Title Page
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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
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Dirty instrument was contained during transport (e.g. Biohazard bag).
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Instrument has been cleaned prior to disinfection (wiped with PDI wipe or enzymatic).
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Staff conducting HLD has had initial and annual competencies.<br>
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Test strips have had quality control on each new lot number (3 positive and 3 negative strips).
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Top portion of HLD log has been filled out.
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Test strips are dated with open and expiration date.
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PPE is available (gown, gloves, goggles).
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Log: each item that has been HLD is recorded properly including patient sticker, temperature of solution, users initials, strip was tested prior to use, etc.
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Original bottle has been dated with an expiration date that is 90 days from the open date but does not exceed the expiration date on the original bottle.
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Secondary container of Resert has been dated with expiration date 21 days from the pour date.
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Instruments were soaked for 8 minutes and is evident on log.
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Instrument was rinsed for 1 minute and is evident on log.
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Instrument was flushed ( if applicable) and dried.
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Instrument was covered in clean pouch and transported back to storage to minimize contamination.
