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PlUnIMIRC-C.1CC.G.019 Form * Rev, O- Ventator Assecited Pacumena Bands of i Repu of tre Piipies Departmen of Heal Reponal Office MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER Git of Base, Nocos Nore “ruc in 077-600-800, Fax ine 07-792-3133 ‘Email dress: mmm dan@aoo com “PHIC Accredited Health Care Provider” “ISO 9001:2015 Certified” VENTILATOR ASSOCIATED PNEUMONIA BUNDLE OF CARE CHECKLIST BED NUMBER: ___ DATE OF INTUBATIO! NAME: DATE OF ADMISSIOI CULTURE RESULTS: imen:___Date/Result: Specimen: Instruction: Ploase check ()) if done, (NA) if nat applical t 7 smut |» BUNDLE OF CARE| | | | | { Taronearereene + aaeeen ee ater patertconiact | { Ea tends teweas TTT fslens | [Schone plover between | catents. i HGS seme ama New | Noa Recenter i | | | pag) in each patient. pitti L boPaentsposmann cote TT TTT 1 ae itau entered” | |_“Goosensccss er nrony teers srocreopeeaeei lescache uaeg ate ipecangal ara. Fe soe ter burda tongs ie bs eee eas | Bier nei soled 00 | | Sera fin Bearing | | | Sion P Stakge WE wen + + oon vably Sle iit LL Hissar clogs | pressure in endotracheal ioe oot Fawear cean gies IH deed suctonng. aL sur | 3 Wear diaile gaves wih a doen suctanng | 4 Using sere annals when appinng sterie | suction | 5 Use suction caelar iT sgl use ony | 6 Uso separate sucion 7 catheter for ET and al | | suctioning 7 Use cispoeabie cup for 1 fusung and cnange every | ® Repiace Varner ube and | | ier ever 2¢ hours [S.Ute of sean suction Leaupment “0, Clean, dieard secretons and disnect canister every shit [Perform oral hygiene with al leleler | cnerwedine mah wat | | Goneeneenesevmunsey [7 Have proper stress T T Dleacng prooivians as i | sesged ont Jett EE jaa L l i t "ae [7 Perform daiy assessmenis | | TTT] | teadnesstoweonana | | | | east le [sve ae ee) a [epee ant embote | songs oidieaies | tw meter hope pa DvTscenen | | STAFF NURSE SIGNATURE OVER PRINTED NAME | respinarony tenarist [SSStenarure oven | Somamennane CHARGE NURSE | | SIGNATURE OVER: PRITNED NAME | | INFECTION | PREVENTION AND | | CONTROLNURSE | { SIGNATURE OVER | PRINTED NAME: L L

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