Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • OR Personnel: Surgeon: Assistant: Anesthesia:

  • Time out completed according to policy?

  • Abx timing addressed with Surgeon?

Surgical Scrub

  • Scrub is performed according to manufacturer's directions and aseptic technique.

  • Scrubbing personnel do not contaminate themselves (or are not contaminated by others) while growing and gloving.

Surgical Attire (every person)

  • Top is secured or close to body.

  • All hair is covered. Cloth hair covers are covered by disposable hair cover.

  • Mask is worn securely in the presence of the sterile field. Masks are not reused.

Surgical Prep of the Patient

  • Hair is removed outside of the OR using clippers.

  • Skin prep is performed according to the manufacturer's directions and aseptic technique.

  • Prep agent:

  • Sufficient dry time is allowed prior to draping without puddling of prep agent.

Sterile Technique

  • Draping is accomplished in a sterile manner with: Hands are cuffed while presenting drapes to unsterile personnel; anesthesia screen is not dropped prior to placement; drapes are not lifted or moved after placement .

  • Sterile field is prepared close to the time of surgery.

  • Sterilized items are transported in covered or enclosed carts.

  • Sterile field is maintained throughout procedure, traffic pattern 1foot perimeter is respected.

  • Sterile persons do not turn their backs to the field or sterile supplies.

  • Sterile items are presented in a manner in which not to contaminate the field to scrubbed person or placed securely in field.

  • Liquids are poured once, without splashing, and remainder discarded.

  • Items are not flashed (IUS). If performed should only be due to emergency, closed container is used to transport yo sterile field and MD is made aware of BI result.

  • Used instruments are placed into pre-enzymatic cleaner, covered. Are covered for transport to CSR.

Traffic

  • Traffic in and out of room is limited to essential personnel/tasks.

  • Traffic pattern avoids the sterile field.

Environmental Cleaning

  • Soiled instruments are removed from room in covered containers, marked as soiled.

  • Horizontal surfaces are free of dust and debris.

  • After procedure, reusable items are cleaned (such as straps).

  • After procedure, visibly soiled areas of the floor (3-4 foot perimeter around bed) is mopped.

Other:

Action Plan

  • Action plan due to Infection Control by: Action plan as decided by department Director and/or designee:

  • Infection Control Practitioner

  • OR Director or Designee

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