Previous Inspection

Has the last inspection been reviewed?


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?

1.2. Available liquid soap within all treatment rooms?

1.3. Wall mounted paper towels available near each sink?

1.4. Free from bar soaps?

1.5. Posters in appropriate locations demonstrating good handwashing techniques?

1.6. Clinical staff able to demonstrate good handwashing techniques?

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

2.0. Waste Management

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

2.2. Waste containers covered and with labels?

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

2.4. Regulated medical waste discarded appropriately?

2.5. Waste clearly segregated?

2.6. Sharp containers secured and labeled appropriately?

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

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

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

3.0 Medications/ Items

3.1. No outdated IV solutions, items and medicines?

3.2. Open vials dated and times as per policy?

3.3. Safe injection practices followed as per policy?

3.4. Out of date sterile supplies are not present?

3.5. Double pouch for sharp instruments applied?

3.6. Correct temperature observed?
Medications: 36-46 Fahrenheit

4.0. Utility and Storage Room

4.1. Floors and walls clean?

4.2. Horizontal and vertical surfaces are clean?

4.3. Adequate separation of clean and soiled?

4.4. Bottom shelf is solid?

4.5. No supplies stored 6" from the floor?

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

4.7. No supplies stored in the dirty utility room?

4.8. Soiled linen is bagged accordingly?

5.0. Nurses Station/ Medication Room

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

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

5.3. Medication are handled appropriately?

5.4. Biohazard trash is segregated from regular trash?

5.5. Needles and syringes are disposed of properly?

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

5.7. Halls are uncluttered?

5.8. Respiratory hygiene available?

5.9. Medication cart locked?

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

5.11. Is equipment properly cleaned and stored?

5.12. Is this section free of additional findings?

6.0. Corridors/ Hallways/ Environment

6.1. Furniture is clean and in a good state?

6.2. The wall is clean and dust free?

6.3. Free of obstruction and equipment?

6.4. Respiratory hygiene available for visitors and patients?

7.0. Room inspection

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

7.2. Floor impervious and sealed?

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

7.4. Flat surfaces clean and free from stains?

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

7.6. Shower room clean and orderly?

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

7.8. Dust not found in high places?

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

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

Additional Comments

Additional Recommendations

Inspector's Signature
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Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.