1 4 0 0 0 0 0 0 4 0 0 0 0 v 4/8/2018 3 2 2 1 3 0 0 0 0 0 1 3 0 0 0 0 v 4/9/2018 3 2 2 1 3 0 0 0 0 0 0 3 0 0 0 0 v 4/10/2018 2 2 2 0 2 0 0 0 0 0 0 2 0 0 0 0 v 4/11/2018 4 3 2 2 4 0 0 0 0 0 0 4 0 0 0 0 v 4/12/2018 6 2 1 5 6 0 0 0 0 0 0 6 0 0 0 0 v 4/13/2018 4 1 0 4 4 0 0 0 0 0 0 4 0 0 0 0 v 4/14/2018 4 1 0 4 4 0 0 0 0 0 0 4 0 0 0 0 v 4/15/2018 4 2 1 4 4 0 0 0 0 0 0 4 0 0 0 0 v 4/16/2018 3 2 1 3 3 0 0 0 0 0 0 3 0 0 0 0 v 4/17/2018 3 2 1 3 3 0 0 0 0 0 0 3 0 0 0 0 v 4/18/2018 3 2 2 2 3 0 0 0 0 0 0 3 0 0 0 0 v 4/19/2018 3 2 2 2 3 0 0 0 0 0 0 3 0 0 0 0 v 4/20/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 4/21/2018 3 3 1 2 3 0 0 0 0 0 0 3 0 0 0 0 v 4/22/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v .K. F.03.

4/23/2018 2 2 1 1 2 0 0 0 0 0 0 2 0 0 0 0 v 4/24/2018 4 4 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 4/25/2018 4 4 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 4/26/2018 4 3 2 3 4 0 0 0 0 0 0 4 0 0 1 0 v 4/27/2018 3 2 2 2 3 0 0 0 0 0 0 3 0 0 0 0 v 4/28/2018 3 2 2 2 3 0 0 0 0 1 0 3 0 0 0 0 v 4/29/2018 3 1 2 2 3 0 0 0 0 0 0 3 0 0 0 0 v 4/30/2018 3 1 2 2 3 0 1 0 0 0 0 3 0 0 1 1 v KETERANGAN ETT : Endotracheal Tube VAP : Ventilator Associated Pneumonia v : Pakai Antibiotik CVL : Central vena line ISK : Infeksi Saluran Kemih IVL : Intra vena line/ vena perifer IADP : Infeksi Aliran Darah Primer UC : Urine Catheter IDO : Infeksi Daerah Operasi TB : Tirah Baring .

K.PPIRS FORMULIR SURVEYLANS BULANAN INFEKSI RUMAH SAKIT RUMAH SAKIT : BP Batam BULAN/TAHUN : Maret2018 RUANGAN : ICU SURVEYOR : PEMAKAIAN ALAT INFEKSI RS INFEKSI LAIN HASIL KULTUR ANTI TGL JLH PS ETT CVL IVL UC VAP ISK IADP IDO PLEBITIS DECUB TB DARAH SWAB SPUTUM URINE BIOTIKA 3/1/2018 4 3 0 4 4 0 0 0 0 0 0 0 0 0 0 0 v 3/2/2018 6 4 0 6 6 0 0 0 0 0 0 0 0 0 0 0 v 3/3/2018 4 2 1 3 4 0 0 0 0 0 0 0 0 0 0 0 v 3/4/2018 4 2 1 3 4 0 0 0 0 0 0 0 0 0 0 0 v 3/5/2018 4 2 1 3 4 0 0 0 0 0 0 0 0 0 0 0 v 3/6/2018 3 1 1 2 3 0 0 0 0 0 0 0 0 0 0 0 v 3/7/2018 3 1 1 2 3 0 0 0 0 0 0 0 0 0 0 0 v 3/8/2018 5 2 1 4 5 0 0 0 0 0 0 0 0 0 0 0 v 3/9/2018 4 1 1 3 4 0 0 0 0 0 0 0 0 0 0 0 v 3/10/2018 5 2 1 4 5 0 0 0 0 0 0 0 0 0 0 0 v 3/11/2018 4 1 1 3 4 0 0 0 0 0 0 0 0 0 0 0 v 3/12/2018 3 0 1 2 3 0 0 0 0 0 0 0 0 0 0 0 v 3/13/2018 4 1 1 3 4 0 0 0 0 0 0 0 0 0 0 0 v 3/14/2018 3 1 1 2 3 0 0 0 0 0 0 0 0 0 0 0 v 3/15/2018 4 2 1 3 4 0 0 0 0 0 0 0 1 0 0 0 v 3/16/2018 4 3 1 3 4 0 0 0 0 0 1 0 0 0 0 0 v 3/17/2018 4 4 1 3 4 0 0 0 0 0 0 0 0 0 0 0 v 3/18/2018 4 4 1 3 4 0 0 0 0 0 0 0 0 0 0 0 v 3/19/2018 3 3 1 2 3 0 0 0 0 0 0 0 0 0 0 0 v 3/20/2018 4 4 1 3 4 0 0 0 0 0 0 0 0 0 0 0 v 3/21/2018 4 4 1 3 4 0 0 0 0 0 0 0 0 0 0 0 v 3/22/2018 5 5 1 4 5 0 0 0 0 0 0 0 0 0 0 0 v . F.03.

3/23/2018 5 3 1 4 5 0 0 0 0 0 0 0 0 0 0 0 v 3/24/2018 4 4 1 3 4 0 0 0 0 0 0 0 0 0 0 0 v 3/25/2018 5 5 1 4 5 0 0 0 0 1 0 0 0 0 0 0 v 3/26/2018 3 3 1 2 3 0 0 0 0 1 0 0 0 0 0 0 v 3/27/2018 4 4 1 3 4 0 0 0 0 0 0 0 0 0 0 0 v 3/28/2018 5 3 1 4 5 0 0 0 0 0 0 1 0 0 0 0 v 3/29/2018 4 2 1 3 4 0 0 0 0 0 0 0 0 0 0 0 v 3/30/2018 5 2 1 4 5 0 0 0 0 0 0 0 0 0 0 0 v 3/31/2018 4 3 1 3 4 0 0 0 0 0 0 0 0 0 0 0 v KETERANGAN ETT : Endotracheal Tube VAP : Ventilator Associated Pneumonia v : Pakai Antibiotik CVL : Central vena line ISK : Infeksi Saluran Kemih IVL : Intra vena line/ vena perifer IADP : Infeksi Aliran Darah Primer UC : Urine Catheter IDO : Infeksi Daerah Operasi TB : Tirah Baring .

SAH 1 1 0 1 1 0 0 1 v 3 Denny S 403613 10/17/1984 Enchepalopaty. 0 0 1 1 1 0 0 0 B20 v (+) jam 05.SAH 1 0 1 1 1 0 0 0 v 3 Denny S 403613 10/17/1984 Enchepalopaty. 0 0 1 1 1 0 0 0 v B20 4/2/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v 2 Keberia S 408593 4/1/1974 EDH. 0 0 1 1 1 0 0 0 B20 v 4/3/2018 1 Nurhayati 402718 4/4/1954 DM.45 wib 4/5/2018 1 Nurhayati 402718 4/4/1954 DM. F.SAH 1 0 1 1 1 0 0 0 v 3 Denny S 403613 10/17/1984 Enchepalopaty.01. Strok 1 1 0 1 1 0 0 0 v 2 Keberia S 408593 4/1/1974 EDH.K.SAH 1 0 1 1 1 0 0 0 v 3 Denny S 403613 10/17/1984 Enchepalopaty.Ok --Teratai . Strok 1 1 0 1 1 0 0 0 v 2 Keberia S 408593 4/1/1974 EDH.10 wib rg.PPIRS FORMULIR SURVEYLANS HARIAN INFEKSI RUMAH SAKIT RUMAH SAKIT : RSBP Batam BULAN/TAHUN : April 2018 RUANGAN : ICU SURVEYOR : USIA PEMAKAIAN ALAT TIRAH DEKU TGL NO NAMA/MR DX. 0 0 1 1 1 0 0 0 B20 v 4/4/2018 1 Nurhayati 402718 4/4/1954 DM.MEDIS Plebitis KULTUR ANTIBIOTIKA KET JK ETT CVL IVL UC BARING BITUS 4/1/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v 2 Keberia S 408593 01/04/01974 EDH.SAH 1 1 0 1 1 0 0 0 v 3 Abdul Aziz 406583 1/1/1954 post VATS 1 1 0 1 1 0 0 0 ceftriaxon 2x1 gr PB 14. Strok 1 1 0 1 1 0 0 0 v 2 Keberia S 408593 4/1/1974 EDH.

Strok 1 1 0 1 1 0 0 0 v 2 Keberia S 408593 4/1/1974 EDH.4/6/2018 1 Nurhayati 402718 4/4/1954 DM.15 wib 2 Napsiah 300761 12/31/1949 TB Paru. Strok 1 1 0 1 1 0 0 0 v 2 Keberia S 408593 4/1/1974 EDH. Strok 1 1 0 1 1 0 0 0 v 2 Keberia S 408593 4/1/1974 EDH.AF 1 0 1 1 1 0 0 0 cefoferazon 2x1 gr PB jam 05 25 wib Rg IGD 4/12/2018 1 Keberia S 408593 4/1/1974 EDH.SAH 1 1 0 1 1 0 0 0 v 3 Abdul Aziz 406583 1/1/1954 post VATS 1 1 0 1 1 0 0 0 v jam 13 wib Pdh Rg.AF 1 0 1 1 1 0 0 0 v 4 Abdul Karim 407084 12/31/1955 SOL 0 0 1 1 1 0 0 0 Timipen 2x1gr PB jam 17 wib Rg IGD 5 Dewi Hastuti 388065 1/11/1980 Anemia 0 0 1 1 1 0 0 0 Cefoperazon 2x1gr PB jam 22. Strok 1 1 0 1 1 0 0 0 v Jam 19. Strok 1 1 0 1 1 0 0 0 v 2 Keberia S 408593 4/1/1974 EDH.Pdh Teratai 4/10/2018 1 Nurhayati 402718 4/4/1954 DM.SAH 1 1 0 1 1 0 0 0 v (+)jam 13.SAH 1 1 0 1 1 0 0 0 v 3 Abdul Aziz 406583 1/1/1954 post VATS 1 1 0 1 1 0 0 0 v 4/7/2018 1 Nurhayati 402718 4/4/1954 DM.SAH 1 1 0 1 1 0 0 0 v 3 Napsiah 300761 12/31/1949 TB Paru.AKI 0 0 1 1 1 0 0 0 v (+) jam13.DM.DM.CHF.SAH 1 1 0 1 1 0 0 0 v 3 Sallori 405425 4/21/1961 TB paru 0 0 1 1 1 0 0 0 v jam 17.SAH 1 1 0 1 1 0 0 0 v 4/11/2018 1 Nurhayati 402718 4/4/1954 DM.SAH 1 1 0 1 1 1 0 0 v 3 Sallori 405425 4/21/1961 TB paru 0 0 1 1 1 0 0 0 v 4/9/2018 1 Nurhayati 402718 4/4/1954 DM.23 wib 3 Madwiarjo 249806 3/5/1947 CKD. CKD 1 0 1 1 1 0 0 0 merofenem 3x1gr PB jam 13 rg Teratai ( + ) jam 16.45 wib.AKI 0 0 1 1 1 0 0 0 Cepoferazon 2x1gr PB jam 18 wib Rg IGD 4 Madwiarjo 249806 3/5/1947 CKD. Strok 1 1 0 1 1 0 0 0 v 2 Keberia S 408593 4/1/1974 EDH.50 wib Rg IGD .30 wib Rg IGD 4/8/2018 1 Nurhayati 402718 4/4/1954 DM.58 wib 5 Sallori 405425 4/21/1961 TB paru 0 0 1 1 1 0 0 0 Ceftriaxon 2x1gr PB jam 22.Teratai 4 Santani 135353 8/17/1958 TB Paru.30 wib Pdh HCU 2 Keberia S 408593 4/1/1974 EDH.CHF.

Strok 1 1 0 1 1 0 0 0 v .40 Rg IGD (+) 03.DM 1 0 1 1 1 0 0 0 Merofenen 3x1gr PB jam 15 wib.40 wib 2 Dewi Hastuti 388065 1/11/1980 Anemia 0 0 1 1 1 0 0 0 v jam 20. Rg Melati 4 Kiki Andesta 4074070 10/12/1995 Kll SAH.DM 1 0 1 1 1 0 0 0 v 3 Jumaat Bin Waji 407533 9/17/1954 Epilepsi.DM 1 0 1 1 1 0 0 1 v 3 Jumaat Bin Waji 407533 9/17/1954 Epilepsi.DM 1 0 1 1 1 0 0 0 v 3 Nurhayati 402718 4/4/1954 DM.DM type II 0 0 1 1 1 0 0 0 v 4/14/2018 1 Madwiarjo 249806 3/5/1947 CKD.EDH 1 0 1 1 1 0 0 0 Ceftriaxozon 2x1gr PB jam 20.DM 1 0 1 1 1 0 0 0 Sulbacef 2x1 gr PB jam 05.HT.AF 1 0 1 1 1 0 0 0 v (+) jam 05.DM type II 0 0 1 1 1 0 0 0 v 4 Sri Hartati 186171 7/14/1958 ilius obstruksi 0 0 1 1 1 0 0 0 cefotaxim 2x1 gr PB jam 22 wibRg Anggrek 4/15/2018 1 Suryan 139930 12/31/1949 CKD.50 PAPS 2 Sri Hartati 186171 7/14/1958 ilius obstruksi 0 1 1 1 1 0 0 0 v 3 Sutadi 407120 12/30/1966 Kolelitiasis.15 Rg Teratai 4/19/2018 1 Sri Hartati 186171 7/14/1958 ilius obstruksi 0 1 1 1 1 0 0 0 v (+) jam 22.DM 1 0 1 1 1 0 0 0 v 3 Nurhayati 402718 4/4/1954 DM.30 wib Rg IGD 4/17/2018 1 Sri Hartati 186171 7/14/1958 ilius obstruksi 0 1 1 1 1 0 0 1 v 2 Sutadi 407120 12/30/1966 Kolelitiasis.40 wib Rg IGD 4/13/2018 1 Madwiarjo 249806 3/5/1947 CKD.HT.DM 1 0 1 1 1 0 0 0 Jam17.40 Evakuasi sgpore 4/18/2018 1 Sri Hartati 186171 7/14/1958 ilius obstruksi 0 1 1 1 1 0 0 0 v 2 Sutadi 407120 12/30/1966 Kolelitiasis.DM. Strok 1 1 0 1 1 0 0 0 Levofloxacin 1x500 PB jam 21. 6 Suryan 139930 12/31/1949 CKD.50 wib Pdh teratai 3 Suryan 139930 12/31/1949 CKD.DM type II 0 0 1 1 1 0 0 0 Merofenem 3x1gr PB jam 01.DM type II 0 0 1 1 1 0 0 0 jam 12.AF 1 0 1 1 1 0 0 0 v 2 Abdul Karim 407084 12/31/1955 SOL 0 0 1 1 1 0 0 0 v jam 14 Pdh Rg Teratai 3 Dewi Hastuti 388065 1/11/1980 Anemia 0 0 1 1 1 0 0 0 v 4 Suryan 139930 12/31/1949 CKD.DM.CHF.40 wib 2 Sutadi 407120 12/30/1966 Kolelitiasis.CHF.32 wib 4/16/2018 1 Sri Hartati 186171 7/14/1958 ilius obstruksi 0 1 1 1 1 0 0 0 v 2 Sutadi 407120 12/30/1966 Kolelitiasis.

30 wib Rg IGD (+) jam 01. Strok 1 1 0 1 1 0 0 0 v 2 Abdul Jalil 407696 7/7/1975 SDH 1 0 1 1 1 0 0 0 v 3 Nurhidayat.407833 12/17/1980 TB paru. Strok 1 1 0 1 1 0 0 0 v 2 Abdul Jalil 407696 7/7/1975 SDH 1 0 1 1 1 0 0 0 v 3 zammil S 283896 5/2/1977 Selulitis 1 0 1 1 1 0 0 0 (+) jam 17.30 wib . Strok 1 1 0 1 1 0 0 0 v 2 Abdul Jalil 407696 7/7/1975 SDH 1 0 1 1 1 0 0 0 v 3 zammil S 283896 5/2/1977 Selulitis 1 0 1 1 1 0 0 0 v 4/22/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v 2 Abdul Jalil 407696 7/7/1975 SDH 1 0 1 1 1 0 0 0 v 3 Suhaini 265667 8/9/1978 ROSC 1 0 1 1 1 0 0 0 (+) jam 05. Strok 1 1 0 1 1 0 0 0 v 2 Abdul Jalil 407696 7/7/1975 SDH 1 0 1 1 1 0 0 0 v 3 Suhaini 265667 8/9/1978 ROSC 1 0 1 1 1 0 0 0 v 4 Kasam 407890 9/24/1985 enchepalopati 1 0 1 1 1 0 0 0 ceftriaxon 2x1 gr PB jam 17.4/20/2018 1 Sutadi 407120 12/30/1966 Kolelitiasis.45 wib 2 Nurhayati 402718 4/4/1954 DM.00Wib 4 Suhaini 265667 8/9/1978 ROSC 1 0 1 1 1 0 0 0 Ceftriazon 2x1gr PB jam 15. Strok 1 1 0 1 1 0 0 0 v 3 Abdul Jalil 407696 7/7/1975 SDH 1 0 1 1 1 0 0 0 Timipen 2x1 gr PB jam08.30 wib 4 Berliana 407632 8/19/1975 Ca Mamma 0 0 1 1 1 0 0 0 PB jam 00.45 wib 4/26/2018 1 Nurhayati 402718 4/4/1954 DM.R.35wib Rg IGD 4 zammil S 283896 5/2/1977 Selulitis 0 0 1 1 1 0 0 0 Cepoferazon 2x1gr Pbjam 13 wib Rg Melati 4/21/2018 1 Nurhayati 402718 4/4/1954 DM.DM 1 0 1 1 1 0 0 0 (+) 13. Massa 1 0 1 1 1 0 0 0 Ceftriazon 2x1gr PB jam 9.45 Rg Teratai (+) 01 wib 4/23/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v 2 Abdul Jalil 407696 7/7/1975 SDH 1 0 1 1 1 0 0 0 v 4/24/2018 1 Nurhayati 402718 4/4/1954 DM.20 wib Rg IGD 4/25/2018 1 Nurhayati 402718 4/4/1954 DM. 25R g teratai (+)00.

4 Anis S. Strok 1 1 0 1 1 0 0 0 v 2 Abdul Jalil 407696 7/7/1975 SDH 1 0 1 1 1 0 0 0 v 3 Anis S. Kiberia : Hipoalbumin NB : Ny. Strok 1 1 0 1 1 0 0 0 v 2 Abdul Jalil 407696 7/7/1975 SDH 0 0 1 1 1 0 0 0 v 3 Anis S. Strok 1 1 0 1 1 0 0 0 v 2 Abdul Jalil 407696 7/7/1975 SDH 1 0 1 1 1 0 0 0 v 3 Anis S.Ningsih 405534 4/4/1962 tumor meningioma 0 1 1 1 1 0 0 0 imipenem 2x1gr PB jam 14.Ningsih 405534 4/4/1962 tumor meningioma 0 1 1 1 1 0 0 0 v 4/28/2018 1 Nurhayati 402718 4/4/1954 DM. Nurhayati : Hipoalbumin .Ningsih 405534 4/4/1962 tumor meningioma 0 1 1 1 1 0 0 0 v NB : Ny.Ningsih 405534 4/4/1962 tumor meningioma 0 1 1 1 1 0 0 0 v 4/30/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 v 2 Abdul Jalil 407696 7/7/1975 SDH 0 0 1 1 1 0 0 0 v 3 Anis S.Ningsih 405534 4/4/1962 tumor meningioma 0 1 1 1 1 0 1 0 v 4/29/2018 1 Nurhayati 402718 4/4/1954 DM.15Rg Melati 4/27/2018 1 Nurhayati 402718 4/4/1954 DM.

Keterangan DX.MEDIS : Diagnosa Medis ETT : Endotracheal Tube (+) : Meninggal Dunia CVL : Central vena line IVL : Intra vena line/ vena perifer UC : Urine Catheter .

01 wib PB Rg.S 323381 7/1/1960 PPOK 1 0 1 1 1 0 0 0 3 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 0 4 Julianis 404144 10/3/1953 post op batu 1 0 1 1 1 0 0 0 ureter 3/2/2018 1 Mustofa/379116 6/13/1956 Stroke 1 0 1 1 1 0 0 0 Haemoragic 2 Bambang.24 wib PB Rg.01.S 323381 7/1/1960 PPOK 1 0 1 1 1 0 0 0 j. 13. F.K.H 182805 10/19/1939 Hematemisis 0 1 0 1 1 0 0 0 .23wib.Pindah teratai ureter 5 Jamiun 405402 2/8/1966 post op SOL 1 0 1 1 1 0 0 0 Moxifloxacin 1x400 j.IGD 3/3/2018 1 Mustofa/379116 6/13/1956 Stroke 1 0 1 1 1 0 0 0 Haemoragic 2 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 0 3 Jamiun 405402 2/8/1966 post op SOL 1 0 1 1 1 0 0 0 4 Latifah.PPIRS FORMULIR SURVEYLANS HARIAN INFEKSI RUMAH SAKIT RUMAH SAKIT : RSBP Batam BULAN/TAHUN : MARET 2018 RUANGAN : ICU SURVEYOR : TGL NO NAMA/MR USIA DX. Pindah HCU 3 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 0 4 Julianis 404144 10/3/1953 post op batu 1 0 1 1 1 0 0 0 J.H 182805 10/19/1939 hematemisis 0 0 1 1 1 0 0 0 Merofenem 4x500 j.MEDIS PEMAKAIAN ALAT TIRAH DEKU Plebitis KULTUR ANTIBIOTIKA KET JK ETT CVL IVL UC BARING BITUS 3/1/2018 1 Mustofa/379116 6/13/1956 Stroke 1 0 1 1 1 0 0 0 Haemoragic 2 Bambang. OK-Melati 6 Latifah.15 wib.

Teratai 4 Latifah.H 182805 10/19/1939 Hematemisis 0 1 0 1 1 0 0 0 3/7/2018 1 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 0 2 Latifah.05 pindah R Melati 5 Kliwon Y.H 182805 10/19/1939 Hematemisis 0 1 0 1 1 0 0 0 3 Mustafa 379116 6/13/1956 Stroke 1 0 1 1 1 0 0 0 Haemoragic .H 182805 10/19/1939 Hematemisis 0 1 0 1 1 0 0 0 3 Mustafa 379116 6/13/1956 Stroke 1 0 1 1 1 0 0 0 Haemoragic 4 Anis Setia .30 wib 3/9/2018 1 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 0 2 Latifah.N 405534 4/4/1962 post op SOL 1 0 1 1 1 0 0 0 jam12.H 182805 10/19/1939 Hematemisis 0 1 0 1 1 0 0 0 3/5/2018 1 Mustofa/379116 6/13/1956 Stroke 1 0 1 1 1 0 0 0 Haemoragic 2 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 0 3 Jamiun 405402 2/8/1966 post op SOL 1 0 1 1 1 0 0 0 jam 13 pindah R.3/4/2018 1 Mustofa/379116 6/13/1956 Stroke 1 0 1 1 1 0 0 0 Haemoragic 2 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 0 3 Jamiun 405402 2/8/1966 post op SOL 1 0 1 1 1 0 0 0 4 Latifah.H 182805 10/19/1939 Hematemisis 0 1 0 1 1 0 0 0 3 Mustafa 379116 6/13/1956 Stroke 1 0 1 1 1 0 0 0 Haemoragic 3/8/2018 1 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 0 2 Latifah.H 182805 10/19/1939 Hematemisis 0 1 0 1 1 0 0 0 3/6/2018 1 Mustofa/379116 6/13/1956 Stroke 1 0 1 1 1 0 0 0 Haemoragic 2 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 1 3 Latifah.Melati jam 10.I 405555 12/31/1970 post op EVD 0 0 1 1 1 0 0 0 Moxifloxacin 1 x 400 PB R.

H 182805 10/19/1939 Hematemisis 0 1 0 1 1 0 0 0 3 Saenah 386307 12/30/1958 ALE.30 R.Pindah R.H 182805 10/19/1939 Hematemisis 0 1 0 1 1 0 0 0 3 Kliwon Y.Anggrek 3 Saenah 386307 12/30/1958 ALE.H 182805 10/19/1939 Hematemisis 0 1 0 1 1 0 0 0 3 Kliwon Y.H 182805 10/19/1939 Hematemisis 0 1 0 1 1 0 0 0 3 Kliwon Y.ACSSTEMI 1 0 1 1 1 0 0 0 4 Sujitno 406064 3/14/1943 ALE. IGD 3/14/2018 1 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 0 2 Latifah.I 405555 12/31/1970 post op EVD 0 0 1 1 1 0 0 0 jam 11 .H 182805 10/19/1939 Hematemisis 0 1 0 1 1 0 0 0 3 Mustafa 379116 6/13/1956 Stroke 1 0 1 1 1 0 0 0 jam 19. R Teratai jam 23 wib 3/11/2018 1 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 0 2 Latifah.15 R.Jam 02.50 wib ( + ) 3/12/2018 1 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 0 2 Latifah.I 405555 12/31/1970 post op EVD 0 0 1 1 1 0 0 0 5 Bambang S 323381 7/1/1960 CHF.ACSSTEMI 1 0 1 1 1 0 0 0 cefoferazon 2x1gr PB.I 405555 12/31/1970 post op EVD 0 0 1 1 1 0 0 0 3/13/2018 1 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 0 2 Latifah. PPOK 1 0 1 1 1 0 0 0 merofenem 3x1 gr PB.Melati 4 Saenah 386307 12/30/1958 ALE. PPOK 1 0 1 1 1 0 0 0 jam 06. 4 Kliwon Y.ACSSTEMI 1 0 1 1 1 0 0 0 3/15/2018 1 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 0 2 Latifah. IGD . Pneumonia 1 0 1 1 1 0 0 0 PB Jam 03.I 405555 12/31/1970 post op EVD 0 0 1 1 1 0 0 0 4 Bambang S 323381 7/1/1960 CHF.H 182805 10/19/1939 Hematemisis 0 1 0 1 1 0 0 0 jam 13 pindah R. HCU Haemoragic 4 Kliwon Y.15 pindah R.I 405555 12/31/1970 post op EVD 0 0 1 1 1 0 0 0 3/10/2018 1 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 0 2 Latifah.

Pneumonia 1 0 1 1 1 0 0 0 4 Firdaus 406146 4/22/1977 Endothoretomy 1 0 1 1 1 0 0 0 Ceftriaxon 2x1 gr PB jam06.50 wib 3/19/2018 1 Nurhayati 402718 4/4/1954 DM. Strok 1 1 0 1 1 0 0 0 2 Saenah 386307 12/30/1958 ALE.55 wib 3 Mustafa 379116 6/13/1956 Tumor Paru 1 0 1 1 1 0 0 0 Merofenem 3x1 gr PB jam )1 wib.20 R. Pneumonia 1 0 1 1 1 0 0 0 Merofenem 3x1gr PB jam 03.R. Strok 1 1 0 1 1 0 0 0 merofenem 3x1 gr PB jam 23. Strok 1 1 0 1 1 0 0 0 3 Mustafa 379116 6/13/1956 Tumor Paru 1 0 1 1 1 0 0 0 .40 wib 3/20/2018 1 Nurhayati 402718 4/4/1954 DM.30 wib OK 3/18/2018 1 Nurhayati 402718 4/4/1954 DM.Teratai 3 Saenah 386307 12/30/1958 ALE.ACSSTEMI 1 0 1 1 1 0 0 0 3 Sujitno 406064 3/14/1943 ALE.ACSSTEMI 1 0 1 1 1 0 0 0 3 Sujitno 406064 3/14/1943 ALE.ACSSTEMI 1 0 1 1 1 0 0 0 4 Sujitno 406064 3/14/1943 ALE.ACSSTEMI 1 0 1 1 1 0 0 0 3 Sujitno 406064 3/14/1943 ALE. Strok 1 1 0 1 1 0 0 0 2 Saenah 386307 12/30/1958 ALE.ACSSTEMI 1 0 1 1 1 0 0 0 (+) jam 18. Pneumonia 1 0 1 1 1 0 0 0 4 Firdaus 406146 4/22/1977 Endothoretomy 1 0 1 1 1 0 0 0 (+) jam 9. Strok 1 1 0 1 1 0 0 0 2 Saenah 386307 12/30/1958 ALE.Teratai 4 Maryati 381775 8/5/1970 Post op SOL 1 0 1 1 1 0 0 0 moxifloxacin 1x400 PB jam 12 wib OK/ Teratai 1 Rubiani234829 6/3/1982 MG post op 1 0 1 1 1 0 0 0 Sharox 3x1 gr PB Jam 13 wib OK/Melati 3/21/2018 2 Nurhayati 402718 4/4/1954 DM. IGD 3/17/2018 1 Nurhayati 402718 4/4/1954 DM.3/16/2018 1 Susmiati 243964 4/14/1937 sydrome fatige 0 0 1 1 1 0 0 0 jam 23. Strok 1 1 0 1 1 0 0 0 2 Saenah 386307 12/30/1958 ALE.30 wib ( + ) 2 Nurhayati 402718 4/4/1954 DM.15 wib R. Pneumonia 1 0 1 1 1 0 0 0 (+) jam 06.

Teratai 4 Maryati 381775 8/5/1970 Post op SOL 1 0 1 1 1 0 0 0 5 Saharudin 406161 5/5/1953 Stroke H 1 0 1 1 1 0 0 0 Merofenem 3x1 gr PB jam 22 wib.R.Melati 2 Nurhayati 402718 4/4/1954 DM.IGD 3/24/2018 1 Rubiani234829 6/3/1982 MG post op 1 0 1 1 1 0 0 0 2 Nurhayati 402718 4/4/1954 DM.15. 4 Maryati 381775 8/5/1970 Post op SOL 1 0 1 1 1 0 0 0 3/22/2018 1 Rubiani234829 6/3/1982 MG post op 1 0 1 1 1 0 0 0 2 Nurhayati 402718 4/4/1954 DM.Pdh R. Strok 1 1 0 1 1 0 0 0 3 Maryati 381775 8/5/1970 Post op SOL 1 0 1 1 1 0 0 0 jam 14 wib.40 Pdh R. Strok 1 1 0 1 1 0 0 0 2 Haris 406374 11/3/1982 IVH 1 0 1 1 1 0 0 0 3 Andika T.084266 8/28/1964 Ca Paru 1 0 1 1 1 0 0 0 4 Anis Setia N. Strok 1 1 0 1 1 0 0 0 3 Saharudin 406161 5/5/1953 Stroke H 1 0 1 1 1 0 0 0 (+) jam 15. Strok 1 1 0 1 1 0 0 0 3 Mustafa 379116 6/13/1956 Tumor Paru 1 0 1 1 1 0 0 0 Jam 18.55 wib 4 Haris 406374 11/3/1982 IVH 1 0 1 1 1 0 0 0 5 Andika T. Strok 1 1 0 1 1 0 0 0 3 Saharudin 406161 5/5/1953 Stroke H 1 0 1 1 1 0 0 0 4 Haris 406374 11/3/1982 IVH 1 0 1 1 1 0 0 0 3/25/2018 1 Rubiani234829 6/3/1982 MG post op 1 0 1 1 1 0 0 0 Jam 17 wib. HCU 3/23/2018 1 Rubiani234829 6/3/1982 MG post op 0 0 1 1 1 0 0 0 2 Nurhayati 402718 4/4/1954 DM.OK . Strok 1 1 0 1 1 0 0 0 2 Haris 406374 11/3/1982 IVH 1 0 1 1 1 0 0 0 3 Andika T.084266 8/28/1964 Ca Paru 1 0 1 1 1 0 1 0 Ceftriaxon 2x1 gr PB jam 23 wib.R.R Anggrek 3/26/2018 1 Nurhayati 402718 4/4/1954 DM.405534 4/4/1962 post op Sol 1 0 1 1 1 0 0 0 Timipen 2 x 1gr PB jam 11.084266 8/28/1964 Ca Paru 1 0 1 1 1 0 1 0 3/27/2018 1 Nurhayati 402718 4/4/1954 DM.20 wib R.Pdh Melati 4 Saharudin 406161 5/5/1953 Stroke H 1 0 1 1 1 0 0 0 5 Haris 406374 11/3/1982 IVH 0 0 1 1 1 0 0 0 moxifloxacin 1x400 PB jam.

30 wib 3 Keberia S 408593 01/04/01974 EDH.B20. Strok 1 1 0 1 1 0 0 0 2 Haris 406374 11/3/1982 IVH 1 0 1 1 1 0 0 0 3 Andika T.SAH 1 0 1 1 1 0 0 0 4 Denny S 403613 10/17/1984 Enchepalopaty.30 R Anggrek 3/29/2018 1 Nurhayati 402718 4/4/1954 DM.HbSAg 0 0 1 1 1 0 0 0 Imipenem 3x1 gr PB jam 04.IGD 3/31/2018 1 Nurhayati 402718 4/4/1954 DM.3/28/2018 1 Nurhayati 402718 4/4/1954 DM.Pdh R. Strok 1 1 0 1 1 0 0 0 2 Haris 406374 11/3/1982 IVH 1 0 1 1 1 0 0 0 3 Anis Setia N.HbSAg 0 0 1 1 1 0 0 0 (+) jam 16.20 wib 5 Keberia S 408593 01/04/01974 EDH.SAH 0 0 1 1 1 0 0 0 Moxifloxacin 1x400 PB jam 18 wib .B 0 0 1 1 1 0 0 0 Ceftazidim 2x1 gr PB jam 02 wib R.405534 4/4/1962 post op Sol 0 0 1 1 1 0 0 0 Jam 17.B20.R.Teratai 20 .084266 8/28/1964 Ca Paru 1 0 1 1 1 0 0 0 (+) jam 00.55 Wib 4 Anis Setia N. Strok 1 1 0 1 1 0 0 0 2 Haris 406374 11/3/1982 IVH 1 0 1 1 1 0 0 0 (+) jam 22.B20.HbSAg 0 0 1 1 1 0 0 0 3/30/2018 1 Nurhayati 402718 4/4/1954 DM.405534 4/4/1962 post op Sol 0 0 1 1 1 0 0 0 4 Rosdita E P 338349 8/5/1989 TB. Strok 1 1 0 1 1 0 0 0 2 Haris 406374 11/3/1982 IVH 1 0 1 1 1 0 0 0 3 Anis Setia N.Melati 4 Rosdita E P 338349 8/5/1989 TB.405534 4/4/1962 post op Sol 0 0 1 1 1 0 0 0 5 Rosdita E P 338349 8/5/1989 TB.

DX.MEDIS : Diagnosa Medis ETT : Endotracheal Tube (+) : Meninggal Dunia CVL : Central vena line IVL : Intra vena line/ vena perifer UC : Urine Catheter .

.

K. F.03.PPIRS FORMULIR SURVEYLANS BULANAN INFEKSI RUMAH SAKIT RUMAH SAKIT : BP Batam BULAN/TAHUN : Februari 2018 RUANGAN : ICU SURVEYOR : PEMAKAIAN ALAT INFEKSI RS INFEKSI LAIN HASIL KULTUR ANTI TGL JLH PS ETT CVL IVL UC VAP ISK IADP IDO PLEBITIS DECUB TB DARAH SWAB SPUTUM URINE BIOTIKA 2/1/2018 4 1 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 2/2/2018 5 2 1 4 5 0 0 0 0 0 0 5 0 0 0 0 v 2/3/2018 4 2 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 2/4/2018 4 1 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 2/5/2018 4 1 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 2/6/2018 3 1 1 2 3 0 0 0 0 0 0 3 0 0 0 0 v 2/7/2018 4 1 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 2/8/2018 5 3 1 4 5 0 0 0 0 0 0 5 0 0 0 0 v 2/9/2018 4 4 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 2/10/2018 5 5 1 4 5 0 0 0 0 1 0 5 0 0 0 0 v 2/11/2018 4 1 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 2/12/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 2/13/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 2/14/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 2/15/2018 5 3 1 4 5 0 0 0 0 0 0 5 0 0 0 0 v 2/16/2018 4 2 0 4 4 0 0 0 0 0 0 4 0 0 0 0 v 2/17/2018 4 2 0 4 4 0 0 0 0 0 0 4 0 0 0 0 v 2/18/2018 4 3 0 4 4 0 0 0 0 0 0 4 0 0 0 0 v 2/19/2018 4 2 0 4 4 0 0 0 0 0 0 4 0 0 0 0 v 2/20/2018 5 3 0 5 5 0 0 0 0 0 0 5 0 0 0 0 v 2/21/2018 4 3 0 4 4 0 0 0 0 0 0 4 0 0 0 0 v 2/22/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v .

2/23/2018 3 2 1 2 3 0 0 0 0 0 0 3 0 0 0 0 v 2/24/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 2/25/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 2/26/2018 6 4 1 5 6 0 0 0 0 0 0 6 0 0 0 0 v 2/27/2018 4 3 0 4 4 0 0 0 0 0 0 4 0 0 0 0 v 2/28/2018 3 2 0 3 3 0 0 0 0 0 0 3 0 0 0 0 v KETERANGAN ETT : Endotracheal Tube VAP : Ventilator Associated Pneumonia v : Pakai Antibiotik CVL : Central vena line ISK : Infeksi Saluran Kemih IVL : Intra vena line/ vena perifer IADP : Infeksi Aliran Darah Primer UC : Urine Catheter IDO : Infeksi Daerah Operasi TB : Tirah Baring .

K. CKD 1 1 0 1 1 0 0 0 3 Nopi Susanti 11/10/1987 CKD 0 0 1 1 1 0 0 0 4 lamseria 3/28/1968 CKD 0 0 1 1 1 0 0 0 1/4/2018 1 Rikanah 27/12/1975 strok H 1 0 1 1 1 0 0 0 2 Irwansyah 3/23/1968 ROSC.01.MEDIS Plebitis KULTUR ANTIBIOTIKA KET JK ETT CVL IVL UC BARING BITUS 1/01/2018 1 Rikanah 27/12/1975 strok H 1 0 1 1 1 0 0 0 2 Irwansyah 3/23/1968 ROSC. CKD 1 1 0 1 1 0 0 0 3 Nopi Susanti 11/10/1987 CKD 0 0 1 1 1 0 0 0 jam17.10 wib + 4 lamseria 3/28/1968 CKD 0 0 1 1 1 0 0 0 5 Raimen lasmini 400569 9/27/1970 post op. F. CKD 1 1 0 1 1 1 0 0 3 Nopi Susanti 11/10/1987 CKD 0 0 1 1 1 0 0 0 4 lamseria 3/28/1968 CKD 0 0 1 1 1 0 0 0 1/2/2018 1 Rikanah 27/12/1975 strok H 1 0 1 1 1 0 0 0 2 Irwansyah 3/23/1968 ROSC.R .20 wibPB.PPIRS FORMULIR SURVEYLANS HARIAN INFEKSI RUMAH SAKIT RUMAH SAKIT : RSBP Batam BULAN/TAHUN : Januari 2018 RUANGAN : ICU SURVEYOR : USIA PEMAKAIAN ALAT TIRAH DEKU TGL NO NAMA/MR DX.Teratai 1/5/2018 1 Rikanah 27/12/1975 strok H 1 0 1 1 1 0 0 0 2 Irwansyah 3/23/1968 ROSC.lap expl 1 0 1 1 1 0 0 0 cefoferazon 2x1gr jam 20. CKD 1 1 0 1 1 0 0 1 . CKD 1 1 0 1 1 0 0 0 3 Nopi Susanti 11/10/1987 CKD 0 0 1 1 1 0 0 0 4 lamseria 3/28/1968 CKD 0 0 1 1 1 0 0 1/3/2018 1 Rikanah 27/12/1975 strok H 1 0 1 1 1 0 0 0 2 Irwansyah 3/23/1968 ROSC.

52 wib[ + ] 1/9/2018 1 Rikanah 27/12/1975 strok H 1 0 1 1 1 0 0 0 2 Raismen lasmini 400569 9/27/1970 post op.CKD 0 0 1 1 1 0 0 0 ceftriaxon 2x1 gr jam 22. 3 lamseria 3/28/1968 CKD 0 0 1 1 1 0 0 0 4 Raismen lasmini 400569 9/27/1970 post op.teratai 2 Raismen lasmini 400569 9/27/1970 post op. PB dr Rg.lap expl 1 0 1 1 1 0 0 0 3 kartono 403146 2/23/1969 ppok 1 0 1 1 1 0 0 0 PB jam 15 wib IGD jam 19.pindah R.lap expl 1 0 1 1 1 0 0 0 4 Raja Suparman276997 10/18/1964 CKD 0 0 1 1 1 0 1 0 Merofenem 3x1gr jam 14.30 wib.lap expl 1 0 1 1 1 0 0 0 4 Raja Suparman276997 10/18/1964 CKD 0 0 1 1 1 0 0 0 5 Fitri Aprilia 402981 4/12/1992 ALE. jam 02.10 wib [ + ] . CKD 1 1 0 1 1 0 0 0 3 lamseria 3/28/1968 CKD 0 0 1 1 1 0 0 0 jam 01.lap expl 1 0 1 1 1 0 0 0 1/6/2018 1 Rikanah 27/12/1975 strok H 1 0 1 1 1 0 0 0 2 Irwansyah 3/23/1968 ROSC.00 wib PB dr Rg IGD.55 wib + 4 Raismen lasmini 400569 9/27/1970 post op.lap expl 1 0 1 1 1 0 0 0 1/7/2018 1 Rikanah 27/12/1975 strok H 1 0 1 1 1 0 0 0 2 Irwansyah 3/23/1968 ROSC.pindah R.lap expl 1 0 1 1 1 0 0 0 3 Raja Suparman 276997 10/18/1964 CKD 0 0 1 1 1 0 0 0 jam 20.Anggrek 3 Raismen lasmini 400569 9/27/1970 post op. CKD 1 1 0 1 1 0 0 0 jam 18 wib.lap expl 1 0 1 1 1 0 0 0 3 Raja Suparman276997 10/18/1964 CKD 0 0 1 1 1 0 0 0 1/10/2018 1 Rikanah 27/12/1975 strok H 1 0 1 1 1 0 0 0 2 Raismen lasmini 400569 9/27/1970 post op. CKD 1 1 0 1 1 0 0 0 3 Raismen lasmini 400569 9/27/1970 post op. HCU 1/8/2018 1 Rikanah 27/12/1975 strok H 1 0 1 1 1 0 0 0 2 Irwansyah 3/23/1968 ROSC.pindah ruang Melati 1/11/2018 1 Rikanah 27/12/1975 strok H 1 0 1 1 1 0 0 0 jam 17 wib.

15 wib R.lap expl 1 0 1 1 1 0 0 0 2 Rikanah 402502 12/27/1975 post op cranio 1 1 0 1 1 0 0 0 stroke H 3 Daeng subuh 402749 7/13/1934 post SC 0 0 1 1 1 0 0 0 jam 10 alih rawat puskesmas 4 suwignyo 403198 12/1/1972 post op cranio 1 0 1 1 1 0 0 0 dekompresi 5 Arfah 400770 1/1/1973 CHF 0 0 1 1 1 0 0 0 ceftriaxon 2x1 gr PB jam 18 wib R.lap expl 1 0 1 1 1 0 0 0 2 Rikanah 402502 12/27/1975 post op cranio 1 0 1 1 1 0 0 0 stroke H 3 Daeng subuh 402749 7/13/1934 post SC 0 0 1 1 1 0 0 0 4 suwignyo 403198 12/1/1972 post op cranio 1 0 1 1 1 0 0 0 timipen 2x1 gr PB jam 10.lap expl 1 0 1 1 1 0 0 0 2 Rikanah 402502 12/27/1975 post op cranio 1 1 0 1 1 0 0 0 stroke H 3 Daeng subuh 402749 7/13/1934 post SC 0 0 1 1 1 0 0 0 4 suwignyo 403198 12/1/1972 post op cranio 1 0 1 1 1 0 0 0 dekompresi 1/16/2018 1 Raismen lasmini 400569 9/27/1970 post op. Mawar 1 Raismen lasmini 400569 9/27/1970 post op.R.teratai stroke H 3 Daeng subuh 402749 7/13/1934 post SC 0 0 1 1 1 0 0 0 ceftriaxon 1x2 gr PB jam 12 wib.lap expl 1 0 1 1 1 0 0 0 2 Rikanah 402502 12/27/1975 post op cranio 1 0 1 1 1 0 0 0 cefriaxon 2x1 gr PB jam 22.15 wib R. Melati ) 1/15/2018 1 Raismen lasmini 400569 9/27/1970 post op.1/12/2018 1 Raismen lasmini 400569 9/27/1970 post op.OK dekompresi MTZ 3 x 500 mg { R.melati .lap expl 1 0 1 1 1 0 0 0 1/13/2018 2 Rikanah 402502 12/27/1975 post op cranio 1 0 1 1 1 0 0 0 stroke H 3 Daeng subuh 402749 7/13/1934 post SC 0 0 1 1 1 0 0 0 1/14/2018 1 Raismen lasmini 400569 9/27/1970 post op.

HCU 1/18/2018 1 Raismen lasmini 400569 9/27/1970 post op.30.Ok --> R. teratai .lap expl 1 0 1 1 1 0 0 0 2 Rikanah 402502 12/27/1975 post op cranio 1 1 0 1 1 0 0 0 stroke H 3 suwignyo 403198 12/1/1972 post op cranio 1 0 1 1 1 0 0 0 dekompresi 4 Arfah 400770 1/1/1973 CHF 0 0 1 1 1 0 0 0 jam 14 wib PAPS 5 Ummi Asniati 400697 3/16/1960 CKD/DM 0 0 1 1 1 0 0 0 sulbacef 2x1 gr PB jam 15 wib R.lap expl 1 0 1 1 1 0 0 0 2 Rikanah 402502 12/27/1975 post op cranio 1 0 1 1 1 0 0 0 stroke H 3 suwignyo 403198 12/1/1972 post op cranio 1 0 1 1 1 0 0 0 jam 11.anggrek dekompresi 4 Ummi Asniati 400697 3/16/1960 CKD/DM 0 0 1 1 1 0 0 0 1/21/2018 1 Raismen lasmini 400569 9/27/1970 post op.lap expl 1 0 1 1 1 0 0 0 2 Rikanah 402502 12/27/1975 post op cranio 1 1 0 1 1 0 0 0 stroke H 3 suwignyo 403198 12/1/1972 post op cranio 1 0 1 1 1 0 0 0 dekompresi 4 Ummi Asniati 400697 3/16/1960 CKD/DM 0 0 1 1 1 0 0 0 1/19/2018 1 Raismen lasmini 400569 9/27/1970 post op.lap expl 1 0 1 1 1 0 0 0 2 Rikanah 402502 12/27/1975 post op cranio 1 1 0 1 1 0 0 0 stroke H 3 suwignyo 403198 12/1/1972 post op cranio 1 0 1 1 1 0 0 0 dekompresi 4 Ummi Asniati 400697 3/16/1960 CKD/DM 0 0 1 1 1 0 0 0 1/20/2018 1 Raismen lasmini 400569 9/27/1970 post op.1/17/2018 1 Raismen lasmini 400569 9/27/1970 post op.R.lap expl 1 0 1 1 1 0 0 0 2 Rikanah 402502 12/27/1975 post op cranio 1 1 0 1 1 0 0 0 3 Ummi Asniati 400697 3/16/1960 CKD/DM 0 0 1 1 1 0 0 0 4 piah 401375 9/3/1966 laminektomy 0 0 1 1 1 0 0 0 moxifloxacin PB jam 18 R.pindah.

lap expl 1 0 1 1 1 0 0 0 Jam 14 wib ( + ) 2 Rikanah 402502 12/27/1975 post op cranio 1 1 0 1 1 0 0 0 3 piah 401375 9/3/1966 laminektomy 0 0 1 1 1 0 0 0 Jam 16 wib.30 wib. 16. HCU 1/27/2018 1 Tifa Chelya 403572 9/19/2008 SOL temporal 1 0 1 1 1 0 0 0 JAM 13. S 403227 4/7/1994 craniotomy sol 0 0 1 1 1 0 0 0 moxifloxacin 1x400 PB jam.Pindah R.30 wib Pindah teratai 5 Hairunnisyah 403808 1/2/1956 CKD/ HT 1 1 0 1 1 0 0 0 cefoperazon 2x1gr PB Jam 13. complex 1x400 mg 1/22/2018 1 Raismen lasmini 400569 9/27/1970 post op.45 wib.pindah R.R.35 wib ( + ) 1/25/2018 1 Tifa Chelya 403572 9/19/2008 SOL temporal 1 0 1 1 1 0 0 0 2 Rikanah 402502 12/27/1975 post op cranio 1 1 0 1 1 0 0 0 3 syamsudin 403477 1/20/1953 Tumor Paru 1 0 1 1 1 0 0 0 ceftriaxon 2x1 gr PB jam11.R Teratai 1/26/2018 1 Tifa Chelya 403572 9/19/2008 SOL temporal 1 0 1 1 1 0 0 0 2 Rikanah 402502 12/27/1975 post op cranio 1 1 0 1 1 0 0 0 3 syamsudin 403477 1/20/1953 Tumor Paru 1 0 1 1 1 0 0 0 4 Barden .30 WIB ( + ) 2 Rikanah 402502 12/27/1975 post op cranio 1 1 0 1 1 0 0 0 3 syamsudin 403477 1/20/1953 Tumor Paru 1 0 1 1 1 0 0 0 Jam 07.lap expl 1 0 1 1 1 0 0 0 2 Rikanah 402502 12/27/1975 post op cranio 1 1 0 1 1 0 0 0 3 Ummi Asniati 400697 3/16/1960 CKD/DM 0 0 1 1 1 0 0 0 jam 19 wib.S 403699 9/24/1959 Dispneu/ DM 1 0 1 1 1 0 0 0 merofenem 3x1gr PB jam17.Teratai 1/24/2018 1 Tifa Chelya 403572 9/19/2008 SOL temporal 1 0 1 1 1 0 0 0 2 Rikanah 402502 12/27/1975 post op cranio 1 1 0 1 1 0 0 0 3 Ojak .30 wib ( + ) .Melati 4 piah 401375 9/3/1966 laminektomy 0 0 1 1 1 0 0 0 complex 1/23/2018 1 Raismen lasmini 400569 9/27/1970 post op.00wib.R Teratai 4 Barden . S 403227 4/7/1994 craniotomy sol 0 0 1 1 1 0 0 0 Jam 11.30wib R.Teratai complex 4 Tifa Chelya 403572 9/19/2008 SOL temporal 1 0 1 1 1 0 0 0 PB jam 16.20wib.R Teratai jam 00.

4 Hairunnisyah 403808 1/2/1956 CKD/ HT 1 1 0 1 1 0 0 0 5 Rosalita 403809 3/2/1984 combutio 63% 0 0 1 1 1 0 0 0 ceftriaxon 2x1 gr PB jam 21.10 wib.MEDIS : Diagnosa Medis ETT : Endotracheal Tube (+) : Meninggal Dunia CVL : Central vena line IVL : Intra vena line/ vena perifer UC : Urine Catheter .05 wib.Melati 1/31/2018 1 Hairunnisyah 403808 1/2/1956 CKD/ HT 1 1 0 1 1 0 0 0 2 baharudin 402597 9/9/1975 sol 0 0 1 1 1 0 0 0 3 Syahbudin Pane 317178 12/31/1958 Meningitis TB 0 0 1 1 1 0 0 0 Ceftriaxon 1x2 gr Jam 2 wib PB R. HCU 2 Hairunnisyah 403808 1/2/1956 CKD/ HT 1 1 0 1 1 0 0 0 3 Rosalita 403809 3/2/1984 combutio 63% 1 0 1 1 1 0 0 0 1/30/2018 1 Hairunnisyah 403808 1/2/1956 CKD/ HT 1 1 0 1 1 0 0 0 2 Rosalita 403809 3/2/1984 combutio 63% 1 0 1 1 1 0 0 0 jam 18. ER Keterangan DX.Melati 1/28/2018 1 Rikanah 402502 12/27/1975 post op cranio 1 1 0 1 1 0 0 0 2 Hairunnisyah 403808 1/2/1956 CKD/ HT 1 1 0 1 1 0 0 0 3 Rosalita 403809 3/2/1984 combutio 63% 1 0 1 1 1 0 0 0 1/29/2018 1 Rikanah 402502 12/27/1975 post op cranio 1 1 0 1 1 0 0 0 Jam 18 wib pindah R. ( + ) 3 baharudin 402597 9/9/1975 sol 1 0 1 1 1 0 0 0 Moxiploxacin 1x 400 jam 01 wib R.R.

F.PPIRS FORMULIR SURVEYLANS BULANAN INFEKSI RUMAH SAKIT RUMAH SAKIT : BP Batam BULAN/TAHUN : Januari 2018 RUANGAN : ICU SURVEYOR : PEMAKAIAN ALAT INFEKSI RS INFEKSI LAIN HASIL KULTUR ANTI TGL JLH PS ETT CVL IVL UC VAP ISK IADP IDO PLEBITIS DECUB TB DARAH SWAB SPUTUM URINE BIOTIKA 1/1/2018 4 2 1 3 4 0 0 0 0 0 1 4 0 0 0 0 v 1/2/2018 4 2 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 1/3/2018 4 2 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 1/4/2018 5 4 1 4 5 0 0 0 0 0 0 5 0 0 0 0 v 1/5/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 1 0 v 1/6/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 1/7/2018 4 3 1 3 4 0 0 0 0 1 0 4 0 0 0 0 v 1/8/2018 5 3 1 4 5 0 0 0 0 0 0 5 0 0 0 0 v 1/9/2018 3 2 0 3 3 0 0 0 0 0 0 3 0 0 0 0 v 1/10/2018 3 2 0 3 3 0 0 0 0 0 0 3 0 0 0 0 v 1/11/2018 3 3 0 3 3 0 0 0 0 0 0 3 0 0 0 0 v 1/12/2018 3 2 0 3 3 0 0 0 0 0 0 3 0 0 0 0 v 1/13/2018 3 2 0 3 3 0 0 0 0 0 0 3 0 0 0 0 v 1/14/2018 4 3 0 4 4 0 0 0 0 0 0 4 0 0 0 0 v 1/15/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 1/16/2018 5 3 1 4 5 0 0 0 0 0 0 5 0 0 0 0 v 1/17/2018 5 3 1 4 5 0 0 0 0 0 0 5 0 0 0 0 v 1/18/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 1/19/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 1/20/2018 4 3 0 4 4 0 0 0 0 0 0 4 0 0 0 0 v 1/21/2018 4 2 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 1/22/2018 4 2 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v .K.03.

1/23/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 1/24/2018 3 3 1 2 3 0 0 0 0 0 0 3 0 0 0 0 v 1/25/2018 4 3 1 3 4 0 0 0 0 0 0 4 0 0 0 0 v 1/26/2018 5 4 2 3 5 0 0 0 0 0 0 5 0 0 0 0 v 1/27/2018 5 4 2 3 5 0 0 0 0 0 0 5 0 0 0 0 v 1/28/2018 3 3 2 1 3 0 0 0 0 0 0 3 0 0 0 0 v 1/29/2018 3 3 1 2 3 0 0 0 0 0 0 3 0 0 0 0 v 1/30/2018 3 3 1 2 3 0 0 0 0 0 0 3 0 0 0 0 v 1/31/2018 3 1 1 2 3 0 0 0 0 0 0 3 0 0 0 0 v KETERANGAN ETT : Endotracheal Tube VAP : Ventilator Associated Pneumonia v : Pakai Antibiotik CVL : Central vena line ISK : Infeksi Saluran Kemih IVL : Intra vena line/ vena perifer IADP : Infeksi Aliran Darah Primer UC : Urine Catheter IDO : Infeksi Daerah Operasi TB : Tirah Baring .