General

Competency checklists with documentation training for each person eligible to perform High Level Disinfection is on file and available in the room?

Appropriate High Level Disinfection policies are readily available in the room and signed by Medical Director.

Are manufacturer maintenance and instrument manuals are maintained and are available in the room?

Are instruments pre-cleaned per manufacturers guide
lines and allowed to fully dry prior to disinfecting?

Appropriate PPE and Spill Kits are available?

Daily High Level Disinfection Probe
Instrument Log is filled out
and up to date.

High Level Disinfection Solution Log
is filled out and up to date.

Is eye wash available and checked
weekly with documentation?

Are there any expired solutions?

Is a timer available and utilized?

Is a thermometer available and temperature checked prior to each use?

All Instrument processing containers
have a lid that is secure and labeled
with a BIOHAZARD and DIAMOND Label.

Only manufacturer recommended brushes are utilized. Brushes are disinfected following manufacturer guidelines. They should not be lying on the sink.

Are chemical and or biohazard materials disposed of properly?

Equipment has PM stickers current within
the last 12 months and appropriately
calibrated?

No Food, Drinks, or Make up are stored or applied in or around the designated HLD area.

Room Temperature is maintained between 59-86F for proper storage CidexOPA, Revital-Ox Solutions and/or Trophon Cartridges.

GUS

Only approved solutions are being utilized in the GUS System.
(Cidex OPA or Revital-Ox)

Enzol Instructions for use
with GUS are posted.

Cidex OPA

HLD with Cidex OPA
Understanding the Process
Educational Slides are available

Are quality Control test performed with each new bottle?

Concentration test of MEC performed prior to each use with Cidex OPA test strips? (pass/Fail)

Cidex- OPA Test Strips are discarded 90 days from opening date?

Cidex OPA solutions is labeled with date opened and 75 day expiration date.

Soaking container is labeled with date solution was poured and 14 day expiration date.

Soak time of 12 minutes is observed for each instrument.

Are three (3) 1 minute separate rinses performed with sterile or potable (drinking) water?

Quality Control Instructions
are posted.

Cidex OPA High Level Disinfection
Instructions are posted.

Revital-Ox

HLD with Revital-ox Process
Educational Slides are available
for reference in the room.

Are quality Control test performed with each new bottle?

Concentration test of MEC performed prior to each use with Revital-Ox R60 test strips? (pass/Fail)

Revital-Ox Resert R60 solution test strips are discarded 90 days from opening date?

Revital-Ox solution is labeled with the date opened and the 90 day expiration date.

Soaking container is labeled with date solution was poured and 21 day expiration date.

Soak time of 8 minutes is observed for each instrument.

Is a single rinse with sterile or potable (drinking) water performed with each instrument?

Quality Control Instructions are posted.

Revital- Ox High Level Disinfection
Instructions are posted.

Trophon

Trophon HLD Process
Educational Slides are available
for reference in the room.

Trophon EPR left connected to power and switched on at all times?

Chemical Indicator available and unexpired? Stored away from direct UV light?

Cartridges changed every 30 days

Single use cleaning clothes available for cleaning before disinfecting?

Quality Control is interpreted at end of each cycle and documented.

Quality Control Instructions are posted.

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.