Title Page

  • Beach Road Surgery & Skin Clinic

  • Conducted on

  • Prepared by

Untitled Page

Beach Road Surgery and Skin Clinic

Sterilisation and Cleaning of Equipment

  • Signage is visible

  • Record book is up to date

  • Vaccum test is completed weekly

  • Lead pencil test is completed weekly

  • Packing equipment is kept in cupboard

  • All successful sterilisation is documented

  • Equipment is signed and dated

  • Used equipment is logged in Dr's diary

  • Microfibre cloths are kept clean

  • Benches are kept clean and wiped down prior use

  • Clean/dirty areas are clearly labelled e.g. sink

  • All equipment is packed properly

  • PPE is used and available

  • Silver dishes are clean correctly after use

  • Disinfectant is available and kept up to stock

Employee Hand Hygiene Compliance

  • Employees Monitored

Hand Hygiene

  • Sinks for hand hygiene are well stocked?

  • Sinks are available in all areas as needed?

  • Alcohol hand rubs are well stocked?

  • Alcohol hand rubs are available in patient's rooms?

  • Placement of alcohol hand rubs is compliant with safety?

  • Hand washing/hand hygiene is performed between patients?

  • Hand Hygiene reminder posters present?

  • Sink storage area empty and clean?

  • Thrash cans or waste basket are not overfilled or overflowing?

  • Ceiling tiles are not stained or wet?

  • Floors are clean?

  • Supplies are stored at least 6 inches off of the floor?

  • Air intake vents and diffusers are clean?

  • Is this section free of additional findings?

Practice Rooms

  • Clean Utility / Central Supply / Storage

  • Horizontal surfaces are clean?

  • Thrash cans or waste basket are not overfilled or overflowing?

  • Hand hygiene products are available?

  • Soap and paper towels are available in each room?

  • PPE's are available as needed?

  • Patient equipment is clean?

  • No visible soil on vertical surfaces?

  • Ceiling tiles are not discolored, wet, missing, or damaged?

  • Air intake vents and diffusers are clean?

  • Furniture are without tears or wear?

  • Beds are cleaned and covered with disposable protectors?

  • Floors are clean?

  • Sharp containers are no more than 3/4 full?

  • Dust not found in high places?

  • General area is dust free?

  • There is no evidence of pest present?

  • No needles, syringes, medications within reach of the patient?

  • No signs of mildew or mold present?

  • Is this section free of additional findings?

Employee Kitchen / Breakroom

  • Floors and walls clean?

  • Horizontal and vertical surfaces are clean?

  • Microwave oven clean?

  • Refrigerator clean and thawed of ice?

  • Under sink clean and without storage?

  • Employee food labeled and dated?

  • Is this section free of additional findings?

Nurse's Room

  • Unit/area generally clean (without dust, clutter or debris)?

  • Medication, specimens, and vaccinations are handled appropriately?

  • Biohazard trash is segregated from regular trash?

  • Needles and syringes are disposed of properly?

  • Out of date supplies are not present?

  • Infectious waste in red bag or container?

  • Clean items are not stored in soiled utility room?

  • Ceiling tiles are not discolored/ wet/ missing / damaged?

  • Nothing is stored under the sink and there is no sign of leaks?

  • Halls are uncluttered?

  • Respiratory hygiene available?

  • Trash basket are not overflowing?

  • No personal lotion use

  • There are no expired products found

  • Is this section free of additional findings?

  • Monthly checks are completed and recorded

  • Defibrillator checked monthly

  • Temperature checked BID for vaccine / medication storage?

  • Daily refrigerators checks with corrective actions as needed?

  • Glucose meter strips dated

  • Is this section free of additional findings

Employee General Knowledge

  • Employees know the procedure for blood exposure?

  • Personnel can locate their Infection Control Manual?

  • Personnel can locate their Exposure Control Plan?

  • Personnel can locate the spill kit?

  • Employees can state the WHO's 5 moments of Hand Hygiene

  • Dust not found in high places?

  • Is this section free of additional findings?

Bathroom

  • Toilet/Sink clean?

  • clean and orderly?

  • Signage up and visible

  • Hand sanitizer/soap is available

  • Paper towel is available

  • Walls and floor are clean?

  • Ceiling tiles are not discolored/ wet/ missing / damaged?

  • Dust not found in high places?

  • Is this section free of additional findings?

General Areas

  • Cleaning is attended to daily and documented on checklist

  • Furniture has no wear and tear, is clean

  • Cleaners attend to surgery when required

  • Dehumifier is working and maintained

  • Sanitizers are available for clients when entering practice

  • Face masks are worn in areas

  • Signage is up and visible for infection control

Completion

  • Additional Comments

  • Surveyor's Name and Signature shontae giles

  • 10.10.2022 12:18 AEDT

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