Suggested format for documenting significant BSI for later analyses. Sub documents with key definitions will be provided soon. Print this sheet onto a single A4 page and maintain a records folder. Include documentation of the clinical liaison process as below. Definitions for significance will be discussed in a future posting.
Significant BSI Event Sheet
| Patient medical record number | |
| Patient name | |
| Age or DOB | |
| Sex | |
| Date first positive culture | |
| Lab number | |
| Organism 1 species | |
| Organism 2 species | |
| Organism 3 species | |
| Antibiotic susceptibility
|
MSSA MRSA
Other
|
| Healthcare-associated infection status (circle) | HCA-inpatient HCA-noninpatient Community |
| Principle clinical manifestation
(select from this list) |
|
| IV device associated with event | N/A Periph IV Central IV |
| Service | Med Surg Paed O&G ICU Neonatal ED |
| Comments
|
|
| Isolate(s) storage coordinate | Box number: Coordinate: |
| Record of clinical liaison calls (dates, person called, contact details and summary of recommendations |
Microbiology and Infectious Diseases postgraduate teaching (PRIDA) 