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SENSUS HARIAN PERAWATAN HAND RUB DI RUANG/INSTALASI ............................................ No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED C ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED C ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED C ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED C ISI ED ISI ED ISI ISI 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 Keterangan 1. Berikan Tanda ceklist ( V ) pada kolom ISI sesuai ruang dan tanggal pengisian cairan hand rub dan tanggal 7,14,21,28 Bukti pengecekan hands rub berkala/minggu 2. Berikan Tanggal ED sesaat setelah mengisi hand rub yaitu 1 bulan setelah pengisian 3. Lembar ini di fotocopi 2 lembar, 1 lembar untuk IPCN dan 1 Lembar untuk data Tim PPI di ruangan sebagai alat bantu mengecek hand rub yang harus di ganti pada bulan berikutnya. 4. Lembar ini dikumpulkan setiap akhir bulan ke IPCN LOKASI HAND RUB 5. kolom Tanda "C" yang diberi garis warna berbeda berarti tanggal dimana petugas harus mengecek setiap minggu apakah cairannya kosong atau masih isi.

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Page 1: Sesnsus Hand Rub New

SENSUS HARIAN PERAWATAN HAND RUB DI RUANG/INSTALASI ............................................

No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED C ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED C ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED C ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED ISI ED C ISI ED ISI ED ISI ISI

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Keterangan : 1. Berikan Tanda ceklist ( V ) pada kolom ISI sesuai ruang dan tanggal pengisian cairan hand rub dan tanggal 7,14,21,28 Bukti pengecekan hands rub berkala/minggu

2. Berikan Tanggal ED sesaat setelah mengisi hand rub yaitu 1 bulan setelah pengisian

3. Lembar ini di fotocopi 2 lembar, 1 lembar untuk IPCN dan 1 Lembar untuk data Tim PPI di ruangan sebagai alat bantu mengecek hand rub yang harus di ganti pada bulan berikutnya.

4. Lembar ini dikumpulkan setiap akhir bulan ke IPCN

LOKASI HAND RUB

5. kolom Tanda "C" yang diberi garis warna berbeda berarti tanggal dimana petugas harus mengecek setiap minggu apakah cairannya kosong atau masih isi.

Page 2: Sesnsus Hand Rub New

Mengetahui, Wonogiri , 2015

Kepala Ruang....................................... Tim PPI Ruang ................

..................................... ..............................................


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