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
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BUNDLE OF CARE| | | | | {
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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
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[7 Perform daiy assessmenis | | TTT]
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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