Infection Control Monitoring

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Previous Inspection

• Has the last inspection been reviewed?

• Details

Managers - Infection Control performed an inspection of your unit. Please review your survey and document your Plan of Correction next to each deficiency.

1.0 Hand Hygiene

• 1.1. Hand sanitizer is available and accessible for the patients and visitors in all waiting areas?

  Yes

  No

  N/A

• 1.2. Available liquid soap within all treatment rooms?

  Yes

  No

  N/A

• 1.3. Wall mounted paper towels available near each sink?

  Yes

  No

  N/A

• 1.4. Free from bar soaps?

  Yes

  No

  N/A

• 1.5. Posters in appropriate locations demonstrating good handwashing techniques?

  Yes

  No

  N/A

• 1.6. Clinical staff able to demonstrate good handwashing techniques?

  Yes

  No

  N/A

• 1.7. Staff able to apply 5 moments of hand hygiene?

  Yes

  No

  N/A

2.0. Environment

• 2.1. Overall appearance of the environment is tidy and uncluttered with only appropriate, clean and well maintained furniture used?

  Yes

  No

  N/A

• 2.2. Tables are tidy and uncluttered to enable effective cleaning?

  Yes

  No

  N/A

• 2.3. Chairs are free from rips and tears?

  Yes

  No

  N/A

• 2.4. All dispensers, holders and all parts of the surfaces of dispensers of soap and alcohol gels, paper towel are visibly clean with no body substances, dust, dirt or debris or adhesive tape?

  Yes

  No

  N/A

• 2.5. The complete floor, including edges and corners are visibly clean with no visible body substances, dirt, dust or debris?

  Yes

  No

  N/A

3.0. Waste management

• 3.1. Waste containers, clean, operational and in good condition?

  Yes

  No

  N/A

• 3.2. Waste containers covered with labels?

  Yes

  No

  N/A

• 3.3. There is evidence that staff are segregating waste correctly?

  Yes

  No

  N/A

• 3.4. Staff are aware of the waste segregation procedures?

  Yes

  No

  N/A

• 3.5. There is evidence that the waste contractor is registered with a valid license (check records).

  Yes

  No

  N/A

4.0. Storage Room

• 4.1. Floor and walls clean?

  Yes

  No

  N/A

• 4.2. Horizontal and vertical surfaces are clean?

  Yes

  No

  N/A

• 4.3. Bottom shelf is solid?

  Yes

  No

  N/A

• 4.4. No supplies stored 6" from the floor?

  Yes

  No

  N/A

• 4.5. No supplies stored touching 18" from the ceiling

  Yes

  No

  N/A

5.0. Spillage and/or Contamination with Blood and Body Fluids

• 5.1. Staff are aware of procedures for dealing with body fluid spillages?

  Yes

  No

  N/A

• 5.2. Staff have been checked for hepatitis titer?

  Yes

  No

  N/A

• 5.3. Dedicated blood and body fluid spillage kits are available for decontaminating and cleaning body fluids and are in date?

  Yes

  No

  N/A

6.0. Medications/Vaccines

• 6.1. No outdated items and medicines?

  Yes

  No

  N/A

• 6.2. Regulated drugs/medicines are monitored and updated?

  Yes

  No

  N/A

• 6.3. The vaccine refrigerator is fit for purpose and is not a domestic refrigerator?

  Yes

  No

  N/A

• 6.4. The refrigerator vaccine shows maximum and minimum temperatures?

  Yes

  No

  N/A

• 6.5. Temperature checks are performed and recorded daily?

  Yes

  No

  N/A

• 6.6. All vaccines are in date?

  Yes

  No

  N/A

Additional Comments

• Additional Comments

Recommendations

• Inspector's signature

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• Received by:

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