Sample Form for Documentation of Wound Infections

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Whenever there is a wound infection at Lakeland (Fla.) Surgical & Diagnostic Center, the ASC conducts a thorough investigation of the incident and documents numerous pieces of information about the incident, treatment and patient characteristics.


Other pieces of information gathered include staff members involved in the case; whether implants were used and, if so, their type, lot number, serial number and expiration date; whether instruments used in the case were flash sterilized; and type of skin preparation used.


To download a sample copy of Lakeland's form used for investigation of wound infections you can adapt for use in your ASC, click here (doc).


Learn more about Lakeland Surgical & Diagnostic Center.


Download other sample forms for adaptation and use in your ASC:


- Sample OR/Procedure Room Cleaning Checklist


- Sample General Area Cleaning Checklist


- Sample Incomplete Biological Result Form

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