ABCDEFGHIJKLMNOPQRSTUVWXYZ
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mFORMULIR SURVEILANS HARIAN INFEKSI
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RUMAH SAKIT UMUM DAERAH LAHAT
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4
Bulan/Tahun:Desember 2022
Ruangan:
IGD
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TanggalNamaUmurL/PDiagnosa MedisTanggalTINDAKANInfeksi Rumah SakitDecubAntibiotik (AB)
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MRSKRSIVLUCETTVAPISKPleb
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PasangLepasJumlah HariPasangLepasJumlah HariPasangLepasJumlah Hari
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1/12/22HAWARRY AZZUBAIR1THLSUSP BP + TDBD GR 2 + MORBILI1/12/221/12/22CEFTRIAXONE
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KAMISRAKA NAZA8 BLNLGEAD RS + RFA1/12/221/12/22CEFTRIAXONE
11
INNKO PUTRA MADETA2TH LTDBD GR 1 + TFA + STOMATITIS1/12/221/12/22CEFTRIAXONE
12
AIYGA MARSELLA9THPDEHIDRASI RS EC VOMITUS1/12/221/12/22CEFTRIAXONE
13
ALFINA INAYAH SENAYA4THPKDK+OBS.FEBRIS EC TDBD GR 11/12/221/12/22CEFTRIAXONE
14
QUEENARA VANESA4THPKDS FEBRIS EC TDBD 11/12/221/12/22CEFTRIAXONE
15
HERLINA EDISON 55THPHIPERGLIKEMI DD DM TP 2+HT1/12/221/12/22CEFTRIAXONE
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IIS YUNITA SARI 16THPOBS FEBRIS H4+TDBD GR 11/12/221/12/22CEFTRIAXONE
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ANARIA ROHMIN50THPVT MONOMORPHIC+GEAD RS1/12/221/12/22
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NAJWA AYESA7THPOBS. COLIC ABD EC SUSP APP1/12/221/12/22CEFTRIAXONE
19
QIYAS NATHAN4THPFEBRIS H3 EC AKUT VIRAL INFECTION1/12/221/12/22CEFTRIAXONE
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RIFAT AKBAR8THLTDBD GR 3 + TFA1/12/221/12/22CEFTRIAXONE
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AFDIB PRANAJA10THLACUTE VIRAL INFECTION1/12/221/12/22CEFTRIAXONE
22
KMS EDDY YUSUF65THLOBS DYSPNEA EC SUSP PNEUMONIA1/12/221/12/22CEFTRIAXONE
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FRSYA FRISKI5THPSUSP COVID 19 RS1/12/221/12/22CEFTRIAXONE
24
RASWAN ROHIMIN 64THLHERNIA INGUINALIS DEX INKASERTA1/12/221/12/22
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BEBI SAHIDIN 44THLCAD PRO CABG+DYSPEPSIA LIKE ULCER1/12/221/12/22
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MELATI PASARIBU42THPHHD+HIPOKALEMI+DYSPEPSIA+DM TP 21/12/221/12/22CEFTRIAXONE
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ILHAM NAULI HARHAP22THLTC GCS 13+M.V LASERATUM1/12/221/12/22CEFTRIAXONE
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SITI HURIA62THPOBS DYSPNEA EC CHF+DM+ANEMIA 1/12/221/12/22CEFTRIAXONE
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HANDIKA HUTAMA32THLTC GCS 7-8 + M.V EKSORIATUM1/12/221/12/22CEFTRIAXONE
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NURYETI44THPLBP EC SUSP HNP1/12/221/12/22CEFTRIAXONE
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32
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IVL : Intra vena Line
Decub : Decubitus
Lahat, DESEMBER 2022
34
UC : Urin Chateter
Pleb : PlebitisIPCLN
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ETT : Endo Tracheal Tube
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VAP : Ventilation Associated Pneumonia
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ISK : Infeksi Saluran Kemih
(..............................)
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41
FORMULIR SURVEILANS HARIAN INFEKSI
42
RUMAH SAKIT UMUM DAERAH LAHAT
43
44
Bulan/Tahun:
DESEMBER
Ruangan:
IGD
45
46
TanggalNamaUmurL/PDiagnosa MedisTanggalTINDAKANInfeksi Rumah SakitDecubAntibiotik (AB)
47
MRSKRSIVLUCETTVAPISKPleb
48
PasangLepasJumlah HariPasangLepasJumlah HariPasangLepasJumlah Hari
49
2-12-2022RUDI HARTONO47THLSUSP CVD HEMORAGIC2/12/222/12/22CEFTRIAXONE
50
JUMATAL HAFIZ NUR RIZKY4THLFEBRIS H6 EC TDBD+TFA2/12/222/12/22CEFTRIAXONE
51
ASMAWATI60THPDYSPEPSIA+CHESTPAIN+HT2/12/222/12/22
52
JAMARI80THLHIPOTENSI+DYSPEPSIA+SELULITIS+CKD2/12/222/12/22CEFTRIAXONE
53
JON KENIDI 56THLTB PARU ON THERAPY2/12/222/12/22CEFTRIAXONE
54
ANSORI SANUSIN 66THLOBS DYSPNEA EC TB PARU2/12/222/12/22CEFTRIAXONE
55
WIWIN SANDI SARTIKA42THPSUSP TB PARU2/12/222/12/22CEFTRIAXONE
56
ATHIYA2THPL.B GR2 49%+HIPOKALEMI+HIPONATREMI2/12/222/12/22CEFTRIAXONE
57
AL-AFIF22THLSUSP COVID 19+ANTIGEN POSITIF2/12/222/12/22CEFTRIAXONE
58
SEPTA KURNIAWAN 20THLOBS FEBRIS H5 EC INFEKSI AKUT2/12/222/12/22CEFTRIAXONE
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SUPRAPTO51THLTC GCS 12+ FR COLLUMN FEMUR DEX+CA PARU2/12/222/12/22CEFTRIAXONE
60
SYAFRUDIN SUKIMIN52THLANEMIA EC HEMATOZEA EC CA PARU2/12/222/12/22
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CHARISSA SHAQUEENA6BLNPDISTRESS NAFAS BERAT EC PJB+PNEUMONIA2/12/222/12/22CEFTRIAXONE
62
HARMAN SEMAR59THLSUSP CKD DD NH+HT URGENCY2/12/222/12/22
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ALEA GHANIA5BLNPSUSP BP DD BRONKITIS + OBS FEBRIS H12/12/222/12/22CEFTRIAXONE
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ALEZZA GHANIA5BLNPSUSP BP DD BRONKITIS + OBS FEBRIS H12/12/222/12/22CEFTRIAXONE
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ELAN SETIONO29THLENSELOPATI INFECTION2/12/222/12/22CEFTRIAXONE
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STIVEN NOEL3THLOBS FEBRIS H5 EC VIRAL INFECTION +DBD 12/12/222/12/22CEFTRIAXONE
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AFSHIN BAHIRA2THPDEHIDRASI RS EC MUNTAH PROFUSE2/12/222/12/22CEFTRIAXONE
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NORMIANA MASUDIN36THPGEA+TR. TUMPUL ABDOMEN2/12/222/12/22CEFTRIAXONE
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NARA QUEEN F4THPSUSP COVID 19 GEJALA SEDANG+GEAD RS2/12/222/12/22CEFTRIAXONE
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MATCLE61THLHT+HIPOGLIKEMIA2/12/222/12/22
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ESNI UJANG18THPTC GCS 15+TR. TUMPUL ABDOMEN2/12/222/12/22CEFTRIAXONE
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IVL : Intra vena Line
Decub : Decubitus
Lahat, DESEMBER 2022
74
UC : Urin Chateter
Pleb : PlebitisIPCLN
75
ISK : Infeksi Saluran Kemih
76
ETT : Endo Tracheal Tube
77
VAP : Ventilation Associated Pneumonia
78
ISK : Infeksi Saluran Kemih
(..............................)
79
80
81
FORMULIR SURVEILANS HARIAN INFEKSI
82
RUMAH SAKIT UMUM DAERAH LAHAT
83
84
Bulan/Tahun:
DESEMBER
Ruangan:
IGD
85
86
TanggalNamaUmurL/PDiagnosa MedisTanggalTINDAKANInfeksi Rumah SakitDecubAntibiotik (AB)
87
MRSKRSIVLUCETTVAPISKPleb
88
PasangLepasJumlah HariPasangLepasJumlah HariPasangLepasJumlah Hari
89
SABTURUKIYATUN M. BASRI68THPPENKES EC SUSP CVD H3/12/223/12/223/12/22CEFTRIAXONE
90
3/12/22NAYRA RUMAISHA1.5THPGEAD RS DG GIZI KURANG3/12/223/12/22CEFTRIAXONE
91
FADHILA MAULIDINA23THPINFEKSI VIRAL AKUT DD TDBD GR 23/12/223/12/22CEFTRIAXONE
92
BURDAN74THLSUSP TB PARU DG KASUS BARU+HIPERGLIKEMI3/12/223/12/22CEFTRIAXONE
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KHALIFA HIKARU7BLNPGEAD RS+OBS.FEBRIS H3 EC TDBD GR 13/12/223/12/22CEFTRIAXONE
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HARMIANAH55THPOBS DYSPNEA+HEMIPLEGI SIN. DEXTRA3/12/223/12/22CEFTRIAXONE
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SYAKIRIN SARKUNI17THLPENKES EC PENINGKATAN TIK+HEMATURIA3/12/223/12/223/12/22CEFTRIAXONE
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EC SUSP SN
97
M.SABIL RAYANZA7BLNLFEBRIS H3 EC TDBD+ AKUT VIRAL INFECTION3/12/223/12/22CEFTRIAXONE
98
SHAFFA AQILA K3THPFEBRIS H2 EC AKUT VIRAL INFECTION+ TDBD 13/12/223/12/22CEFTRIAXONE
99
ELIZA MAUREN P12BLNPSUSP COVID 19 GJL SDG DG PNEUMONIA+ KDK3/12/223/12/22CEFTRIAXONE
100
AHMAD ALGHIFARI6THLOBS FEBRIS EC AKUT VIRAL INFECTION3/12/223/12/22CEFTRIAXONE
101
RANDA BAMBANG19THLOBS FEBRIS EC AKUT VIRAL INFECTION DD TDDB3/12/223/12/22CEFTRIAXONE