CMHS Operating Room Infection Prevention Tool

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

Surgical Attire

• Staff changed into scrubs at the hospital

  Yes

  No

  N/A

• Top is secured at waist, tucked in or close to body

  Yes

  No

  N/A

• All hair is covered

  Yes

  No

  N/A

• No visible jewelry worn by scrubbed and non-scrubbed staff

  Yes

  No

  N/A

• Mask is worn by (secured with both ties) in the presence of open sterile items and equipment

  Yes

  No

  N/A

• Cover gowns/jackets are worn and secured to prevent inadvertent contamination while walking past sterile field

  Yes

  No

  N/A

• Dedicated shoes or shoe covers are worn

  Yes

  No

  N/A

Sterile Technique

• Sterile field is prepared close to time of surgery

  Safe

  At Risk

  N/A

• Sterile items are transported in covered or enclosed cases/carts

  Yes

  No

  N/A

• Sterile packages are inspected for punctures, tears, and expiration dates

  Yes

  No

  N/A

• Sterile field is maintained troughout the procedure with traffic patterns established with a minimum of one foot perimeter respected by the unsterile personnel

  Yes

  No

  N/A

• Sterile items are presented to scrubbed person or placed securely on field

  Yes

  No

  N/A

• Liquids are poured only once, without splashing, and the remainder is discarded

  Yes

  No

  N/A

• Draping is accomplished in a sterile manner:<br> * Draping is performed by a minimum of two people<br> * Hands are "cuffed" while presenting drapes to unsterile personnel<br> * Anesthesia screen is not dropped prior to placement<br> * Drapes are not lifted or moved after placement

  Yes

  No

  N/A

• Items are flashed sterilized only in an emergency situation and a closed container is used or transport to the sterile field

  Yes

  No

  N/A

Surgical Hand Scrub

• Scrub is performed according to manufacturer's directions and aseptic technique

  Yes

  No

  N/A

• Scrubbed personnel do not contaminate themselves while gowning and gloving

  Yes

  No

  N/A

Time Out

• Observe Universal Protocol "Time Out"

  Yes

  No

  N/A

• Site marked prior to entry into OR suite (in pre-op holding area)

  Yes

  No

  N/A

• Chart review- H&P reviewed - completed within 30 days, update completed if H&P is over 24 hours old.

  Yes

  No

  N/A

• Circulator checks patient's ID bracelet- patient identificiation prior to incision/ invasive procedure

  Yes

  No

  N/A

• Circulator calls "TIME OUT"

  Yes

  No

  N/A

• Circulator states the correct site

  Yes

  No

  N/A

• Circulator reads aloud the surgical procedure to be done

  Yes

  No

  N/A

Skin Prep

• Hair is removed using clippers

  Yes

  No

  N/A

• Skin prep is performed according to manufacturer's directions and aspectic technique

  Yes

  No

  N/A

• Type of Prep used

• Sufficient drying time is allowed prior to draping

  Yes

  No

  N/A

Traffic

• Traffic in and out of the room is kept to essential personnel/tasks

  Yes

  No

  N/A

• The traffic pattern during the case avoids the sterile field whenever possible

  Yes

  No

  N/A

Environmental Cleaning

• Horizontal surfaces are free of dust and organic debris

  Yes

  No

  N/A

• After procedure, reusable patient items such as straps are cleaned between uses

  Yes

  No

  N/A

• After procedure, visibly soiled areas of the floor (three to four feet perimeter around the bed) is mopped free of all blood and debris

  Yes

  No

  N/A

• OR doors are closed between cases

  Yes

  No

  N/A

• Scrub tech removes excess tissue from instruments

  Yes

  No

  N/A

• Enzymatic spray prior to delivery to CS

  Yes

  No

  N/A

• Operating room's environmental temperature and humidity temperature range 68-73 degrees and humidity range 30-60%. Staff takes and documents corrective action if temperature and humidity ranges are not met

  Yes

  No

  N/A

• Linen, equipment and supplies are properly stored within the operating room and OR department, including appropriate covers and storage practices to minimize the potential for dust and contamination

  Yes

  No

  N/A

Medications

• Medications are labeled appropriately when in use

  Yes

  No

  N/A

• Refrigerators are specific for medications, staff foods, etc.

  Yes

  No

  N/A

• Sharps are removed and disposed of appropriately at the completion of each case

  Yes

  No

  N/A

• Sharps containers are accessible, secured to wall/counter and emptied when the "full" line is reached

  Yes

  No

  N/A

• Unused medications/fluids are disposed of at the end of each case

  Yes

  No

  N/A

• Fluid warmers are checked for approved temperature ranges each day the OR is functioning or automatically checked with thermaviewer.

  Yes

  No

  N/A

Cleaned / Soiled Areas

• Dirty / clean equipment is stored separately

  Yes

  No

  N/A

• Biohazard waste is labeled and covered

  Yes

  No

  N/A

• Cleaning supplies are labeled

  Yes

  No

  N/A

• Approved cleaning supplies

  Yes

  No

  N/A

General Infection Prevention

• Soiled linens are placed in designated covered hampers

  Yes

  No

  N/A

• Under sink storage is limited to disinfectants / cleaners

  Yes

  No

  N/A

• No eating or drinking in patient care area

  Yes

  No

  N/A

• Clean equipment is labeled clean / clean label removed for used equipment

  Yes

  No

  N/A

• All sterile supplies are dry with intact packaging, not stored on the floor

  Yes

  No

  N/A

• Low storage areas must have solid surface shelving

  Yes

  No

  N/A

• Storage of sterile supplies is 8" above the floor and 18 inches from ceiling/sprinkler heads.

  Yes

  No

  N/A

• Ice scoop is not stored in the ice machine

  Yes

  No

  N/A

• Staff know where to find and how to access infection prevention policies and procedures

  Yes

  No

  N/A

• Staff are aware of when to use Airborne isolation and PPE (N-95 masks)

  Yes

  No

  N/A

• Staff are knowledgable about blood spill protocol

  Yes

  No

  N/A

• Staff know the kill time for disinfectants used

  Yes

  No

  N/A

• Staff have knowledge of hand hygiene requirements and practice these requirements

  Yes

  No

  N/A