General Infection Control Audit Checklist

• Hospital Name

• Conducted on

  Date

• Prepared by

• Location
  Address

Employee Hand Hygiene Compliance

• Employees Monitored

Hand Hygiene

• Sinks for hand hygiene are well stocked?

  Yes

  No

  N/A

• Sinks are available in all areas as needed?

  Yes

  No

  N/A

• Alcohol hand rubs are well stocked?

  Yes

  No

  N/A

• Alcohol hand rubs are available in patient's rooms?

  Yes

  No

  N/A

• Placement of alcohol hand rubs is compliant with safety?

  Yes

  No

  N/A

• Hand washing/hand hygiene is performed between patients?

  Yes

  No

  N/A

• Hand Hygiene reminder posters present?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Clean Utility / Central Supply / Storage

• Clean linen cart is covered?

  Yes

  No

  N/A

• Clean linen cart has solid surface on bottom shelf?

  Yes

  No

  N/A

• Sink storage area empty and clean?

  Yes

  No

  N/A

• Thrash cans or waste basket are not overfilled or overflowing?

  Yes

  No

  N/A

• Ceiling tiles are not stained or wet?

  Yes

  No

  N/A

• Floors are clean?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Air intake vents and diffusers are clean?

  Yes

  No

  N/A

• Is this section free of additional findings?

  Yes

  No

  N/A

• Please describe other findings:

Patient Rooms

• Horizontal surfaces are clean?

  Yes

  No

  N/A

• Thrash cans or waste basket are not overfilled or overflowing?

  Yes

  No

  N/A

• Bathrooms are clean?

  Yes

  No

  N/A

• Hand hygiene products are available?

  Yes

  No

  N/A

• Soap and paper towels are available in each bathroom?

  Yes

  No

  N/A

• PPE's are available as needed?

  Yes

  No

  N/A

• Patient equipment is clean?

  Yes

  No

  N/A

• No visible soil on vertical surfaces?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Air intake vents and diffusers are clean?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Mattress pad is without tears or puncture holes?

  Yes

  No

  N/A

• Floors are clean?

  Yes

  No

  N/A

• Sharp containers are no more than 3/4 full?

  Yes

  No

  N/A

• Dust not found in high places?

  Yes

  No

  N/A

• General area is dust free?

  Yes

  No

  N/A

• 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]

  

• Foley catheters hanging and secured appropriately?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• There is no evidence of pest present?

  Yes

  No

  N/A

• Clean / dirty linen handled appropropriatly?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• No signs of mildew or mold present?

  Yes

  No

  N/A

• Is this section free of additional findings?

  Yes

  No

  N/A

• Please describe other findings:

Patient Kitchen / Breakroom

• Floors and walls clean?

  Yes

  No

  N/A

• Horizontal and vertical surfaces are clean?

  Yes

  No

  N/A

• Microwave oven clean?

  Yes

  No

  N/A

• Refrigerator clean and thawed of ice?

  Yes

  No

  N/A

• Under sink clean and without storage?

  Yes

  No

  N/A

• Patient refrigerator labeled for patient use only?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Patient food is labeled appropriately with no expired food found?

  Yes

  No

  N/A

• Ice machine is clean?

  Yes

  No

  N/A

• There is no evidence of pest present?

  Yes

  No

  N/A

• Is this section free of additional findings?

  Yes

  No

  N/A

• Please describe other findings:

Employee Kitchen / Breakroom

• Floors and walls clean?

  Yes

  No

  N/A

• Horizontal and vertical surfaces are clean?

  Yes

  No

  N/A

• Microwave oven clean?

  Yes

  No

  N/A

• Refrigerator clean and thawed of ice?

  Yes

  No

  N/A

• Under sink clean and without storage?

  Yes

  No

  N/A

• Employee food labeled and dated?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is this section free of additional findings?

  Yes

  No

  N/A

• Please describe other findings:

General Unit / Nurses Station / Medication Room

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

  Yes

  No

  N/A

• Unused patient equipment/supplies are stored and handled appropriately?

  Yes

  No

  N/A

• Medication, specimens, and food are handled appropriately?

  Yes

  No

  N/A

• Biohazard trash is segregated from regular trash?

  Yes

  No

  N/A

• Clean linen is handled appropriately?

  Yes

  No

  N/A

• Dirty linen is handled appropriately?

  Yes

  No

  N/A

• All clean linen carts are covered?

  Yes

  No

  N/A

• Linen carts have a solid bottom shelf?

  Yes

  No

  N/A

• Needles and syringes are disposed of properly?

  Yes

  No

  N/A

• Out of date supplies are not present?

  Yes

  No

  N/A

• Infectious waste in red bag or container?

  Yes

  No

  N/A

• Clean items are not stored in soiled utility room?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Lab supplies are not expired?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Halls are uncluttered?

  Yes

  No

  N/A

• Respiratory hygiene available?

  Yes

  No

  N/A

• Restrooms clean?

  Yes

  No

  N/A

• Trash basket are not overflowing?

  Yes

  No

  N/A

• Biohazard symbol on door of biomedical waste storage?

  Yes

  No

  N/A

• Medication cart locked?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• No personal lotion use.

  Yes

  No

  N/A

• Medication Room refrigerator is clean and without ice?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is this section free of additional findings?

  Yes

  No

  N/A

• Please describe other findings:

Logs

• Crash cart checked daily?

  Yes

  No

  N/A

• Defibrillator checked daily

  Yes

  No

  N/A

• Narcotic counts documented every shift?

  Yes

  No

  N/A

• Temperature checked BID for vaccine / medication storage?

  Yes

  No

  N/A

• Daily refrigerators checks with corrective actions as needed?

  Yes

  No

  N/A

• Ice machine cleaning date / time stamped?

  Yes

  No

  N/A

• Glucose meter strips dated

  Yes

  No

  N/A

• Cidex monitoring Log complete?

  Yes

  No

  N/A

• Is this section free of additional findings.

  Yes

  No

  N/A

• Please describe other findings:

Isolation Rooms

• Appropriate signage in place?

  Yes

  No

  N/A

• Supplies and PPE's available?

  Yes

  No

  N/A

• Trash and linen handled per policy?

  Yes

  No

  N/A

• Appropriate PPE's used by staff?

  Yes

  No

  N/A

• Door closed as appropriate?

  Yes

  No

  N/A

• Negative pressure is being supplied as required?

  Yes

  No

  N/A

• Patient and family instructed on isolation requirements?

  Yes

  No

  N/A

• Patient with proper attire when being transported?

  Yes

  No

  N/A

• Is this section free of additional findings?

  Yes

  No

  N/A

• Please describe other findings:

Employee General Knowledge

• Employees know the procedure for blood exposure?

  Yes

  No

  N/A

• Personnel can locate their Infection Control Manual?

  Yes

  No

  N/A

• Personnel can locate their Exposure Control Plan?

  Yes

  No

  N/A

• Personnel can locate the blood spill kit?

  Yes

  No

  N/A

• Personnel can locate their spill kit for Cidex?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Dust not found in high places?

  Yes

  No

  N/A

• Is this section free of additional findings?

  Yes

  No

  N/A

• Please describe other findings:

Soiled Linen / Dirty Utility Room

• Biohazard symbol on door of biomedical waste storage?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Walls / floors are clean

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Dust not found in high places?

  Yes

  No

  N/A

• Is this section free of additional findings?

  Yes

  No

  N/A

• Please describe other findings:

Patient Shower Room

• Shower clean?

  Yes

  No

  N/A

• Shower room clean and orderly?

  Yes

  No

  N/A

• Walls and floor are clean?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Dust not found in high places?

  Yes

  No

  N/A

• Is this section free of additional findings?

  Yes

  No

  N/A

• Please describe other findings:

Completion

• Additional Comments

• Surveyor's Name and Signature

  Sign