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. Waste Management

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

  Yes

  No

  N/A

• 2.2. Waste containers covered and with labels?

  Yes

  No

  N/A

• 2.3. Contaminated instruments or disposables placed on designated area not mixed with clean items?

  Yes

  No

  N/A

• 2.4. Regulated medical waste discarded appropriately?

  Yes

  No

  N/A

• 2.5. Waste clearly segregated?

  Yes

  No

  N/A

• 2.6. Sharp containers secured and labeled appropriately?

  Yes

  No

  N/A

• 2.7. Sharp bins not mixed with any general/biomedical waste?

  Yes

  No

  N/A

• 2.8. Sharp containers are no more than 3/4 full?

  Safe

  At Risk

  N/A

• 2.9. Staffs are aware not to bend, recap ore remove contaminated needle or sharps unless it is absolutely necessary?

  Yes

  No

  N/A

3.0 Medications/ Items

• 3.1. No outdated IV solutions, items and medicines?

  Yes

  No

  N/A

• 3.2. Open vials dated and times as per policy?

  Yes

  No

  N/A

• 3.3. Safe injection practices followed as per policy?

  Safe

  At Risk

  N/A

• 3.4. Out of date sterile supplies are not present?

  Yes

  No

  N/A

• 3.5. Double pouch for sharp instruments applied?

  Yes

  No

  N/A

• 3.6. Correct temperature observed? <br> Medications: 36-46 Fahrenheit

  Yes

  No

  N/A

4.0. Utility and Storage Room

• 4.1. Floors and walls clean?

  Yes

  No

  N/A

• 4.2. Horizontal and vertical surfaces are clean?

  Yes

  No

  N/A

• 4.3. Adequate separation of clean and soiled?

  Yes

  No

  N/A

• 4.4. Bottom shelf is solid?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 4.6. No supplies stored touching the 18" from the ceiling?

  Yes

  No

  N/A

• 4.7. No supplies stored in the dirty utility room?

  Yes

  No

  N/A

• 4.8. Soiled linen is bagged accordingly?

  Yes

  No

  N/A

5.0. Nurses Station/ Medication Room

• 5.1. Unit/ Area generally clean (without dust, clutter or debris)?

  Yes

  No

  N/A

• 5.2. Unused patient equipment/supplies are stored and handled appropriately?

  Yes

  No

  N/A

• 5.3. Medication are handled appropriately?

  Yes

  No

  N/A

• 5.4. Biohazard trash is segregated from regular trash?

  Yes

  No

  N/A

• 5.5. Needles and syringes are disposed of properly?

  Yes

  No

  N/A

• 5.6. Ceiling are not discolored/wet/missing or damaged?

  Yes

  No

  N/A

• 5.7. Halls are uncluttered?

  Yes

  No

  N/A

• 5.8. Respiratory hygiene available?

  Yes

  No

  N/A

• 5.9. Medication cart locked?

  Yes

  No

  N/A

• 5.10. No artificial/ acrylic nails use. Nails are no more than 1/4 inch above finger?

  Yes

  No

  N/A

• 5.11. Is equipment properly cleaned and stored?

  Yes

  No

  N/A

• 5.12. Is this section free of additional findings?

  Yes

  No

  N/A

6.0. Corridors/ Hallways/ Environment

• 6.1. Furniture is clean and in a good state?

  Yes

  No

  N/A

• 6.2. The wall is clean and dust free?

  Yes

  No

  N/A

• 6.3. Free of obstruction and equipment?

  Yes

  No

  N/A

• 6.4. Respiratory hygiene available for visitors and patients?

  Yes

  No

  N/A

7.0. Room inspection

• 7.1. Furniture in a good state and free of tears?

  Yes

  No

  N/A

• 7.2. Floor impervious and sealed?

  Yes

  No

  N/A

• 7.3. In patient bed is clean and in a good state?

  Yes

  No

  N/A

• 7.4. Flat surfaces clean and free from stains?

  Yes

  No

  N/A

• 7.5. Hand gel/ sanitizer available for patient and watchers used?

  Yes

  No

  N/A

• 7.6. Shower room clean and orderly?

  Yes

  No

  N/A

• 7.7. Ceiling tiles are not discolored/wet/missing/damaged?

  Yes

  No

  N/A

• 7.8. Dust not found in high places?

  Yes

  No

  N/A

• 7.9. Isolation room maintained negative air pressure air flow rate of 6-12 ACH?

  Yes

  No

  N/A

• 7.10. PPE available for isolation room and instructions, informations for visitors available?

  Yes

  No

  N/A

Additional Comments

Additional Recommendations

• Inspector's Signature

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• Received by:

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