Example template for documenting significant bloodstream infections

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
Date first positive culture
Lab number
Organism 1 species
Organism 2 species
Organism 3 species
Antibiotic susceptibility





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





Isolate(s) storage coordinate Box number:                     Coordinate:
Record of clinical liaison calls (dates, person called, contact details and summary of recommendations

About mdjkf

Microbiologist and Infectious Diseases Physician
This entry was posted in Quality management, Statistics and tagged . Bookmark the permalink.

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