Infection Control Environmental Rounds

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Admitting

• Horizontal and vertical surfaces are clean.

  Yes

  No

  N/A

• Trash cans not over filled.

  Yes

  No

  N/A

• Hand hygiene products available.

  Yes

  No

  N/A

• PPE available. Appropriate PPE used by staff.

  Yes

  No

  N/A

• Sharps containers less than 3/4 full.

  Yes

  No

  N/A

• Sharps containers are on IV trays.

  Yes

  No

  N/A

• IV start trays clean.

  Yes

  No

  N/A

• Medication preparation area clean, organized and ready for use.

  Yes

  No

  N/A

ENDO

• Horizontal and vertical surfaces are clean.

  Yes

  No

  N/A

• Trash cans and linen hampers not over filled. Trash and linen handled per policy. Suction canisters are handled per policy.

  Yes

  No

  N/A

• Hand hygiene products available.

  Yes

  No

  N/A

• PPE available. Appropriate PPE used by staff

  Yes

  No

  N/A

• Sharps containers less than 3/4 full.

  Yes

  No

  N/A

• Sharps containers secured properly.

  Yes

  No

  N/A

• Scope cleaning is done according to manufacturer's instructions.

  Yes

  No

  N/A

• Scopes are labeled and stored according to policy.

  Yes

  No

  N/A

• Bathroom is clean.

  Yes

  No

  N/A

• No paper supplies or patient care items stored under sinks.

  Yes

  No

  N/A

• Procedure room, including Anesthesia Carts, are cleaned and disinfected between patients.

  Yes

  No

  N/A

• Safe medication preparation and administration practices are followed. IV bags are not spiked more than 1 hour prior to use.

  Yes

  No

  N/A

• DSD's are maintained and operated according to manufacturer's instructions. Logs are maintained.

  Yes

  No

  N/A

• Procedure rooms are terminally cleaned at the end of the day.

  Yes

  No

  N/A

OR

• Horizontal and vertical surfaces are clean.

  Yes

  No

  N/A

• Trash cans and linen hampers are emptied between each case (PE tubes exempt). Trash and linen handled per policy.

  Yes

  No

  N/A

• Hand hygiene products available.

  Yes

  No

  N/A

• PPE available. Appropriate PPE used by staff

  Yes

  No

  N/A

• Sharps containers less than 3/4 full.

  Yes

  No

  N/A

• Sharps containers secured properly.

  Yes

  No

  N/A

• No paper supplies or patient care items stored under the sink.

  Yes

  No

  N/A

• Safe medication preparation and administration practices are followed.

  Yes

  No

  N/A

• Operating room, including Anesthesia Carts, are cleaned and disinfected between patients.

  Yes

  No

  N/A

• Containers are securely closed for transport.

  Yes

  No

  N/A

• All OR's are terminally cleaned at the end of the day.

  Yes

  No

  N/A

• Sterilizers are tested daily according to manufacturer's instructions.

  Yes

  No

  N/A

• Sterile processing and storage is done according to policy.

  Yes

  No

  N/A

• Cidex trays have expiration date and are not expired.

  Yes

  No

  N/A

• Log books are complete and up to date. Cidex test strips, biological indicators, immediate use, chemical indicators, mechanical indicators

  Yes

  No

  N/A

• Sterilization equipment is in good working condition

  Yes

  No

  N/A

• Preventive maintainance program is in place for sterilizers.

  Yes

  No

  N/A

• Employee protection measures are implemented during sterile processing.

  Yes

  No

  N/A

• Event related sterilization packaging is used.

  Yes

  No

  N/A

• Surgical teams are observed during procedure and masks are securely in place prior to entering the OR.

  Yes

  No

  N/A

• All head and facial hair is covered.

  Yes

  No

  N/A

• Doors are completely closed.

  Yes

  No

  N/A

• Time out process completed according to policy.

  Yes

  No

  N/A

PACU

• Horizontal and vertical surfaces are clean.

  Yes

  No

  N/A

• Trash cans and linen hampers not over filled. Trash and linen handled per policy.

  Yes

  No

  N/A

• Hand hygiene products available.

  Yes

  No

  N/A

• PPE available. Appropriate PPE used by staff

  Yes

  No

  N/A

• Sharps containers less than 3/4 full.

  Yes

  No

  N/A

• Sharps containers secured properly.

  Yes

  No

  N/A

• Glucose monitor clean and only one time use lancets are available.

  Yes

  No

  N/A

• Bathrooms are clean.

  Yes

  No

  N/A

• No paper supplies or patient care items stored under the sink.

  Yes

  No

  N/A

• Crash Cart checked.

  Yes

  No

  N/A

• Medication preparation area clean, organized and ready for use.

  Yes

  No

  N/A

• Safe medication preparation and administration practices are followed.

  Yes

  No

  N/A

• Patient bays and carts are cleaned and disinfected according to procedure between each patient.

  Yes

  No

  N/A

DWA

• Horizontal and vertical surfaces are clean.

  Yes

  No

  N/A

• Trash cans not over filled.

  Yes

  No

  N/A

• Hand hygiene products available.

  Yes

  No

  N/A

• PPE available. Appropriate PPE used by staff.

  Yes

  No

  N/A

• Food stored and distributed according to policy. Food area clean.

  Yes

  No

  N/A

• Preventing SSI included in patient discharge instructions.

  Yes

  No

  N/A

• No paper supplies or patient care items stored under the sink.

  Yes

  No

  N/A

Nurses stations

• Horizontal and vertical surfaces are clean and free of clutter.

  Yes

  No

  N/A

• No food present, only drinks with lids.

  Yes

  No

  N/A

• Hand hygiene products available.

  Yes

  No

  N/A

Linen

• Clean linens are in good condition.

  Yes

  No

  N/A

• Clean linen is stored in a covered cart.

  Yes

  No

  N/A

• Soiled linen bagged for transport.

  Yes

  No

  N/A

• Soiled linen hampers have impervious liner or are emptied regularly.

  Yes

  No

  N/A

• Soiled linen is removed from building on a regular schedule.

  Yes

  No

  N/A

• Clean and dirty linen are kept separate.

  Yes

  No

  N/A

Hazardous/biological waste

• Door is labeled. Biohazard symbol on door. Emergency call button operational.

  Yes

  No

  N/A

• Waste containers have correct emblem, are dated and bags are correctly tied and closed.

  Yes

  No

  N/A

• Room is clean and uncluttered.

  Yes

  No

  N/A

• OSHA compliant storage containers are used. Including sharps containers.

  Yes

  No

  N/A

• Pick up for transfer is on a specified schedule.

  Yes

  No

  N/A

• Containers are not overfilled.

  Yes

  No

  N/A

• Appropriate waste manifests are maintained.

  Yes

  No

  N/A

• Red bags are available in each regulated medical waste container.

  Yes

  No

  N/A

• Eye wash station is available.

  Yes

  No

  N/A

Trash

• Door is labeled. Room is clean and uncluttered. Trash is in appropriate bag.

  Yes

  No

  N/A

• Pick up for transfer is on a specified schedule.

  Yes

  No

  N/A

Clean Storage areas - clean utility, equipment, sterile items, supplies, receiving,

• Horizontal and vertical surfaces are clean. Area is clean and uncluttered.

  Yes

  No

  N/A

• Items are clean and ready to use.

  Yes

  No

  N/A

• Supplies are at least 18 inches from the ceiling and 6 inches from the floor.

  Yes

  No

  N/A

• No patient care items or paper products are stored under sinks.

  Yes

  No

  N/A

Refrigerators

• Daily temperature is checked and recorded appropriately on medication refrigerators. Correct temp range 36-46F

  Yes

  No

  N/A

• Refrigerators have single uses. Medication, Staff Food, Patient Supplies. No batteries should be stored in the refrigerator.

  Yes

  No

  N/A

• Items are appropriately labeled.

  Yes

  No

  N/A

• Refrigerators are routinely cleaned and cleaning is documented.

  Yes

  No

  N/A

Halls

• Uncluttered

  Yes

  No

  N/A

• Floors and walls are clean.

  Yes

  No

  N/A

• No stained ceiling tiles.

  Yes

  No

  N/A

• Unobstructed access to exits.

  Yes

  No

  N/A

Offices/reception

• Horizontal and vertical surfaces and floors are clean.

  Yes

  No

  N/A

• Trash / recycle is not overflowing.

  Yes

  No

  N/A

• Area in uncluttered.

  Yes

  No

  N/A

Waiting room

• Horizontal, vertical surfaces and floors are clean.

  Yes

  No

  N/A

• Trash is not overflowing.

  Yes

  No

  N/A

• Coffee area is clean.

  Yes

  No

  N/A

• Area is uncluttered.

  Yes

  No

  N/A

Bathrooms

• All surfaces are clean.

  Yes

  No

  N/A

• Hand washing supplies are available.

  Yes

  No

  N/A

• Trash not overflowing.

  Yes

  No

  N/A

Hand Hygiene

• Sinks for handwashing are appropriately stocked with soap, paper towels and waste can.

  Yes

  No

  N/A

• Sinks are available in all areas. If not available, Alcohol hand rubs are available.

  Yes

  No

  N/A

• Alcohol hand rubs are availalbe near patient care areas and other areas as needed.

  Yes

  No

  N/A

• Placement of alcohol hand rubs comply with regulations.

  Yes

  No

  N/A

• Hand hygiene is monitored for staff compliance.

  Yes

  No

  N/A

• HCW do not wear artificial nails. Nail polish is less than 4 days old.

  Yes

  No

  N/A

• Only hospital approved hand lotion is available, so glove protection is not compromised.

  Yes

  No

  N/A

Staff Knowledge

• Staff know how to access policies and procedures.

  Yes

  No

  N/A

• Staff demonstrate proper hand hygiene technique.

  Yes

  No

  N/A