Observations

Hand Hygiene

Alcohol based hand rub (ABHR) available

Soap and water available

Staff know when the use Soap versus ABHR

Performed before patient contact

Performed after patient contact

Other:

Transmission Based Precautions

Gloves readily available

Gowns readily available

Masks readily available

Eye protection available

Appropriate use of PPE demonstrated

Don PPE appropriately

Doff PPE appropriately

Universal masking

Respiratory etiquette signage in place

Standard precautions observed for all patients

Appropriate precautions implemented for indicated precautions (.e. enteric, neutropenic, airborne, droplet, etc.)

Process for potential/confirmed respiratory infectious disease

Staff can state what to do for accidental exposure to transmissible pathogens

Other:

Environment

Patient care surfaces disinfected between patients

Appropriate surface disinfectants are used

Wet times appropriate for disinfectant

Patient care area free of dust accumulation

Care areas free of clutter

Air vents free of dust accumulation

Clean rooms positively pressured

Soiled rooms negatively pressured

Aerosolizing procedures conducted in negative pressure room

Biohazardous waste is managed appropriately

Pharmaceutical waste is managed appropriately

Sharps disposal management appropriately

Battery disposal managed appropriately

Hazardous materials are managed appropriately

Mainstream trash is managed appropriately

Clean linens are covered

Biomedical Equipment has a current Preventive Maintenance (PM) Sticker date

Equipment is clean (free of dust and debris)

Other:

Point of Care Testing

There should be no evidence of grime, dirt, adhesive marks, or blood left on the device, case or supplies

Devices and cases are cleaned after every use

Reagents dated per manufacturer's instructions for use

Other:

Procedure Rooms / Instruments

Appropriately "restricted" or "semirestricted"

Traffic controlled during procedures

Temperature and humidity monitored & documented

Surgical attire, if required, managed appropriately

Appropriately turnedover between patients

Terminally cleaned/logged

Positively pressured (unless bronchoscopy or other aerosolizing procedure)

Instruments for reprocessing rinsed at point of use

Instruments for reprocessing kept moist with enzymatic spray until transported to SPD

Instruments for reprocessing transported in rigid, covered biohazardous labelled container

Sharps discarded prior to transport

Other:

HighLevel Disinfection

Instruments for HLD are processed initially at point of use

Instruments are transported for HLD appropriately

HLD quality controls are documented for the sterilants used

HLD lot numbers and indicators are documented (logged) as applicable

Bidirectional traceability documentation is present as applicable

After HLD, instruments are stored in a manner that protects their disinfection

Other:

Clean Storage

Temperature and humidity monitored & documented

Room is positively pressured

Pouched sterilized instruments are stored appropriately

Processed scopes (TEEs) are stored appropriately; and storage cabinet is free of dust and debris

Only clean items/equipment are stored in this area

The room is free of dust, dirt, grime, etc

Scopes are labeled with process date. Per hospital procedure, are reprocessed at least every 14 days

No expired supplies

Other:

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.