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Audit

Employee Hand Hygiene Compliance

Employees Monitored

Hand Hygiene

Sinks for hand hygiene are well stocked?

Sinks are available in all areas as needed?

Alcohol hand rubs are well stocked?

Alcohol hand rubs are available in patient's rooms?

Placement of alcohol hand rubs is compliant with safety?

Hand washing/hand hygiene is performed between patients?

Hand Hygiene reminder posters present?

Hand soap is available in all hand washing stations/bathrooms?

Clean Utility / Central Supply / Storage

Clean linen cart is covered?

Clean linen cart has solid surface on bottom shelf?

Sink storage area empty and clean?

Thrash cans or waste basket are not overfilled or overflowing?

Ceiling tiles are not stained or wet?

Floors are clean?

Supplies are stored at least 6 inches off of the floor?

Air intake vents and diffusers are clean?

Is this section free of additional findings?

Please describe other findings:

Patient Rooms

Horizontal surfaces are clean?

Thrash cans or waste basket are not overfilled or overflowing?

Bathrooms are clean?

Hand hygiene products are available?

Soap and paper towels are available in each bathroom?

PPE's are available as needed?

Patient equipment is clean?

No visible soil on vertical surfaces?

Ceiling tiles are not discolored, wet, missing, or damaged?

Air intake vents and diffusers are clean?

Furniture (chairs, sleepers) are without tears or wear?

Mattress pad is without tears or puncture holes?

Floors are clean?

Sharp containers are no more than 3/4 full?

Dust not found in high places?

General area is dust free?

REFERENCE: General area is dust free
[This is an example of how you can use iAuditor to include best practice reference images in your templates to assist with inspections]

clean.PNG

Foley catheters hanging and secured appropriately?

IV pumps and poles, feeding pumps etc. are clean?

There is no evidence of pest present?

Clean / dirty linen handled appropropriatly?

No needles, syringes, medications within reach of the patient?

No signs of mildew or mold present?

Is this section free of additional findings?

Please describe other findings:

Patient Kitchen / Breakroom

Floors and walls clean?

Horizontal and vertical surfaces are clean?

Microwave oven clean?

Refrigerator clean and thawed of ice?

Under sink clean and without storage?

Patient refrigerator labeled for patient use only?

Temperature checks are documented with corrective action when temp is out of range?

Patient food is labeled appropriately with no expired food found?

Ice machine is clean?

There is no evidence of pest present?

Is this section free of additional findings?

Please describe other findings:

Employee Kitchen / Breakroom

Floors and walls clean?

Horizontal and vertical surfaces are clean?

Microwave oven clean?

Refrigerator clean and thawed of ice?

Under sink clean and without storage?

Employee food labeled and dated?

Temperature checks are documented with corrective action when temp is out of range?

Is this section free of additional findings?

Please describe other findings:

General Unit / Nurses Station / Medication Room

Unit/area generally clean (without dust, clutter or debris)?

Unused patient equipment/supplies are stored and handled appropriately?

Medication, specimens, and food are handled appropriately?

Biohazard trash is segregated from regular trash?

Clean linen is handled appropriately?

Dirty linen is handled appropriately?

All clean linen carts are covered?

Linen carts have a solid bottom shelf?

Needles and syringes are disposed of properly?

Out of date supplies are not present?

Infectious waste in red bag or container?

Clean items are not stored in soiled utility room?

Ceiling tiles are not discolored/ wet/ missing / damaged?

Lab supplies are not expired?

Nothing is stored under the sink and there is no sign of leaks?

Halls are uncluttered?

Respiratory hygiene available?

Restrooms clean?

Trash basket are not overflowing?

Biohazard symbol on door of biomedical waste storage?

Medication cart locked?

No artificial/acrylic nails use. Nails are no more than 1/4 inch above finger?

No personal lotion use.

Medication Room refrigerator is clean and without ice?

There are no expired products found(IV solutions, medications, reagents, nutritional supplement, sterile items, etc.)

Is this section free of additional findings?

Please describe other findings:

Logs

Crash cart checked daily?

Defibrillator checked daily

Narcotic counts documented every shift?

Temperature checked BID for vaccine / medication storage?

Daily refrigerators checks with corrective actions as needed?

Ice machine cleaning date / time stamped?

Glucose meter strips dated

Cidex monitoring Log complete?

Is this section free of additional findings.

Please describe other findings:

Isolation Rooms

Appropriate signage in place?

Supplies and PPE's available?

Trash and linen handled per policy?

Appropriate PPE's used by staff?

Door closed as appropriate?

Negative pressure is being supplied as required?

Patient and family instructed on isolation requirements?

Patient with proper attire when being transported?

Is this section free of additional findings?

Please describe other findings:

Employee General Knowledge

Employees know the procedure for blood exposure?

Personnel can locate their Infection Control Manual?

Personnel can locate their Exposure Control Plan?

Personnel can locate the blood spill kit?

Personnel can locate their spill kit for Cidex?

Employees can state the WHO's 5 moments of Hand Hygiene.

Dust not found in high places?

Is this section free of additional findings?

Please describe other findings:

Soiled Linen / Dirty Utility Room

Biohazard symbol on door of biomedical waste storage?

Boxes are stored at least 6 inches off of the floor?

Walls / floors are clean

Ceiling tiles are not discolored/ wet/ missing / damaged?

Dust not found in high places?

Is this section free of additional findings?

Please describe other findings:

Patient Shower Room

Shower clean?

Shower room clean and orderly?

Walls and floor are clean?

Ceiling tiles are not discolored/ wet/ missing / damaged?

Dust not found in high places?

Is this section free of additional findings?

Please describe other findings:

Completion

Additional Comments

Surveyor's Name and Signature

General Infection Control Audit Checklist

Created by: SafetyCulture Staff | Industry: Health Services | Downloads: 371

Use this infection control audit template to ensure the completion of baseline control measures against healthcare-associated infections.

Signup for a free iAuditor account to download and edit this checklist. It will be added to your free account and you will be able to conduct inspections from your mobile device.

Download and edit this free checklist

Browse for other checklists


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Audit

Employee Hand Hygiene Compliance

Employees Monitored

Hand Hygiene

Sinks for hand hygiene are well stocked?

Sinks are available in all areas as needed?

Alcohol hand rubs are well stocked?

Alcohol hand rubs are available in patient's rooms?

Placement of alcohol hand rubs is compliant with safety?

Hand washing/hand hygiene is performed between patients?

Hand Hygiene reminder posters present?

Hand soap is available in all hand washing stations/bathrooms?

Clean Utility / Central Supply / Storage

Clean linen cart is covered?

Clean linen cart has solid surface on bottom shelf?

Sink storage area empty and clean?

Thrash cans or waste basket are not overfilled or overflowing?

Ceiling tiles are not stained or wet?

Floors are clean?

Supplies are stored at least 6 inches off of the floor?

Air intake vents and diffusers are clean?

Is this section free of additional findings?

Please describe other findings:

Patient Rooms

Horizontal surfaces are clean?

Thrash cans or waste basket are not overfilled or overflowing?

Bathrooms are clean?

Hand hygiene products are available?

Soap and paper towels are available in each bathroom?

PPE's are available as needed?

Patient equipment is clean?

No visible soil on vertical surfaces?

Ceiling tiles are not discolored, wet, missing, or damaged?

Air intake vents and diffusers are clean?

Furniture (chairs, sleepers) are without tears or wear?

Mattress pad is without tears or puncture holes?

Floors are clean?

Sharp containers are no more than 3/4 full?

Dust not found in high places?

General area is dust free?

REFERENCE: General area is dust free
[This is an example of how you can use iAuditor to include best practice reference images in your templates to assist with inspections]

clean.PNG

Foley catheters hanging and secured appropriately?

IV pumps and poles, feeding pumps etc. are clean?

There is no evidence of pest present?

Clean / dirty linen handled appropropriatly?

No needles, syringes, medications within reach of the patient?

No signs of mildew or mold present?

Is this section free of additional findings?

Please describe other findings:

Patient Kitchen / Breakroom

Floors and walls clean?

Horizontal and vertical surfaces are clean?

Microwave oven clean?

Refrigerator clean and thawed of ice?

Under sink clean and without storage?

Patient refrigerator labeled for patient use only?

Temperature checks are documented with corrective action when temp is out of range?

Patient food is labeled appropriately with no expired food found?

Ice machine is clean?

There is no evidence of pest present?

Is this section free of additional findings?

Please describe other findings:

Employee Kitchen / Breakroom

Floors and walls clean?

Horizontal and vertical surfaces are clean?

Microwave oven clean?

Refrigerator clean and thawed of ice?

Under sink clean and without storage?

Employee food labeled and dated?

Temperature checks are documented with corrective action when temp is out of range?

Is this section free of additional findings?

Please describe other findings:

General Unit / Nurses Station / Medication Room

Unit/area generally clean (without dust, clutter or debris)?

Unused patient equipment/supplies are stored and handled appropriately?

Medication, specimens, and food are handled appropriately?

Biohazard trash is segregated from regular trash?

Clean linen is handled appropriately?

Dirty linen is handled appropriately?

All clean linen carts are covered?

Linen carts have a solid bottom shelf?

Needles and syringes are disposed of properly?

Out of date supplies are not present?

Infectious waste in red bag or container?

Clean items are not stored in soiled utility room?

Ceiling tiles are not discolored/ wet/ missing / damaged?

Lab supplies are not expired?

Nothing is stored under the sink and there is no sign of leaks?

Halls are uncluttered?

Respiratory hygiene available?

Restrooms clean?

Trash basket are not overflowing?

Biohazard symbol on door of biomedical waste storage?

Medication cart locked?

No artificial/acrylic nails use. Nails are no more than 1/4 inch above finger?

No personal lotion use.

Medication Room refrigerator is clean and without ice?

There are no expired products found(IV solutions, medications, reagents, nutritional supplement, sterile items, etc.)

Is this section free of additional findings?

Please describe other findings:

Logs

Crash cart checked daily?

Defibrillator checked daily

Narcotic counts documented every shift?

Temperature checked BID for vaccine / medication storage?

Daily refrigerators checks with corrective actions as needed?

Ice machine cleaning date / time stamped?

Glucose meter strips dated

Cidex monitoring Log complete?

Is this section free of additional findings.

Please describe other findings:

Isolation Rooms

Appropriate signage in place?

Supplies and PPE's available?

Trash and linen handled per policy?

Appropriate PPE's used by staff?

Door closed as appropriate?

Negative pressure is being supplied as required?

Patient and family instructed on isolation requirements?

Patient with proper attire when being transported?

Is this section free of additional findings?

Please describe other findings:

Employee General Knowledge

Employees know the procedure for blood exposure?

Personnel can locate their Infection Control Manual?

Personnel can locate their Exposure Control Plan?

Personnel can locate the blood spill kit?

Personnel can locate their spill kit for Cidex?

Employees can state the WHO's 5 moments of Hand Hygiene.

Dust not found in high places?

Is this section free of additional findings?

Please describe other findings:

Soiled Linen / Dirty Utility Room

Biohazard symbol on door of biomedical waste storage?

Boxes are stored at least 6 inches off of the floor?

Walls / floors are clean

Ceiling tiles are not discolored/ wet/ missing / damaged?

Dust not found in high places?

Is this section free of additional findings?

Please describe other findings:

Patient Shower Room

Shower clean?

Shower room clean and orderly?

Walls and floor are clean?

Ceiling tiles are not discolored/ wet/ missing / damaged?

Dust not found in high places?

Is this section free of additional findings?

Please describe other findings:

Completion

Additional Comments

Surveyor's Name and Signature