Staff Interiew

Staff know how to access Infection Prevention Policies

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

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

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

What is done when you identify an empty hand sanitizer dispenser

What is done when you identify a full sharp disposal container

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

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

What items are disposed of in the red biohazard containers

When are refrigerator(s) defrosted/cleaned

Department Rounds

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

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

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

Gloves not worn in the hallway

Gurneys are cleaned after use with appropriate disinfectant
(ER, SDS, Radiology)

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

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

Soiled linen is placed in designated covered hampers

Clean utility is separate from dirty utility

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

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

Low storage areas must have solid surface shelving

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

Under sink storage is limited to waste and disinfectants / cleaners

Environment and equipment is clean and dust free

Crash cart is dust free

Crash cart- gloves immediately available

Crash Cart- sharps disposal

Crash Cart- last date checked documented

Crash Cart- Date of last defib strip

Crash Cart- date of 1st medication outdate

Accucheck monitor docked

Accucheck case and machine clean

Date last QC done

open date of high control or expiration date

open date of low control or expiration date

date test strips opened

No eating or drinking in the patient care area

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

Shipping boxes not stored with supplies/ removed from clean areas

Soap dispensers are full and functional

Purell dispensers are full and functional

General appearance of the area is clean and uncluttered

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

Ceiling tiles are clean and dry

Cleaning supplies are labeled and approved for use in the hospital

Urine collection bags (Foley) are not touching the ground

Medication Room

Refrigerator is labeled as "medication" refrigerator

Thermometer present

Multi-dose vials approved for multi-patient use

Opened vials labeled and dated

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

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

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

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

Other irrigation / prep fluids labeled and dated

Glass is disposed of in rigid sharps containers

Single use medication vials discarded

IV tubing labeled with date

Patient Room

Inspect patient rooms and bathrooms for inappropriate supplies or outdated supplies

Gloves boxes filled

Sharps container less than 3/4 full

Hand sanitizer at least 1/2 full

Soap at least 1/2 full

Garbage can with liner

No soiled linen on the floor

If bed is unmade- mattress intact?

Isolation Room / Cart

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

Cart present

Correct sign on door

Adequate amount of supplies available

Only isolation supplies in the drawers

Hand sanitizer available and full

Wastebasket inside doorway

PPE worn correctly

Removed prior to leaving patient room

If negative pressure- PAPR hood utilized

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

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

Refrigerators- staff and patient

Staff refrigerator is labeled "STAFF"

Thermometer present

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

Staff food/ containers identified

Open condiments labelled with staff's name and open date

Patient refrigerator is labled "PATIENT"

Thermometer present

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


No expired food

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

Clean Utility Room

Clean items only

No medical supplies on floor

No medical supplies left in original shipping container

Nothing stored under the sinks

Check for outdated supplies

Door closed

Dirty Utility Room

Dirty items only

Door closed on soiled utility room

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

No hoses touching in floor drains

PPE available

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.