FORMULIR SURVEILANS INFEKSI DAERAH OPERASI

Bulan : November BULAN/TAHUN :

Tahun : 2018 RUANGAN :
Ruangan : Dahlia SURVEYOR :
Petugas : DEPARTEMEN :

Katagori Risk
Total
No Tanggal Nama Pasien Usia JK Diagnosa Score
Jenis Op Klasifikasi ASA T Time Katagori
B BT T K Score 1 2 3 4 5 Score < Jam > Jam Score
1 11/11/2018 Ny.S 35 th P KPD+DM 0 0 1 1 0 0 1
2 11/16/2018 Ny.M 47 th P SC 0 0 0 0 0 0 0
3 11/16/2018 Ny.N 36 th P SC 0 0 0 0 0 0
4 11/17/2018 Ny.R 34 th P G3P1 DM2 0 0 0 0 0 0 0
5 11/24/2018 Ny.K 44 th P G3P2 0 0 1 1 1 1 2
6 11/25/2018 Ny.J 39 th P G4P3 Hipertensi 0 0 1 1 1 1 2

1 11/17/2018 Tn.R 36 th L APP 0 0 0 0 0 0 0

2 11/11/2018 Tn.T 37 th L APP 0 0 1 1 1 1 2
3 11/20/2018 Ny.C 50 th P APP Ferporasi+HT 1 1 1 1 1 1 3
4 11/18/2018 Ny.K 60 th P APP 0 0 1 1 0 0 1
5 1/25/2018 Ny.J 39 th P APP Ferporasi+DM 0 0 1 1 1 1 2

1 11/15/2018 Tn.G 65 th L Katarak dan HT dan DM 0 0 1 1 0 0 1

Tanggal Infeksi Kultur AB

11/22/2018 Enterobacter spp profilaksis Cefazolin 2 gr IV

11/28/2018 Stapylococcus Aureus cefaz 1 gram IV
11/27/2018 Stapylococcus Aureus cefaz 1 gram I V
11/24/2018 Stapylococus Aureus Propilaksis Cefazolin 2 gr IV
11/29/2018 Enterobacter spp cefaz 2 gram IV
11/30/2018 MRSA Propilaksis Cefazolin 2 gr IV

11/24/2018 Stapylococus aureus cefaz 1 gram IV

11/20/2018 Enterobacter spp cefaz 1 gram IV
11/25/2018 Stapylococus aureus propilaksis cefaz 2 gram IV
11/30/2018 Pseudomonas cefaz 1 gram IV
11/29/2018 Stapylococus aureus Propilaksis Cefazolin 2 gr IV

11/24/2018 Stapylococus aureus propilaksis cefaz 1 gram IV

Peta Kuman IDO SC Peta K
3.5
No Jenis Kuman Jumlah % 3
2.5
1 Enterococcus 2 33%
2
2 Staphylococus Aureus 3 50% 1.5
3 MRSA 1 16% 1
0.5
Total 6 100% 0
Enterococcus Sta
Au

Peta Kuman IDO APP

No Jenis Kuman Jumlah % Peta Ku

1 Enterococcus 1 20% 3.5
2 Staphylococus Aureus 3 60% 3
3 Pseudomonas 1 20% 2.5
Total 5 100% 2
1.5
1
0.5
0
Enterococcus Sta
Peta Kuman IDO KATARAK Au

No Jenis Kuman Jumlah %

1 Enterococcus 1 33%
2 Staphylococus Aureus 2 67% Peta Kum
Total 3 100%
2.5

1.5

0.5

0
 Peta Kuman IDO APP
3.5
3
2.5
2 %
1.5
Colum
1 nD
0.5
0
Enterococcus Staphylococus Pseudomonas
Aureus

Peta Kuman IDO APP

3.5
3
2.5
2
1.5 Jumlah
1 %
0.5
0
Enterococcus Staphylococus Pseudomonas
Aureus

Peta Kuman IDO KATARAK

2.5

2
Enterococcus
1.5
Staphylococus
1 Aureus

0.5