NICU Daily Worksheet - Missouri Healthcare-Associated Infections

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					                                                                                                      Figure CLAB-4

            Missouri Healthcare-Associated Infection Reporting System (MHIRS)

                                            NICU Daily Worksheet

                                   Month                     Year


           Birthweight           Birthweight           Birthweight           Birthweight           Birthweight
             ≤750 gm.           751-1000 gm.         1001-1500 gm.         1501-2500 gm.            >2500 gm.
        # of patients with    # of patients with    # of patients with    # of patients with    # of patients with
        umbilical catheter/   umbilical catheter/   umbilical catheter/   umbilical catheter/   umbilical catheter/
Date       central line          central line          central line          central line          center line
   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
Total

NOTE: In neonates, the umbilical artery/vein is considered a great vessel. Count one line per patient.

				
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