Rounds

1. Cough etiquette signs are visibly posted

2. Respiratory stations are appropriately stocked (e.g tissue, hand sanitizer, etc).

3. Covid19 signage is posted at the entrances of the facility.

4. Staff are being screened upon entry to the facility for COVID19/upper respiratory symptoms.

5. Patients are being screened upon entry to the facility for COVID19/upper respiratory symptoms.

6. Visitation Restriction signs are visibly posted (if applicable)

7. Did EVS staff provide appropriate environmental cleaning for known or suspected Covid-19 patients.

8. Signs posted at entrances with instructions to individuals seeking medical care with symptoms of respiratory infection to immediately put on a mask and keep it on during their assessment, cover their mouth/nose when coughing or sneezing, use and dispose of tissues, and perform hand hygiene after contact with respiratory secretions?

9. Staff and Patients are following universal masking.

10. Standard Precautions for All Patients are being observed.

11. Admitted PUI/COVID-19+ patients are appropriately isolated in a negative pressure room, or private room with private bathroom and door closed.

12. Transmission Based Precautions Applied Appropriately.

13. Isolation carts appropriately stocked with PPE. Must contain ONLY PPE.

14. Proper selection of PPE is appropriate for the task or transmission-based isolation precautions.

15. PPE is worn appropriately.

16. Donning and Doffing of selected PPE is performed appropriately.

17.a. The following are being used appropriately for COVID-19: Masking.

17.b. The following are being used appropriately for COVID-19: Gowns.

17.c. The following are being used appropriately for COVID-19: Gloves.

17.d. The following are being used appropriately for COVID-19: Eye protection or face shield.

18. Aerosol Generating Procedures (AGP) are performed in negative pressure rooms.

19. Staff knows who to contact to refill PPE supplies.

20. Hand hygiene compliance performed when indicated (even after removal of gloves).

21. Dedicated or disposable medical equipment is available in isolation carts/patient's room/or ante room for contact precautions.

22 a. Hand hygiene supplies are available: Alcohol based hand sanitizer dispensers are filled.

22 b. Hand hygiene supplies are available: Soap dispensers by hand hygiene sinks are filled.

22 c. Hand hygiene supplies are available: Hand sanitizer delivers adequate amount of foam/gel.

22 d. Hand hygiene supplies are available: Hand sanitizer dispenser is operating and has drip plate.

23. Sani-wipes or Clorox wipes are available on each PPE cart or ante room.

24. No eating or drinking in patient care areas.

25. When transporting a patient on droplet/airborne precautions and movement is medically necessary outside of the patient room, the patient wears a face mask.

26. Staff can state the importance of influenza vaccination for HCWs.

27. Staff can state two instances when hand washing with soap and water is preferred to alcohol hand rub.

28. Staff can state transmission-based precautions for COVID-19 PUI/+ patients.

29. EPA registered and hospital approved disinfectants are used for cleaning and disinfection.

Other COVID-19 related notes or observations.

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.