Infection Control Audit Tool with Action Plan

Information

Document No.
Audit Title
Client / Site
Conducted on
Prepared by
Location
Personnel

Section 1

1 - Overview

1.1 Total number of available beds
1.2 Total number of beds occupied?
1.3 Has the previous audit been reviewed and signed off?
1.4 How many corrective actions were raised during the last audit?
1.5 Have all corrective actions raised during the last audit been completed? If not give further details.

Section 2

2 - Management of The Environment

2.1 is the environment clean all over?
Action required
By who
Date for completion
Date completed
Sign
2.2 is there any dust in high or low places? (Check tops of cupboards and in corners)
Action required
By who
Date for completion
Date completed
Sign
2.3 is there a designated, locked cupboard for cleaning equipment?
Action required
By who
Date for completion
Date completed
Sign
2.4 Are all carpets clean and in good condition?
Action required
By who
Date for completion
Date completed
Sign
2.5 Are all vinyl/wood floor coverings washable and in a good condition?
Action required
By who
Date for completion
Date completed
Sign
2.6 Is all furniture clean and in good condition?
Action required
By who
Date for completion
Date completed
Sign
2.7 Are all chair coverings clean and intact?
Action required
By who
Date for completion
Date completed
Sign
2.8 Are all toilets and bathrooms visibly clean? (Check for lime scale and mould)
Action required
By who
Date for completion
Date completed
Sign
2.9 Are liquid soap and paper towels available for use?
Action required
By who
Date for completion
Date completed
Sign
2.10 Is there a cleaning schedule in place?
Action required
By who
Date for completion
Date completed
Sign
2.11 Is there evidence that the cleaning schedule is followed? Eg: evidence of signing / tick sheet?
Action required
By who
Date for completion
Date completed
Sign
2.11 Further comments / observations for Management of Medication

Section 3

3 Kitchen Areas

3.1 do you record and log all fridge temperatures and take appropriate action if temperatures are not within the normal range of 4 - 8 degrees Celsius?
Action required
By who
Date for completion
Date completed
Sign
3.2 Do you label all food in your fridges with name and the date it was put in there?
Action required
By who
Date for completion
Date completed
Sign
3.3 Are all fridges clean (check seal)?
Action required
By who
Date for completion
Date completed
Sign
3.4 Is the microwave clean?
Action required
By who
Date for completion
Date completed
Sign
3.5 Is the kitchen clean (any spill ages, greasy build up on surfaces, dust on top of cupboards)?
Action required
By who
Date for completion
Date completed
Sign
3.6 Are the fixtures and fittings in the kitchen clean and in good repair?
Action required
By who
Date for completion
Date completed
Sign
3.7 Is the kitchen pest free?
Action required
By who
Date for completion
Date completed
Sign
3.8 Do you date traps for pests (if necessary)?
Action required
By who
Date for completion
Date completed
Sign
3.9 Is all opened food (such as cereals) kept in pest proof containers (like a Tupperware container with a lid)?
Action required
By who
Date for completion
Date completed
Sign
3.10 Is there a dishwasher available for use?
Action required
By who
Date for completion
Date completed
Sign
3.11 Are cloths used to wash dishes disposed daily?
Action required
By who
Date for completion
Date completed
Sign
3.12 Has left over food (such as left over meals) been recovered and stored in the fridge?
Action required
By who
Date for completion
Date completed
Sign
3.13 Have open windows got a mesh screen and / or insecta flash to prevent insects entering the kitchen?
Action required
By who
Date for completion
Date completed
Sign
3.14 are colour coded aprons, rubber gloves etc. in use?
Action required
By who
Date for completion
Date completed
Sign
3.15 Is there a clean functioning foot operated waste bin in place?
Action required
By who
Date for completion
Date completed
Sign
3.16 Is the cooker clean and free from food stuffs?
Action required
By who
Date for completion
Date completed
Sign
3.17 Further comments / observations:

Section 4

4 Hand Hygiene

4.1 Is there alcohol hand rub available with posters encouraging its use?
Action required
By who
Date for completion
Date completed
Sign
4.2 Is there easy access to hand wash basins?
Action required
By who
Date for completion
Date completed
Sign
4.3 In clinical rooms are taps / elbow / wrist mixers in place?
Action required
By who
Date for completion
Date completed
Sign
4.4 Is ther liquid soap and paper towels available in service user rooms?
Action required
By who
Date for completion
Date completed
Sign
4.5 Are all sinks free from bar soap and nail brushes?
Action required
By who
Date for completion
Date completed
Sign
4.6 Are liquid soap dispensers available at all wash hand basins?
Action required
By who
Date for completion
Date completed
Sign
4.7 Are wall mounted paper towels available?
Action required
By who
Date for completion
Date completed
Sign
4.8 Are foot operated waste bins provided for paper waste?
Action required
By who
Date for completion
Date completed
Sign
4.9 Is hand cream, if available, in a hand pump dispenser?
Action required
By who
Date for completion
Date completed
Sign
4.10 Can you confirm that no fabric towels are in use at hand washing sinks?
Action required
By who
Date for completion
Date completed
Sign
4.11 Is there a poster demonstrating good hand washing techniques?
Action required
By who
Date for completion
Date completed
Sign
4.12 Further comments / observations:

Section 5

5 Waste Management

5.1 Is waste segregated into clinical and domestic waste?
Action required
By who
Date for completion
Date completed
Sign
5.2 Is the clinical waste placed in a foot operated bin?
Action required
By who
Date for completion
Date completed
Sign
5.3 Is the clinical waste bin lined with a clinical waste bag?
Action required
By who
Date for completion
Date completed
Sign
5.4 Is the clinical waste bag less than three quarters full?
Action required
By who
Date for completion
Date completed
Sign
5.5 Is clinical waste stored in a secure area, inaccessible to unauthorised persons?
Action required
By who
Date for completion
Date completed
Sign
5.6 Is domestic waste placed in a foot pedal bin?
Action required
By who
Date for completion
Date completed
Sign
5.7 Are black bags available for the disposal of domestic waste?
Action required
By who
Date for completion
Date completed
Sign
5.8 Is a supply of yellow clinical waste bags available for replenishment?
Action required
By who
Date for completion
Date completed
Sign
5.9 Further comments / observations:

Section 6

6 Care of Equipment

5.1. Are detergent wipes available to decontaminate equipment?
Action required
By who
Date for completion
Date completed
Sign
5.2. Are all mattresses clean and in good condition?
Action required
By who
Date for completion
Date completed
Sign
5.3. Are all sterile supplies stored off the floor?
Action required
By who
Date for completion
Date completed
Sign
5.4. Is moving and handling equipment (e.g. Hoists) clean and in good condition?
Action required
By who
Date for completion
Date completed
Sign
6.5. Are commodes/shower trollies/shower chairs clean and in good condition?
Action required
By who
Date for completion
Date completed
Sign
6.6. Are all wheelchairs clean, in good condition and free from food spillages?
Action required
By who
Date for completion
Date completed
Sign
6.7. Have thermometers been stored dry?
Action required
By who
Date for completion
Date completed
Sign
6.8. Are oxygen cylinders clean? Are masks available but not open to contamination by dust or condensation?
Action required
By who
Date for completion
Date completed
Sign
6.9. Have nebulisers been stored clean and dry after individual use?
Action required
By who
Date for completion
Date completed
Sign
6.10. Are suction tubing and catheters being kept within plastic bags?
Action required
By who
Date for completion
Date completed
Sign
6.11. Further comments / observations:

Section 7

7 - Sharps Safety

7.1. Does your area have a sharps box?
Action required
By who
Date for completion
Date completed
Sign
7.2. Are sharps bins wall mounted on an appropriate bracket (as provided by the sharps bin manufacturer)?
Action required
By who
Date for completion
Date completed
Sign
7.3. Are sharps containers stored on the floor when not in use?
Action required
By who
Date for completion
Date completed
Sign
7.4. Are all sharps bins correctly labelled and do they state that they comply with BS7320/UN3291 ?
Action required
By who
Date for completion
Date completed
Sign
7.5. Are all sharps bins no more than three quarters full?
Action required
By who
Date for completion
Date completed
Sign
7.6. Is there a poster available explaining what to do in the event of a sharps injury?
Action required
By who
Date for completion
Date completed
Sign
7.7. Are needles discarded without being re sheathed?
Action required
By who
Date for completion
Date completed
Sign
7.8. Further comments / observations:

Section 8

8. Personal Protective Clothing

8.1. Do you have access to all appropriate PPEs for the work/tasks carried out at the service?
Action required
By who
Date for completion
Date completed
Sign
8.2. Gloves?
Action required
By who
Date for completion
Date completed
Sign
8.3. Aprons?
Action required
By who
Date for completion
Date completed
Sign
8.4. Facemasks?
Action required
By who
Date for completion
Date completed
Sign
8.5. Goggles?
Action required
By who
Date for completion
Date completed
Sign
8.6. Are gloves and aprons wall mounted in appropriate areas?
Action required
By who
Date for completion
Date completed
Sign
8.7. Further comments / observations:

Section 9

9.. Blood and Body Fluid Spillages

9.1. Do you have a blood and body fluid spillages kit?
Action required
By who
Date for completion
Date completed
Sign
9.2. Are all staff aware of how to manage blood/body fluid spills?
Action required
By who
Date for completion
Date completed
Sign
9.3. Are all staff aware of what to do in the event of a splash with body fluids, particularly if it enters mucous membranes?
Action required
By who
Date for completion
Date completed
Sign
9.4. Is clean linen stored in its own separate cupboard?
Action required
By who
Date for completion
Date completed
Sign
9.5. Is clean linen free from stains ? (Check random sample)
Action required
By who
Date for completion
Date completed
Sign
9.6. Is there a separate storage area for soiled/used linen?
Action required
By who
Date for completion
Date completed
Sign
9.7. Do you have dissolvable red bags for infected linen or linen heavily contaminated with blood or body fluids?
Action required
By who
Date for completion
Date completed
Sign
9.8. Does your washing machine/tumble drier have a maintenance contract in place?
Action required
By who
Date for completion
Date completed
Sign
9.9. Are pillows enclosed in washable imperious covers?
Action required
By who
Date for completion
Date completed
Sign
9.10. Are hand washing facilities available in the laundry room?
Action required
By who
Date for completion
Date completed
Sign
9.11. Further comments / observations:

Section 10

10. Training and Education

10.1. Have all staff had an annual Infection Control update training session within the last year?
Action required
By who
Date for completion
Date completed
Sign
10.2. Do all new staff view the prevention and control of infection DVD?
Action required
By who
Date for completion
Date completed
Sign
10.3. Do you have access to the infection control handbook?
Action required
By who
Date for completion
Date completed
Sign
10.4. Further comments / observations:

Section 11

11. Domestic Store

11.1. Are surfaces and fittings in good repair?
Action required
By who
Date for completion
Date completed
Sign
11.2. Is the floor clean, dust free and free from spillages?
Action required
By who
Date for completion
Date completed
Sign
11.3 Is there a dedicated sink available for cleaning equipment?
Action required
By who
Date for completion
Date completed
Sign
11.4 Is there a dedicated hand washing sink?
Action required
By who
Date for completion
Date completed
Sign
11.5. Is liquid soap available and is the dispenser clean?
Action required
By who
Date for completion
Date completed
Sign
11.6. Are disposable paper hand towels available in wall mounted dispensers?
Action required
By who
Date for completion
Date completed
Sign
11.7 Are only items for the purpose of cleaning stored in the room?
Action required
By who
Date for completion
Date completed
Sign
11.8 Is protective clothing available e.g. plastic aprons and gloves?
Action required
By who
Date for completion
Date completed
Sign
11.9 Are cleaning agents suitably stored in a locked cupboard?
Action required
By who
Date for completion
Date completed
Sign
11.10 Is the equipment used by the domestic staff clean, well maintained and stored securely?
Action required
By who
Date for completion
Date completed
Sign
11.11 Are mop heads laundered daily?
Action required
By who
Date for completion
Date completed
Sign
11.12 Are mop heads stored upright?
Action required
By who
Date for completion
Date completed
Sign
11.13 Are rubber gloves stored in a clean and dry place?
Action required
By who
Date for completion
Date completed
Sign
11.14 Are buckets stored inverted in a clean and dry place?
Action required
By who
Date for completion
Date completed
Sign
11.15 Are colour coded mops, heavy duty gloves, and disposable cloths used appropriately? RED - Toilets and bathrooms GREEN - Kitchens BLUE - General use areas YELLOW - Isolation rooms/areas
Action required
By who
Date for completion
Date completed
Sign
11.16 Are cleaning schedules available?
Action required
By who
Date for completion
Date completed
Sign
11.17 Further comments / observations:

Section 12

12. Sluice Room

12.1 are surfaces and fittings clean dry and free from spillages?
Action required
By who
Date for completion
Date completed
Sign
12.2 Is there a sink for washing equipment?
Action required
By who
Date for completion
Date completed
Sign
12.3 Is there a dedicated hand washing sink?
Action required
By who
Date for completion
Date completed
Sign
12.4 Is there a wall mounted antiseptic scrub/liquid soap dispenser and is it clean?
Action required
By who
Date for completion
Date completed
Sign
12.5 Are disposable paper hand towels available in wall mounted dispensers?
Action required
By who
Date for completion
Date completed
Sign
12.6 Are waste disposal facilities appropriate?
Action required
By who
Date for completion
Date completed
Sign
12.7 Is the bedpan washer/macerator clean and functioning?
Action required
By who
Date for completion
Date completed
Sign
12.8 Is the bedpan rack clean?
Action required
By who
Date for completion
Date completed
Sign
12.9 Are bedpan holders and jugs stored inverted and clean?
Action required
By who
Date for completion
Date completed
Sign
12.10 Are chemical reagents stored in a locked cupboard?
Action required
By who
Date for completion
Date completed
Sign
12.13 Further comments / observations:

Section 13

13. Cleaning and Disinfection

13.1 Is general purpose neutral detergent available?
Action required
By who
Date for completion
Date completed
Sign
13.2 Are chlorine releasing disinfectants available e.g. Chlorine spillage kits?
Action required
By who
Date for completion
Date completed
Sign
13.3 Are disinfectants used in accordance with the manufacturers instructions?
Action required
By who
Date for completion
Date completed
Sign
13.4 Are carpets stain and bleach resistant?
Action required
By who
Date for completion
Date completed
Sign
13.5 Are cleaning and dissecting agents stored appropriately?
Action required
By who
Date for completion
Date completed
Sign
13.6 Are spillages of blood/body fluids appropriately cleaned and disinfected?
Action required
By who
Date for completion
Date completed
Sign
13.7 Are medical devices marked as single use only not re-used?
Action required
By who
Date for completion
Date completed
Sign
13.8 Are decontamination guidelines available and staff able to access them?
Action required
By who
Date for completion
Date completed
Sign
13.9 Are COSHH Data sheets available for disinfectants and detergents?
Action required
By who
Date for completion
Date completed
Sign
13.10 Are non sterile gloves available when disinfectants are used?
Action required
By who
Date for completion
Date completed
Sign
13.11 Further comments / observations:

Audit Criteria

Audit Criteria and Additional Comments:

Number of records inspected during this audit.
Details of records inspected during this audit
How many corrective actions were raised from this audit?
Audit Completed By:
Review Date
Audit Reviewed By:

Infection Control Audit Tool with Action Plan

Go digital today!

Convert your paper checklists into digital forms

1 - Overview

2 - Management of The Environment

3 Kitchen Areas

4 Hand Hygiene

5 Waste Management

6 Care of Equipment

7 - Sharps Safety

8. Personal Protective Clothing

9.. Blood and Body Fluid Spillages

10. Training and Education

11. Domestic Store

12. Sluice Room

13. Cleaning and Disinfection

Audit Criteria and Additional Comments:

Related checklists

Infection Control Audit Tool with Action Plan

Free Infection Control Audit Tool with Action Plan Checklist

Go digital today!

Convert your paper checklists into digital forms

1 - Overview

2 - Management of The Environment

3 Kitchen Areas

4 Hand Hygiene

5 Waste Management

6 Care of Equipment

7 - Sharps Safety

8. Personal Protective Clothing

9.. Blood and Body Fluid Spillages

10. Training and Education

11. Domestic Store

12. Sluice Room

13. Cleaning and Disinfection

Audit Criteria and Additional Comments:

Related checklists