Get Nosocomial Infection Report Form Appendix A Final June 152012

The Nosocomial Infection Report Form serves as a vital tool for documenting and reporting healthcare-associated infections. This guide will provide you with clear, step-by-step instructions for filling out the form accurately online.

Follow the steps to complete the Nosocomial Infection Report Form effectively.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Enter the date when the infection was noted in the designated field.
3. Identify the infection site by selecting one of the options listed under the Infection Site section, such as 'Respiratory Tract Infection' or 'Urinary Tract Infection'. Make sure to check all applicable subcategories.
4. Complete the Predisposing Factors section by marking any relevant factors, including 'Indwelling Urinary Catheter' or 'Immunocompromised state'. If none apply, select 'None'.
5. In the Laboratory Data section, indicate whether a specimen was taken by selecting 'Yes' or 'No'. If yes, please provide the date taken and results in the specified fields.
6. Proceed to the Treatment section and indicate whether antimicrobial treatment was administered. If 'Yes', specify the type and duration.
7. Add any additional comments in the designated area to provide context or necessary clarifications.
8. In the final section, indicate if the infection does not meet the definition and, if applicable, specify the purpose of any prophylactic antimicrobial given.
9. Finally, fill in your name and the date when you complete the form to ensure accountability.
10. Once all fields have been completed, you can save, download, print, or share the form according to your needs.

Ensure you complete and submit your form online to contribute to effective infection monitoring.