Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Hand hygiene
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Personnel responsible for environmental cleaning must perform hand hygiene before initial patient environment contact (e.g. before coming into operating/procedure room or patient bed space (admitting and PACU)
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Personnel responsible for environmental cleaning must perform hand hygiene after potential body fluid exposure (e.g. after cleaning bathroom, handling soiled linen, equipment or waste.
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Personnel responsible for environmental cleaning must perform hand hygiene after patient environment contact (e.g. after cleaning patient bed space or operating /procedure room; after cleaning equipment such as stretchers; after changing mop heads.
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Gloves must be removed on leaving each operating /procedure room or patient bed space. Personnel MUST CLEAN HANDS AFTER REMOVING GLOVES as gloves to not provide complete protection against hand contamination.
PPE, etc.
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PPE is worn according to Bloodborne pathogen standard when disposing of wast that could result in exposure to bloodborne or other potentially infectious microorganisms and hazardous material.
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Clean gloves are applied and room is cleaned working from clean to dirty and high to low areas using fresh cloths for completing cleaning of each patient bed space.
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Fresh disinfectant is prepared according to manufacturer's instructions.
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If a bucket is used, there is no double dipping. Cloths are not shaken out.
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An adequate supply of clean cloths are available
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Cleaning cloth is changed when it is no longer saturated with disinfectant and after cleaning heavily soiled areas.
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Mechanical friction and an EPA approved agent is used to clean and disinfect.
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Soiled cleaning cloths are placed in designated container for laundering or disposal. Gloves are removed and hands cleaned.
Terminal cleaning OR/Procedure room
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Terminal cleaning is done daily when procedures are completed for the day.
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Unused rooms are cleaned daily due to personnel entering unused rooms.
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Hands are cleaned and gloves put on. Waste and soiled linen are collected and removed. Gloves are removed, hands are cleaned, clean gloves are put on.
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All horizontal surfaces are cleaned and disinfected.
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Exterior of cabinets and doors (especially around handles) are cleaned and disinfected.
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Telephones and keyboards are cleaned and disinfected.
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Door handles, push plates, light switches and controls are cleaned and disinfected.
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Walls are spot washed as needed.
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Waste recepticles are damp wiped.
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The floor is cleaned including moving the bed and cleaning underneath it. all equipment/furniture is moved to the center or opposite side of the room and floor cleaning is completed.
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Gloves are removed and hands cleaned.
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Furniture and equipment is placed in its proper location. Waste receptacles are relined.
Other patient care areas and environmental surfaces that come in direct contact with patients (PACU, Admitting, DWA).
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Hands are cleaned and gloves put on.
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Dirty linen and waste are removed. Gloves are removed and hands are cleaned.
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Waste cans and linen hampers are cleaned when visibly soiled.
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Doors, door handles, push plates and touched areas of door frame are cleaned first.
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Walls are checked and soiled areas cleaned.
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Light switches and thermostats, wall mounted items (e.g. alcohol hand rub dispensor and glove box holder, top of suction canister, intercom, blood pressure manometer, IV poles are cleaned.
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Furnishing and horizontal surfaces, chairs, window sills, TV, telephone, table are cleaned.
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Outside of cupboards, blanket warmer, countertops, and stainless steel are cleaned.
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Sink, faucet and faucet handles are cleaned and disinfected.
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Debris is cleaned off floor and floors are damp mopped. Carpets are spot cleaned and vacuumed.
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Gloves are removed and hands cleaned.
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New liners are inserted in waste and linen hampers.
OR/Endo non patient contact areas.
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All flat surfaces, outside of cupboards, telephones, door handles, light switches are cleaned and disinfected.
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All sinks, faucets and faucet handles are cleaned and disinfected.
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Gloves are removed and hands cleaned.
Bathrooms
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Gloves are put on.
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Spills are wiped up and waste removed. Waste can us cleaned if visibly soiled.
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Door handle and frame, light switch, wall attachments, light fixture, mirror are cleaned. Walls are spot cleaned
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Baby changing station is disinfected.
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Inside and outside of sink, sink faucets and mirror are cleaned. Plumbing under sink is wiped. Disinfectant is applied to interior of sink and sufficient contact time allowed before rinsing and drying.
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Dispensors, frames, call bell and cord, railings ledges and shelves are cleaned.
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Entire toilet including handle and unserside of flush rim and wall behind toilet is cleaned with sufficient contact time for disinfectant.
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Floor is dry mopped and damp mopped.
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Gloves are removed and hands are washed. Area is replenished.
Housekeeping Closet
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All solutions are labeled and stored correctly.
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Cleaning equipment is disassembled, cleaned and disinfected at end of shift.
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Cleaning carts are cleaned and wiped down at end of shift.
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Square floor drain cleaned and disinfected.
