Infection Control Checklist - Care Homes

• Facility Name

• Conducted on

  Date

• Prepared by

• Location
  Address

Infection Control Policies:

• Are updated Infection Control policies reviewed and communicated to everyone?

  Met

  Not Met

  N/A

• Are copies of the manual accessible to team members in all units?

  Met

  Not Met

  N/A

• Has IPAC manual been reviewed annually in collaboration with JH&S Commitee?

  Met

  Not Met

  N/A

IPAC Program & Committee

• Is there a separate agenda and minutes?

  Met

  Not Met

  N/A

• Is there a dedicated IPAC bulletin/ visual display board? are the information up to date?

  Met

  Not Met

  N/A

• Is the IPAC inspection protocol completed at least annually?

  Met

  Not Met

  N/A

• Are there trained respirator fit testers available?

  Met

  Not Met

  N/A

• Are all team members N95 Fit tested at hire and every 2 years?

  Met

  Not Met

  N/A

• Are there at least 3 days of outbreak supply (PPE, Sanitizer and etc.) available?

  Met

  Not Met

  N/A

• Is there a designated staff member to co-ordinate the infection prevention and control program with education and experience in infection prevention and control practices including: (a) infectious disease (b) cleaning and disinfection (c) data collection

  Met

  Not Met

  N/A

• Are there names on every resident's personal item? <br>• Personal hygiene items (Toothbrushes, Combs and etc) <br>• Nail clippers <br>• Glucometers and eye drops

  Met

  Not Met

  N/A

• Do medications indicate expiry dates? i.e. injections, eyedrops etc..

  Met

  Not Met

  N/A

Screening & Immunization

• Is the policy influenza immunization followed?

  Met

  Not Met

  N/A

• Is the policy on Pneumonia and Tdap immunization followed?

  Met

  Not Met

  N/A

• Is the policy on TB screening followed?

  Met

  Not Met

  N/A

• Is the policy on MRSA, VRE & ESBL Screening followed?

  Met

  Not Met

  N/A

Surveillance program

• Is there surveillance sheet available in each home area and correctly filled out?

  Met

  Not Met

  N/A

• Are the data being monitored and validated daily?

  Met

  Not Met

  N/A

• Are the infections tracked monthly?

  Met

  Not Met

  N/A

• Are the data analyzed monthly?

  Met

  Not Met

  N/A

• Are the infection rates being calculated?

  Met

  Not Met

  N/A

• Is the correct data collection sheet in use?

  Met

  Not Met

  N/A

• Is the information, that was gathered on every shift about the residents’ infections, analyzed daily to detect the presence of infection and reviewed at least monthly to detect trends for the purpose of reducing the incidence of infections and outbreaks?

  Met

  Not Met

  N/A

• Is the surveillance data trended, analyzes and presented at IPAC meeting with action plan created?

  Met

  Not Met

  N/A

• Are the number of Residents with ARO in different units is calculated monthly?

  Met

  Not Met

  N/A

Outbreak

• Is the process for confirming the outbreak being followed?

  Met

  Not Met

  N/A

• Is the investigation checklist being followed?

  Met

  Not Met

  N/A

• Are the additional precautions implemented immediately for affected residents?

  Met

  Not Met

  N/A

• Is Outbreak Management team activated?

  Met

  Not Met

  N/A

• Are the department responsibilities being followed?

  Met

  Not Met

  N/A

• Is the Outbreak Management Team Meeting - Record of action being completed?

  Met

  Not Met

  N/A

• Is there a folder where all relevant documents related to outbreak filed?

  Met

  Not Met

  N/A

• Are there outbreak posters visible at every entrance?

  Met

  Not Met

  N/A

• Is high level disinfectant being used?

  Met

  Not Met

  N/A

Hand Hygiene (HH) program

• Is there a structured HH program is in place? <br>• HH Audit <br>• Team member to assist residents conduct HH before and after meal <br>• Team members to assist residents conduct HH before and after activity <br>• Calculating HH rates,data analyzed and action plan developed where appropriate <br>• Communicating rates with all team members <br>• Adequate nail and skin care <br>• Following policies regarding jewelry

  Met

  Not Met

  N/A

• Are there Alcohol Based Hand Rub (ABHR) at point of care?

  Met

  Not Met

  N/A

• Is the HH compliance before and after using gloves monitored?

  Met

  Not Met

  N/A

Personal protective Equipment (PPE)

• Is the algorithm for PPE donning and doffing followed?

  Met

  Not Met

  N/A

• Are there PPEs available on entrance to residents's room on additional precaution?

  Met

  Not Met

  N/A

• Is there a large enough garbage bin accessible with foot pedal available for residents on additional precaution, within the immediate area?

  Met

  Not Met

  N/A

Fridge Monitoring

• Is the medication fridge monitored and temperatures logged twice daily and action taken when out of range?

  Met

  Not Met

  N/A

• Is the vaccine fridge monitored and temperatures logged twice daily and action taken when out of range?

  Met

  Not Met

  N/A

• Is the specimen fridge monitored and temperatures logged twice daily and action taken when out of range?

  Met

  Not Met

  N/A

Education

• Are there annual in-services in addition to relias scheduled? (Flu, outbreak, IPAC gaps and etc.)

  Met

  Not Met

  N/A

• Are vendors, Public Health Unit and Public Health Ontario involved in education?

  Met

  Not Met

  N/A

• Is there documentation of training kept electronically or paper?

  Met

  Not Met

  N/A

Sharps discarder

• Are Safety Engineered needles in use?

  Met

  Not Met

  N/A

• Are the sharp discard containers closed before overfilling?

  Met

  Not Met

  N/A

• Are team members aware of sharp discard location?

  Met

  Not Met

  N/A

Environmental Hygiene

• Is there an environmental audit conducted on a regular basis? <br>• Audit Tools <br>• Monitoring system <br>• Evaluation and validation of data <br>• Communication to team members

  Met

  Not Met

  N/A

• Is the PPE donning and doffing steps properly followed?

  Met

  Not Met

  N/A

• Is the proper use of gloves being followed?

  Met

  Not Met

  N/A

• Soiled Utility, Clean Utility Rooms, Shower, Tub Room, Linen Room <br>• PPE availability <br>• kept locked inaccessible to residents. <br>• Spray nozzle removed

  Met

  Not Met

  N/A

• Are there any issue with pest infestation? (cockroaches, ants, mice and etc.)

  Met

  Not Met

  N/A

• Are the rooms visually clean? <br>• Privacy Curtain <br>• The Room <br>• The Bathroom

  Met

  Not Met

  N/A

Disinfection of Non-Critical items

• Is the Protocol for disinfection of non-critical items clear? <br>• Nail Clippers <br>• Other

  Met

  Not Met

  N/A

• Is the responsibility for disinfection of non-critical items clear between departments? (Raised toilet seats, Carbolizing beds, lift equipment and etc)

  Met

  Not Met

  N/A

• Is there schedule, protocol or monitoring method/checklist available?

  Met

  Not Met

  N/A

Disinfectant

• Is the care community aware of using the high level disinfectant during outbreak?

  Met

  Not Met

  N/A

• Are there education sessions on the use of disinfectant? <br>• Cleaning vs. Sanitizing vs. Disinfecting <br>• Sanitation vs. Low level disinfection vs. high level disinfection <br>• Dilution/ Titration, Contact time/ dwell time, Mechanical action / Friction <br>• How to read the label

  Met

  Not Met

  N/A

• Is there a sporicidal cleaner available immediately upon request?

  Met

  Not Met

  N/A

Laundry

• Are the clean and soiled areas segregated?

  Met

  Not Met

  N/A

• Is there PPE available in laundry?

  Met

  Not Met

  N/A

• Is there an ABHR available for team members?

  Met

  Not Met

  N/A

• Other <br>• Briefs separated from dirty cloths <br>• Bulk feces removed manually before sending to laundry <br>• Proper wipes are used to clean residents <br>• Personal belongings removed from clothing before sending to laundry <br>• Dirty bins disinfected daily?

  Met

  Not Met

  N/A

Kitchen

• Are there cleaning protocols in place?

  Met

  Not Met

  N/A

• Are all the temperatures (fridge, freezer, hot holding and etc.) checked and logged?

  Met

  Not Met

  N/A

• Are team members using proper aprons? (clothes are protected)

  Met

  Not Met

  N/A

• Is the previous Public Health visit report reviewed and followed up?

  Met

  Not Met

  N/A

Activity and Programs

• Are there plan of care available for pets?

  Met

  Not Met

  N/A

• Is there a schedule for cleaning equipment after activity?

  Met

  Not Met

  N/A

Influenza Season

• Are there education provided to team members?

  Met

  Not Met

  N/A

• Are IPAC Resources being used?

  Met

  Not Met

  N/A

• Are there scheduled influenza clinics?

  Met

  Not Met

  N/A

Other

• Are PPEs available for residents on additional precaution?

  Met

  Not Met

  N/A

• Are there proper signages available for residents on additional precaution?

  Met

  Not Met

  N/A

• Are there other areas that require attention?

  Yes

  No

• Add another area

Area

• Specify other area

• Did it meet the criteria?

  Met

  Not Met

  N/A

Completion

• Title, Name, and Signature of Inspector

  Sign