MAXWELL SUPER MULTI SPECIALITY HOSPITAL PVT. LTD.

(PSQ Data from ICN) Month………………..Year…………. Area/Dept………

1. RATE OF UTI = Total number of CAUTI

X 1000
Total number of catheter days

2. RATE OF SSI = Total number of SSI

X 100
Total number of surgeries

3. RATE OF VAP = Total number of VAP

X 1000
Total number of ventilator days

4. RATE OF CLABSI = Total number of CLABSI X 1000

Total number of central line days

5. RATE OF PHLEBITIS = Total number of phlebitis

X 100
Total number of cannulization
6. RATE OF NSI = Total number of NSI
X 100
Total In patient days in a month

7. RATE OF BED SORE AFTER ADMISSION = Total number of bed sore X 1000
No. of in-patient days
8. Incidence of blood & body fluid exposure = No. blood & body fluid exposure
X 1000
No. of in-patient days
9. Compliance to hand hygiene practice =
No. of observations in which staff complied with hand hygiene
X 100
Total number of observations made

10. Re – Intubation Rate = Total no. of re intubations within 48 hours of ex-tubation X 100
Total number of ex-tubation

Date: …………………. Date: ………………….

ICO name……………………………. ICN Name…………………………….

ICO Signature………………………… ICN Signature…………………………