Audit

Summary of Survey
Number of deficiencies found during this Inspection:
Score - Total Survey Score %
Employee Hand Hygiene Compliance

Employees Monitored

1.0 Hand Hygiene

1.3. Soap and water is available in all patient care areas?

1.4. Alcohol hand rubs are available in all patient care areas?

1.5. alcohol hand rub is installed as required?

1.6. Hand hygiene is performed after removing gloves ?

1.8. Hand hygiene is performed before direct patient contact?

1.7 Hand hygiene is performed after direct patient contact?

Hand hygiene performed after contact with blood, body fluids, or contaminated surfaces (even if gloves were worn)?

Hand hygiene performed before performing invasive procedures e.g. IV placement?

Staff remove gloves before moving to the next task or patient

Staff wear gloves for procedures that might involve contact with blood or body fluids?

Staff wear gloves when handling potentially contaminated patient equipment?

2.0. Injection Practices

2.1. Needles are used for only one patient?

2.2. Syringes are used for only one patient?

2.3. The rubber septum on medication vial is disinfected with alcohol prior to piercing?

2.4. Medication vials are always entered with a new needle?

2.5. Medications that are pre-drawn are labeled with the date and time of draw, initials of the person drawing, medication name, strength and discard date and time?

2.6. Single dose (single use) medication vials are used for only one patient?

2.7. Manufactured prefilled syringes are used for only one patient?

2.8. Bags of IV solution are used for only one patient?

2.9 Medication administration tubing and connectors are used for only one patient?

Multi-dose injectable medications are used for only one patient?

Multi-dose vials are dated when they are first opened and discarded within 28 days?

Multi-dose medication used for more than one patient are stored and accessed away from the immediate area where direct patient contact occurs?

All sharps are disposed of in puncture resistant sharps container?

Sharps containers are replaced when the fill line is reached?

3.0 Single use devices, sterilization, HDL

3.1. if single use devices are reprocessed, they are devices approved by the FDA for reprocessing?

3.2 If single use devices are reprocessed, they are reprocessed by an FDA approved reprocessor?

3.3. Critical equipment is sterilized?

3.4. Are sterilization procedures performed on site?

3.5. Items are pre-cleaned according to manufacturer's instructions or evidence based guidelines prior to sterilization?

3.6. Medical devices and instruments are visually inspected for residual soil and re-cleaned as needed before packaging and sterilization.

3.7. a chemical indicator is placed in each load.

3.8. A biological indicator is performed at least weekly and with all implantable loads.

3.9. Each load is monitored with mechanical indicators (e.g. time, temperature, pressure)

3.10. Documentation for each piece of sterilization equipment is maintained and up to date and includes results from each load.

3.11. Items are appropriately contained and handled during the sterilization process to assure sterility is not compromised prior to use.

3.12. After sterilization, medical devices and instruments are stored in a designated clean area so sterility is not compromised.

3.13. Sterile packages are inspected for integrity and compromised packages are reprocessed.

3.14. Semi critical equipment is high-level disinfected or sterilized.

3.15. Items are pre-cleaned according to manufacturer's instructions or evidence-based guidelines to high-level disinfection.

3.16. High-level disinfection equipment is maintained according to manufacturer's instructions.

3.17. Chemicals used for HDL are prepared according to manufacturer's instructions.

3.18. chemicals used for HDL are tested for appropriate concentration according to manufacturer's instructions.

3.19. Chemicals used for HDL are documented to have been prepared and replaced according to manufacturer's instructions.

3.20. Instruments requiring HDL are disinfected for the appropriate length of time as specified by manufacturer's instructions or evidence based guidelines.

3.21. Instruments requiring HDL are disinfected at the appropriate temperature according to manufacturer's instructions or evidence based guidelines.

3.22. Items that undergo HLD are allowed to dry before use.

3.23 Following HDL, items are stored in a designated clean area in a manner to prevent contamination.

4.0 Environmental Infection Control.

4.1. Operating Rooms are cleaned and disinfected after each surgical or invasive procedure with EPA registered disinfectant.

4.2. Operating rooms are terminally cleaned daily.

4.3. High touch surfaces in patient care areas are cleaned and disinfected with an EPA registered disinfectant.

4.4. The ASC has a procedure in place to decontaminate gross spills of blood.

5.0. Point of care devices (e.g. blood glucose monitor)

5.1. A new single-use, auto disabling lancing device is used for each patient.

Additional Comments

Additional Comments

Surveyor's Signature
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.