Device Audit - CLABSI Prevention

• Conducted on

  Date
• Location
  Address

• MRN

• Patient Name

• Room number

• Audit conducted by

Observation

• Dressing clean, dry, and intact

  YES

  NO

• Dsg labeled with Initials, Date/Time changed (or to be changed) & not expired<br>(changed q7-days & prn unless gauze dsg, then q48-hrs)

  YES

  NO

• Securement device in place/changed with each dsg

  Select YES NO

  • YES
  • NO

• Curos caps in place

  YES

  NO

• IV tubing dated & not expired <br>(Continuous sets changed q 96-hrs & Intermittent sets changed q 24-hrs)

  YES

  No

  N/A

• CHG dressing (or disc) present/applied correctly

  YES

  NO

Documentation

• Order for insertion documented

  YES

  NO

• Daily CL justification reviewed & documented

  YES

  NO

• Dsg changes documented within 24 hrs after insertion, every 7 days, & prn

  YES

  NO

• Tubing changes documented, as apppropriate

  YES

  NO

• Daily CHG bath is documented

  YES

  NO

• CLABSI Education documented

  YES

  No

  N/A