Non substantial changes made to form 57.75Z (Engineering Controls)

NHSN HCPSC Implementation of Engineering Controls OMB version - Form 30 01-09-06.ppt

The National Healthcare Safety Network (NHSN)

Non substantial changes made to form 57.75Z (Engineering Controls)

OMB: 0920-0666

Document [ppt]
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  1. Device Type

  1. Your Code

  1. Safety Feature

  1. Manufacturer and Model

  1. Device Implementation

  1. Device Discontinuation

  1. Qtr

  1. Yr

  1. Scope of Use

  1. Qtr

  1. Yr

  1. Reason

  1. Arterial blood collection device

         
         
         

  1. Hypodermic needle attached to syringe

         
         
         

  1. Unattached hypodermic needle

         
         
         

  1. Prefilled cartridge syringe needle

         
         
         

  1. IV-delivery system

         
         
         

  1. IV catheter - peripheral

         
         
         

  1. IV catheter – central line

         
         
         

  1. Huber needle

         
         
         

 

  1. Device Type

  1. Your Code

  1. Safety Feature

  1. Manufacturer and Model

  1. Device Implementation

  1. Device Discontinuation

  1. Qtr

  1. Yr

  1. Scope of Use

  1. Qtr

  1. Yr

  1. Reason

  1. Winged-steel (Butterfly™-type) needle

         
         
         

  1. Vacuum tube collection holder with needle

         
         
         

  1. Blood culture adapter

         
         
         

  1. Lancet

         
         
         

  1. Hemodialysis needle

         
         
         

  1. Dental aspirating syringe/needle

         
         
         

  1. Suture needle

         
         
         

  1. Scalpel

         
         
         

  1. Capillary tubes

         
         
         

  1. Blood collection tubes

         
         
         

 

  1. Device Type

  1. Your Code

  1. Safety Feature

  1. Manufacturer and Model

  1. Device Implementation

  1. Device Discontinuation

  1. Qtr

  1. Yr

  1. Scope of Use

  1. Qtr

  1. Yr

  1. Reason

  1. Catheter securement device

         
         
         

 
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