Information
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Department(s)
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Conducted on
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Prepared by
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Personnel Involved
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Staff (including contract & physicians) follow CDC hand hygiene guidelines when entering and exiting room?
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Staff (including contract & physicians) follow posted isolation signs?
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Sharp boxes are no more than 3/4 full?
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Patient rooms are clean, organized and free of clutter (especially tubing)?
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Soiled linen is not placed on floor?
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Visitors and patients follow posted isolation signs?
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All necessary PPE is accessible and orderly?
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Disposable equipment (I.e. stethoscopes, blood pressure cuffs) are used in contact isolation rooms?
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Bottom storage shelves have 6" clearance for cleaning?
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Linen carts are covered and in good repair?
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Linens are not "hoarded" in any rooms?
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Nothing stored on top of linen carts?
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Pantry is clean and items stored properly (ice machine, drawers, cupboards)?
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There is no eating/drinking in patient care or public areas by staff?
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Additional Comments
