Hospital infection control Housekeeping surveillance Checklist

• Healthcare Facility

• Department

• Hospital Infection control

• Conducted on

• Unit

• Area

General Audit

• Floors are clean

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Restrooms are clean

  Yes

  No

  N/A

• No visible soil on vertical surfaces?

  Yes

  No

  N/A

• PPE's are available as needed?

  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

• Walls and floor tiles are clean?

  Yes

  No

  N/A

• Bio medica wastes Transported on covered trolley?

  Yes

  No

  N/A

• Separate Mops for patient rooms, Toilets and General areas?

  Yes

  No

  N/A

• Solid linen trolleys closed?

  Yes

  No

  N/A

• Biohazard symbol on door of biomedical waste storage?

  Yes

  No

  N/A

• Appropriate PPE's used by staff?

  Yes

  No

  N/A

Before entering Patient room

• Check isolation status

  Complete

  Incomplete

• Perform hand hygiene

  Complete

  Incomplete

• Don appropriate PPE

  Complete

  Incomplete

• Place wet floor sign in front of the door

  Complete

  Incomplete

Patient bed

• Raise and wipe down arm rails – high touch area

  Complete

  Incomplete

• Wipe foot of bed

  Complete

  Incomplete

Move clockwise from the door and sanitize all equipment

• Ledges (below shoulder height)

  Cleaned

  Not Cleaned

  Not Present in Room

• Door handles, knobs – high touch surfaces

  Cleaned

  Not Cleaned

  Not Present in Room

• Light switches – high touch surfaces

  Cleaned

  Not Cleaned

  Not Present in Room

• Call box – high touch surfaces

  Cleaned

  Not Cleaned

  Not Present in Room

• Telephone – high touch surfaces

  Cleaned

  Not Cleaned

  Not Present in Room

• Computer keyboard – high touch surfaces

  Cleaned

  Not Cleaned

  Not Present in Room

• Window sills and ledges

  Cleaned

  Not Cleaned

  Not Present in Room

• In-room patient sink and faucet

  Cleaned

  Not Cleaned

  Not Present in Room

• Dry erase marker

  Cleaned

  Not Cleaned

  Not Present in Room

• Overbed table – high touch surfaces

  Cleaned

  Not Cleaned

  Not Present in Room

• Patient chairs – high touch surfaces

  Cleaned

  Not Cleaned

  Not Present in Room

• Bedside tables – high touch surfaces

  Cleaned

  Not Cleaned

  Not Present in Room

• All other easily accessible wall mounted equipment

  Cleaned

  Not Cleaned

  Not Present in Room

• Clean commode frame and seat cover last

  Complete

  Incomplete

Patient restroom

• Clean mirror with glass cleaner and wipe dry with a paper towel

  Complete

  Incomplete

• Light switches – high touch surfaces

  Cleaned

  Not Cleaned

  Not Present in Room

• Door handles, knobs – high touch surfaces

  Cleaned

  Not Cleaned

  Not Present in Room

• Hand rails – high touch surfaces

  Cleaned

  Not Cleaned

  Not Present in Room

• Sink and sink counter – high touch surfaces

  Cleaned

  Not Cleaned

  Not Present in Room

• Spot walls

  Complete

  Incomplete

• Clean commode frame and seat cover

  Complete

  Incomplete

Toilet

• Toilet flusher – high touch area

  Cleaned

  Not Cleaned

  Not Present in Room

• Toilet seat – high touch area

  Cleaned

  Not Cleaned

  Not Present in Room

• Under the bowl

  Cleaned

  Not Cleaned

  Not Present in Room

• Toilet rim

  Cleaned

  Not Cleaned

  Not Present in Room

• Clean inside of bowl with disinfectant cleaner and toilet brush

  Complete

  Incomplete

Before leaving room

• Remove gloves and perform hand hygiene

  Complete

  Incomplete

• Mop floor

  Complete

  Incomplete

• Perform hand hygiene

  Complete

  Incomplete

• Remove wet floor sign after the floor has dried

  Complete

  Incomplete

Completion

• Additional Comments

• Hospital infection control Name & Signature

  Sign