某人民醫(yī)院感染管理質(zhì)量手冊

1、0目 錄臨床科室醫(yī)院感染管理小組職責(zé)······················1醫(yī)院感染管理監(jiān)控醫(yī)師職責(zé)·········

2、83;············1醫(yī)院感染管理監(jiān)控護(hù)士職責(zé)····················2醫(yī)務(wù)人員在醫(yī)院感染管理

3、中的職責(zé)·············3本科室醫(yī)院感染管理小組成員··················3本科室風(fēng)險因素評估·

4、···························4科室醫(yī)院感染管理小組年度工作計劃·······

5、;······51 月份醫(yī)院感染管理質(zhì)量持續(xù)改進(jìn)記錄·············62 月份醫(yī)院感染管理質(zhì)量持續(xù)改進(jìn)記錄···········&

6、#183;·73 月份醫(yī)院感染管理質(zhì)量持續(xù)改進(jìn)記錄·············8一季度醫(yī)院感染管理小組質(zhì)控會議記錄·············9一季度醫(yī)院感染管理小組活動記錄

7、·············9一季度醫(yī)院感染管理知識培訓(xùn)記錄···············10一季度醫(yī)院感染病例登記表···

8、3;················11一季度監(jiān)測登記表··················

9、3;·············13一季度抗菌藥物使用登記表····················14一季度消

10、毒設(shè)備檢測記錄······················15一季度職業(yè)暴露登記表···········

11、83;··············16一季度手衛(wèi)生管理質(zhì)量持續(xù)改進(jìn)小結(jié)·················17一季度醫(yī)院感染管理質(zhì)量

12、持續(xù)改進(jìn)小結(jié)···············184 月份醫(yī)院感染管理質(zhì)量持續(xù)改進(jìn)記錄·············192三季度醫(yī)院感染管理質(zhì)量持續(xù)改進(jìn)小結(jié)·

13、··············4410 月份醫(yī)院感染管理質(zhì)量持續(xù)改進(jìn)記錄·············4511 月份醫(yī)院感染管理質(zhì)量持續(xù)改進(jìn)記錄··

14、3;··········4612 月份醫(yī)院感染管理質(zhì)量持續(xù)改進(jìn)記錄·············47四季度醫(yī)院感染管理小組活動記錄·······

15、············48四季度醫(yī)院感染管理知識培訓(xùn)記錄···············49四季度醫(yī)院感染病例登記表····

16、83;·················50四季度監(jiān)測登記表·················

17、83;·············52四季度抗菌藥物使用登記表·····················

18、;··53四季度消毒設(shè)備監(jiān)測記錄···························54四季度職業(yè)暴露登記表···&#

19、183;······················55四季度手衛(wèi)生管理質(zhì)量持續(xù)改進(jìn)小結(jié)···········

20、······56四季度醫(yī)院感染管理質(zhì)量持續(xù)改進(jìn)小結(jié)···············572015 年上半年紫外燈管檢測記錄·········&#

21、183;···········582015 年下半年紫外燈管檢測記錄···············58本年度醫(yī)院感染病例匯總表····

22、83;···················59多重耐藥菌感染病例登記表···············

23、;··········59醫(yī)院感染管理小組年度工作總結(jié)·····················60臨床科室醫(yī)院感染管理小組職責(zé)一