Environmental Cleaning

• Site conducted

• Conducted on

  Date

• Interviewee

Interview questions

• Q1 Did you receive orientation, buddying, and training when you first started?

  Yes

  No

  N/A

• Q1 Comments

• Q2 Do you have written procedures available to you?

  Yes

  No

  N/A

• Q3 Are expectations for your role clear?

  Yes

  No

  N/A

• Q3 comments

• Q4 What happens if not all tasks are completed by the end of your shift?

• Q5 For infection control patients with signage on their doors, do you know how to complete cleaning safely without spreading infection?

  Yes

  No

  N/A

• Q6 During an infection outbreak, such as Gastro, are you included in communication and receive all the support you need?

  Yes

  No

  N/A

• Q7 Is there a protocol for cleaning up blood and body fluids?

  Yes

  No

  N/A

• Q7 explanation

• Q8 Are issues/problems, incidents and hazards dealt with?

  Yes

  No

  N/A

• Q9 Do you feel comfortable raising issues?

  Yes

  No

  N/A

• Q10 Have you raised any recently and what was the outcome?

Compliance questions

• Cleaner communicated with patients when entering a room

  Yes

  No

  N/A

• SOPs performed in right order, mechanical clean then chemical disinfection.

  Yes

  No

  N/A

• Frequent touch areas are cleaned often

  Yes

  No

  N/A

• Cleaning chemicals match list, and disinfectant used correctly

  Yes

  No

  N/A

• All intended areas were cleaned, and no areas appear dirty

  Yes

  No

  N/A

• Cleaner follows transmission-based precautions

  Yes

  No

  N/A

• Cleans area in defined zones meeting criteria of policy

  Yes

  No

  N/A

• Area cleaned from high to low

  Yes

  No

  N/A

• Area cleaned from clean to dirty

  Yes

  No

  N/A

• Equipment and solutions are changed between zones.

  Yes

  No

  N/A

• Equipment is cleaned before leaving infectious rooms.

  Yes

  No

  N/A

• Equipment is colour coded.

  Yes

  No

  N/A

• Cleaner has a pager and can be contacted for urgent assistance

  Yes

  No

  N/A

• Chemical safety data sheets are displayed

  Yes

  No

  N/A

• Cleaning equipment is regularly replaced

  Yes

  No

  N/A