Infection Control - duplicate

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Cleanliness and Storage

• Storage closets are clean

  Yes

  No

  N/A

• Hospital approved disinfectant available

  Yes

  No

  N/A

• Mattresses are intact and clean

  Yes

  No

  N/A

• High level dusting

  Yes

  No

  N/A

• Nurses station is clean and uncluttered

  Yes

  No

  N/A

• Hallways are clean and uncluttered

  Yes

  No

  N/A

• Microwave/refreshment area is clean

  Yes

  No

  N/A

• Ceiling tiles are free of stains

  Yes

  No

  N/A

• Omnicell is clean

  Yes

  No

  N/A

• Medication cart/Omnicell is secured

  Yes

  No

  N/A

• Storage units have solid bottoms

  Yes

  No

  N/A

• Storage units/bins/shelving are clean

  Yes

  No

  N/A

• Supplies 8-10" above floor

  Yes

  No

  N/A

• Supplies are 18" below ceiling

  Yes

  No

  N/A

• No storage under sink

  Yes

  No

  N/A

• Supplies not stored where food is stored

  Yes

  No

  N/A

• No torn or compromised supplies

  Yes

  No

  N/A

• Supplies are clean and intact

  Yes

  No

  N/A

• Dirty items are separate from clean items

  Yes

  No

  N/A

• Clean utility room is clean

  Yes

  No

  N/A

• Dirty utility room is clean

  Yes

  No

  N/A

Expired Medications, Solutions, and Supplies

• Vacutainer tubes are not expired

  Yes

  No

  N/A

• Irrigation fluids labeled, discarded, not exp.

  Yes

  No

  N/A

• Multi-dose vials are labeled and not expired

  Yes

  No

  N/A

• Medications are not expired

  Yes

  No

  N/A

• Open drugs/spiked IVs are labeled per policy

  Yes

  No

  N/A

• Solutions are not expired

  Yes

  No

  N/A

• Sterile supplies are not expired

  Yes

  No

  N/A

• Sterile items are labeled with name visible

  Yes

  No

  N/A

• Food in storage is not expired

  Yes

  No

  N/A

General IC policies

• Staff can locate IC policies

  Yes

  No

  N/A

• Staff can explain what to do in the event of an exposure

  Yes

  No

  N/A

• Food, drinks, cosmetics not in patient care

  Yes

  No

  N/A

• PPE disposed in patient room

  Yes

  No

  N/A

• Handwashing before and after patient care

  Yes

  No

  N/A

• Appropriate use of gloves

  Yes

  No

  N/A

• Clean linen covered, door closed

  Yes

  No

  N/A

• Dirty linen hamper no more than 3/4 full

  Yes

  No

  N/A

• Dirty linen covered

  Yes

  No

  N/A

• Crash cart clean and uncluttered

  Yes

  No

  N/A

• Crash cart checked according to policy

  Yes

  No

  N/A

• Sharps container secured

  Yes

  No

  N/A

• Sharps containers no more than 3/4 full

  Yes

  No

  N/A

• Adherence to hand hygiene/artificial nail policy

  Yes

  No

  N/A

Refrigerators

• Refrigerator temperature logs are current

  Yes

  No

  N/A

• Food in refrigerator is labeled and dated

  Yes

  No

  N/A

• Refrigerator is clean/defrosted; rubber seals ok

  Yes

  No

  N/A

• Gaskets are clean

  Yes

  No

  N/A

• No employee food in patient refrigerator

  Yes

  No

  N/A

• No expired food in patient refrigerator

  Yes

  No

  N/A

• Medication refrigerator temperatures noted

  Yes

  No

  N/A

• Medication refrigerator clean and defrosted

  Yes

  No

  N/A

• Food not stored in medication refrigerator

  Yes

  No

  N/A

• Old medications have been discarded

  Yes

  No

  N/A

• Freezer temperature logs are current

  Yes

  No

  N/A