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.

1.1. Housekeeping

Hand Hygiene

• 1.1. Awareness about the importance of hand hygiene?

  Yes

  No

  N/A

• 1.2. Houskeeping staff perfrom hand washing before and after the procedure?

  Yes

  No

  N/A

• 1.3. Availability of liquid soap dispenser with approved soap only?

  Yes

  No

  N/A

Personal Protective Equipment

• 1.4. Awareness about the importance of PPE?

  Yes

  No

  N/A

• 1.5. Wearing appropriate PPE during cleaning procedure?

  Yes

  No

  N/A

Cleaning and Disinfecting Procedure

• 1.6. Educated and well oriented about the proper flow of cleaning (cleanest to dirtiest)?

  Yes

  No

  N/A

• 1.7. Takin into consideration the type of housekeeping surface when cleaning (high-touch and low-touch surface)?

  Yes

  No

  N/A

• 1.8. Consider the nature of the item/space to be disinfected/cleaned?

  Yes

  No

  N/A

• 1.9. Thorough cleaning before disinfecting of surface observed?

  Yes

  No

  N/A

• 2.0. Observe duration and temperature of germicide contract?

  Yes

  No

  N/A

Chemical Used

• 2.1. Accessibility of MSDS "Material Safety Data Sheet"?

  Yes

  No

  N/A

• 2.2. Correct and updated labels of chemicals used?

  Yes

  No

  N/A

• 2.3. Exact dilution of chemicals for cleaning and disinfecting in practice?

  Yes

  No

  N/A

• 2.4. Proper placement of chemical solution is evident?

  Yes

  No

  N/A

Spill Kit

• 2.5. Orientation and training about CODE BROWN (type of spill and kit)?

  Yes

  No

  N/A

• 2.6. Availability of spill kits on respective area?

  Yes

  No

  N/A

• 2.7. Up to date chemicals and single used PPE inside the kit were checked at least once a week?

  Yes

  No

  N/A

Cleaning Equipment

• 2.8. Mops with detachable head and sent for laundry daily or if contaminated?

  Yes

  No

  N/A

• 2.9. Buckets were cleaned dried after use?

  Yes

  No

  N/A

• 2.10. Daily washing and drying of reusable gloves?

  Yes

  No

  N/A

Linen Management

• 2.11. Linens placed in an impermeable designated and closed bag?

  Yes

  No

  N/A

• 2.12. Proper segregation on different hampers?

  Yes

  No

  N/A

• 2.13. Observed close doors at housekeeping dirty stock room?

  Yes

  No

  N/A

• 2.14. Arranged/organized clean linens at clean linen stock room?

  Yes

  No

  N/A

• 2.15. Inventory recording for laundry in practice?

  Yes

  No

  N/A

Waste Management

• 2.16. Collection of waste according yo quality?

  Yes

  No

  N/A

• 2.17. Collection of waste at 3/4 full?

  Yes

  No

  N/A

• 2.18. Changing of new waste bin bag after waste collection?

  Yes

  No

  N/A

Personnel Hygiene

• 2.19. Wear clean clothes daily?

  Yes

  No

  N/A

• 2.20. Clean shaven shower daily?

  Yes

  No

  N/A

• 2.21. No spitting anywhere and inside facility?

  Yes

  No

  N/A

• 2.22. Food and drinks should be taken in the designated room?

  Yes

  No

  N/A

Additional Comments

• Additional Comments

Recommendations

• Inspector's Signature

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• Received by:

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