Title Page

  • Conducted on

  • Prepared by

Elements Observed

Hand Hygiene

  • There is an adequate number of soaps and sanitiser dispensers are available in the unit

  • Hand hygiene demonstration posters are available where ever required

  • Staff are performed hand hygiene when required as per the 5 moments

  • Hand washing sinks and taps are clean and without an overflow hole

  • There is no storage noted under the sink

Waste Management

  • All waste bins are clean and pedal operated

  • No waste bins are overfilled

  • Proper waste segregation is observed in the unit

Linen Management

  • Proper linen management observed in the unit

  • Linens hampers are not overfilled

  • All linens are free of stains

  • All soiled linens hampers are kept covered and placed in the dirty utility room

  • Alginate liners were placed in red hamper bags

Sharp safety

  • Sharp containers were placed where ever required

  • No sharp containers overfilled more than 3/4 of the volume

  • All sharp containers are labelled

  • Sharp containers were placed at an adequate height

  • No used or contaminated sharps discarded anywhere other than the sharp container

Patient Care items

  • All patient care supplies are clean and dust-free

  • sterile supplies are stored separately

  • All equipment is clean and free of stain and dust

  • Clean tag is present on where ever required

  • No expired supplies were noted in the unit

  • All multiuse supplies were labelled as per the facility policy

Storage of Supplies

  • No items were stored on the floor

  • No shipping cartons were stored in th unit

  • Recommended distance from the floor, wall and ceiling observed while storing the supplies

  • FIFO is practised in the unit

Maintaining the Logs

  • Temperature /Humidity log was maintained daily

  • Differential air pressure log was maintained

  • Fridge /Freezer log is maintained

  • Adequate number of hygrometers are available and working in order

  • other related checklists were maintained if any specify ......................

Environmental Cleaning /Maintenance

  • The unit is clean, free of dust and clutter

  • wall, floor and ceiling, A/C vents are clean free of satins

  • All countertops, cabinets are dust-free

  • patient room and restrooms are well maintained

  • staff pantries are clean, maintained well

  • Curtains are free of satin laundered atleast monthly

  • Pneumatic stations are free of dust and canisters are clean

  • No food has seen in the clinical area

  • Disinfecting wipes are available where ever required

  • Recommended water /Air quality studies were conducted

  • The unit is free of pests

  • All equipment has periodic maintenance records

Clean /Dirty utilities

  • Biohazard spill kit is available in the unit

  • The unit has designated clean and dirty utility rooms

  • clean supplies are only stored in clean utility

  • DU only contains waste, soiled linen, contaminated CSSD instruments

  • Pre - foam is available in the DU room

  • Transporation boxes contain biohazard sticker

  • Colour coded mopes/towels are available

  • Automated chemical mixing available

  • All housekeeping chemicals are labelled

  • Eyewash station is available

Fridge /Freezers /ovens

  • The log is maintained for fridge and freezers

  • No food or other items were stored in a medication fridge

  • No medications stored in the food fridge

  • fridges are cleaned weekly / Defrosted periodically

  • Ovens are clean and stain-free

Isolation Precautions

  • precaution signage was placed in an isolation room

  • Negative air pressure within the reference range

  • Designated isolation cart is available

  • staffs observed with recommend PPE

  • No shortage for PPE in the unit

  • Designated equipment/supplies are available for the patient

  • Communicable disease was notified to DOH

Staff Awareness

  • Staff know 5 moments of hand hygiene and proper hand hygiene technique

  • Staff Know how to manage exposure to blood and body fluids and spill management

  • Satffs knows about HAI reporting and HAI prevention bundles

  • Staff know about Donning and Doffing of PPE

  • Staff knows about communicable disease notification to DOH

  • Staff able to locate the IC policies and forms

Covid -19

  • Unit observed the recommended covid - 19 Precautions

  • Daily staffs monitoring records available

  • Staffs are aware of the current updated Covid -19 guidelines


  • All staffs completed the infection control training at least annually

  • Staff offered Respiratory protection program

Additional Findings

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