Information
-
Audit Title
-
Document No.
-
Unit/Department
-
Unit/Department Director
-
Conducted on
-
Prepared by
Managers, Biannual infection control rounds are made in conjunction with EOC rounds. Below is a list of Infection Control's findings. Please review the findings and correct any deficiencies noted.
1.0 Hand Hygiene
-
1.1. Hand washing sinks are available in all areas as needed?
-
1.2. Hand washing sinks are well stocked with soap and paper towels?
-
1.3. Alcohol-based Hand Rub is available in all areas as needed?
-
1.4. Alcohol-based Hand Rub dispensers are not empty?
-
1.5. Placement of Alcohol-based Hand Rub dispensers is compliant with safety regulations?
-
1.6. Hand Hygiene reminder posters are present?
-
1.7. Is this area free of additional findings?
2.0. Clean Utility/Clean Supply Storage /Linen Storage
-
2.1. Clean linen cart is covered?
-
2.2. Clean linen cart has solid surface on bottom shelf?
-
2.3. Under sink storage area empty and clean?
-
2.4. Ceiling tiles are not stained or wet?
-
2.5. Storage shelving or bins are clean and free of dust?
-
2.6. Air intake vents and diffusers are clean?
-
2.7. Supplies are stored at least 6 inches off of the floor and not within 18 inches of the ceiling?
-
2.8. Out of date supplies are not present?
-
2.9. Outside shipping boxes are not present?
-
2.10. No dirty patient care items are stored in this area?
-
2.11. Is this section is free of additional findings?
3.0. Soiled Linen / Dirty Utility Room
-
3.1. Biohazard symbol on door of biomedical waste storage?
-
3.2. Items are stored at least 6 inches off of the floor and 18 inches from the ceiling?
-
3.3. Walls and floors are clean?
-
3.4. Ceiling tiles are not discolored/ wet/ missing / damaged?
-
3.5. Clean items are not stored in soiled utility room?
-
3.6 Is this section free of additional findings?
4.0 Patient Nutrition Area
-
4.1. Floors and walls clean?
-
4.2. Countertops are clean?
-
4.3. Microwave oven is clean?
-
4.4. Refrigerator is clean and thawed of ice?
-
4.5. Under sink is clean and without storage?
-
4.6. Patient refrigerator is labeled for patient use only?
-
4.7. Temperature checks are documented with corrective action when temp is out of range?
-
4.8. Patient food is labeled appropriately with no expired food found?
-
4.9. Ice machine is clean?
-
4.10. There is no evidence of pest present?
-
4.11. Is this section free of additional findings?
5.0 Patient Rooms
-
5.1. Horizontal surfaces are clean?
-
5.2 Trash cans or waste basket are not overfilled or overflowing?
-
5.3. Bathrooms are clean?
-
5.4. Soap and paper towels are available in each bathroom?
-
5.5. PPE is available as needed?
-
5.6. Patient equipment is clean?
-
5.7. No visible soil on vertical surfaces?
-
5.8. Ceiling tiles are not discolored, wet, missing, or damaged?
-
5.9. Air intake vents and diffusers are clean?
-
5.10. Furniture (chairs, sleepers) are without tears or wear?
-
5.11. Mattress pad is without tears or puncture holes?
-
5.12. Floors are clean?
-
5.13. Sharp containers are no more than 3/4 full?
-
5.14. IV pumps and poles, feeding pumps etc. are clean?
-
5.15. There is no evidence of pest present?
-
5.16. Clean/dirty linen handled is appropropriatly?
-
5.17. No signs of mildew or mold present?
-
5.18. Is this area free of additional findings?
6.0. Employee Breakroom
-
6.1. Floors and walls are clean?
-
6.2. Countertops and vertical surfaces are clean?
-
6.3. Microwave oven is clean?
-
6.4. Refrigerator is clean and thawed of ice?
-
6.5. Under sink area is clean and without storage?
-
6.7. Is this section free of additional findings?
7.0 Medication Room
-
7.1. Floors and walls are clean?
-
7.2. Countertop and work surfaces are clean?
-
7.3.. Medication Room refrigerator is clean and without ice?
-
7.4.. There are no expired products found (IV solutions, medications, sterile items, etc.)
-
7.5. Is this section free of additional findings?
8.0 Waiting Areas
-
8.1. Area generally clean (without dust, clutter or debris)?
-
8.2. Respiratory hygiene products (e.g. masks, tissues, hand gel) are available?
-
8.3. Are "Cover Your Cough" signs are posted?
-
8.4. Vistor restrooms are clean?
-
8.5. Is this section free of additional findings?
9.0 Nurses Station
-
9.1 Staff are not eating or drinking in areas where lab specimens are located?
-
9.2. Staff drinks are covered in areas where drinking is permitted outside the breakroom?
-
9.3. Staff are not using personal hand lotion?
-
9.4. Is this section free of additional findings?
10. Logs
-
10.1. Temperature checked BID for vaccine/medication storage?
-
10.2. Daily refrigerators checks with corrective actions as needed?
-
10.3. Glucose meter strips dated?
-
10.4. Smoke testing for negative pressure rooms are documented daily when patient with suspective or active TB is occupying the room?
-
10.5. Is this section free of additional findings.
11. Isolation Rooms and Precautions
-
11.1. Appropriate signage in place?
-
11.2. Supplies and PPE's available?
-
11.3. Safe zones are appropriately marked with red tape on the floor?
-
11.4. Doors are closed as appropriate in negative pressure rooms?
-
11.5. Negative pressure visual monitor is funtioning correctly?
-
11.6. Staff is wearing appropriate PPE?
-
11.7. Visitors are wearing appropriate PPE?
-
11.8. Is this section free of additional findings?
12. Employee General Knowledge
-
12.1. Employees know the procedure reporting a bloodborn pathogen exposure?
-
12.2. Personnel can locate their Infection Control Manual?
-
12.3. Personnel can state the 5 moments of hand hygiene?
-
12.4. Is this section free of additional findings?
Additional Comments
-
Additional Comments
-
Surveyor's Signature
