ACH Infection Control Rounds

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Staff Interiew

• Staff know how to access Infection Prevention Policies

  Yes

  No

  N/A

• Staff know the location of the Exposure Control Plan / Tuberculosis Control Plan

  Yes

  No

  N/A

• Staff are knowledgable about the blood spill protocol and which disinfectant to use, along with the kill time

  Yes

  No

  N/A

• Proper reporting of exposures (report immediately, complete UOR, report to Employee Health, notify supervisor / manager

  Yes

  No

  N/A

• What is done when you identify an empty hand sanitizer dispenser

  Nurse Response

• What is done when you identify a full sharp disposal container

  Nurse Response

• How is linen taken from the clean utility room to the patient's room

  Nurse Response

• How is water taken from the ice/water machine to the patient's room

  Nurse Response

• What items are disposed of in the red biohazard containers

  Nurse Response

• When are refrigerator(s) defrosted/cleaned

  Nurse Response

Department Rounds

• Have an employee demonstrate soap/water hand washing...20 seconds, paper towel to turn of water / open door

  Yes

  No

  N/A

• Have an employee demonstrate the use of alcohol gel before entering/exiting a patient room

  Yes

  No

  N/A

• Handwashing between patients, after patient contact after glove removal, after personal breaks

  Yes

  No

  N/A

• Gloves not worn in the hallway

  Yes

  No

  N/A

• Gurneys are cleaned after use with appropriate disinfectant<br>(ER, SDS, Radiology)

  Yes

  No

  N/A

• Clean linen is covered and maintained in a clean/dry area

  Yes

  No

  N/A

• Disposable blood pressure cuffs not used for routine patient care<br>(exception SDS/OR/PACU)

  Yes

  No

  N/A

• Soiled linen is placed in designated covered hampers

  Yes

  No

  N/A

• Clean utility is separate from dirty utility

  Yes

  No

  N/A

• 18 inches of clearance from ceiling in clean utility room or other clean areas

  Yes

  No

  N/A

• All sterile supplies are dry with intact packaging, not stored on the floor

  Yes

  No

  N/A

• Low storage areas must have solid surface shelving

  Yes

  No

  N/A

• Storage of sterile supplies 8-10" above the floor, 2" away from exterior walls

  Yes

  No

  N/A

• Under sink storage is limited to waste and disinfectants / cleaners

  Yes

  No

  N/A

• Environment and equipment is clean and dust free

  Yes

  No

  N/A

• Crash cart is dust free

  Yes

  No

  N/A

• Crash cart- gloves immediately available

  Yes

  No

  N/A

• Crash Cart- sharps disposal

  Yes

  No

  N/A

• Crash Cart- last date checked documented

  Yes

  No

  N/A

• Crash Cart- Date of last defib strip

  Yes

  No

  N/A

• Crash Cart- date of 1st medication outdate

  Yes

  No

  N/A

• Accucheck monitor docked

  Yes

  No

  N/A

• Accucheck case and machine clean

  Yes

  No

  N/A

• Date last QC done

  Open Date

• open date of high control or expiration date

  Open Date

• open date of low control or expiration date

  Open Date

• date test strips opened

  Open Date

• No eating or drinking in the patient care area

  Yes

  No

  N/A

• Clean equipment is labeled clean / clean tag is removed prior to use

  Yes

  No

  N/A

• Shipping boxes not stored with supplies/ removed from clean areas

  Yes

  No

  N/A

• Soap dispensers are full and functional

  Yes

  No

  N/A

• Purell dispensers are full and functional

  Yes

  No

  N/A

• General appearance of the area is clean and uncluttered

  Yes

  No

  N/A

• Hampers used appropriately- ie. not bags on the floor, no overflowing linen

  Yes

  No

  N/A

• Ceiling tiles are clean and dry

  Yes

  No

  N/A

• Cleaning supplies are labeled and approved for use in the hospital

  Yes

  No

  N/A

• Urine collection bags (Foley) are not touching the ground

  Yes

  No

  N/A

Medication Room

• Refrigerator is labeled as "medication" refrigerator

  Yes

  No

  N/A

• Thermometer present

  Yes

  No

  N/A

• Multi-dose vials approved for multi-patient use

  Yes

  No

  N/A

• Opened vials labeled and dated

  Yes

  No

  N/A

• Expired medications? What? Removed and taken to pharmacy. Given to...

  Yes

  No

  N/A

• Safety devices are used for all injections, phelbotomy, venipuncture, & IV therapy. Exceptions to safety devices...

  Yes

  No

  N/A

• Sharps containers are accessible, secured to wall/counter and emptied when reach "full" line

  Yes

  No

  N/A

• Sterile irrigation fluid is opened for same day use only (<24hr). Date noted.

  Yes

  No

  N/A

• Other irrigation / prep fluids labeled and dated

  Yes

  No

  N/A

• Glass is disposed of in rigid sharps containers

  Yes

  No

  N/A

• Single use medication vials discarded

  Yes

  No

  N/A

• IV tubing labeled with date

  Yes

  No

  N/A

Patient Room

• Inspect patient rooms and bathrooms for inappropriate supplies or outdated supplies

  Yes

  No

  N/A

• Gloves boxes filled

  Yes

  No

  N/A

• Sharps container less than 3/4 full

  Yes

  No

  N/A

• Hand sanitizer at least 1/2 full

  Yes

  No

  N/A

• Soap at least 1/2 full

  Yes

  No

  N/A

• Garbage can with liner

  Yes

  No

  N/A

• No soiled linen on the floor

  Yes

  No

  N/A

• If bed is unmade- mattress intact?

  Yes

  No

  N/A

Isolation Room / Cart

• CDC isolation guidelines are available on isolation carts or other designated area in the department

  Yes

  No

  N/A

• Cart present

  Yes

  No

  N/A

• Correct sign on door

  Yes

  No

  N/A

• Adequate amount of supplies available

  Yes

  No

  N/A

• Only isolation supplies in the drawers

  Yes

  No

  N/A

• Hand sanitizer available and full

  Yes

  No

  N/A

• Wastebasket inside doorway

  Yes

  No

  N/A

• PPE worn correctly

  Yes

  No

  N/A

• Removed prior to leaving patient room

  Yes

  No

  N/A

• If negative pressure- PAPR hood utilized

  Yes

  No

  N/A

• If negative pressure- check logbook in maintenance- when on pressure to be checked/documented every shift by engineer

  Yes

  No

  N/A

• Equipment used in the isolation room is wiped down after use, before taking into another patients room<br>(dynamaps, thermometers, computers, stethoscope, etc.)

  Yes

  No

  N/A

Refrigerators- staff and patient

• Staff refrigerator is labeled "STAFF"

  Yes

  No

  N/A

• Thermometer present

  Yes

  No

  N/A

• Temperatures logged every day prior to today's date: dates temperatures not checked

  Yes

  No

  N/A

• Staff food/ containers identified

  Yes

  No

  N/A

• Open condiments labelled with staff's name and open date

  Yes

  No

  N/A

• Patient refrigerator is labled "PATIENT"

  Yes

  No

  N/A

• Thermometer present

  Yes

  No

  N/A

• Temperatures logged every day prior to today's date; dates temperatures not checked

  Yes

  No

  N/A

• Clean

  Yes

  No

  N/A

• No expired food

  Yes

  No

  N/A

• If applicable patient's food identified with name and bed #

  Yes

  No

  N/A

Clean Utility Room

• Clean items only

  Yes

  No

  N/A

• No medical supplies on floor

  Yes

  No

  N/A

• No medical supplies left in original shipping container

  Yes

  No

  N/A

• Nothing stored under the sinks

  Yes

  No

  N/A

• Check for outdated supplies

  Yes

  No

  N/A

• Door closed

  Yes

  No

  N/A

Dirty Utility Room

• Dirty items only

  Yes

  No

  N/A

• Door closed on soiled utility room

  Yes

  No

  N/A

• No storage of drinking cups, tissues, paper towels, toilet tissue

  Yes

  No

  N/A

• No hoses touching in floor drains

  Yes

  No

  N/A

• PPE available

  Yes

  No

  N/A