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. General Cleaning/Environment

2.1. Floors are cleaned with a disinfectant?

2.2. Flat surfaces and OR lights are cleaned with a disinfectant solution?

2.3. Special equipment is wiped with a damp cloth and returned to proper storage place?

2.4. Linen/trash bags are closed and placed in appropriate area for disposal?

2.5. Walls and doors are spot cleaned?

2.6. Hallways and sub-sterile areas are mopped with disinfectant?

2.7. Cabinets, autoclave and countertops are wiped with disinfectant?

2.8. Patient care stations are kept clean and neat?

2.9. Is OT cleaned according to policy?

2.10. Are storage shelves clean?

2.11.Is equipment properly cleaned and stored?

2.12. Are sharp containers at appropriate levels?

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

3.0 Staff Controls

3.1. All staff is free of respiratory infections and/or skin lesions?

3.2. Good personal hygiene is observed?

3.3. Scrub suits worn are cleaned by facility service; caps, shoe covers are worn when in department for non-dedicated shoes?

3.4. Masks are worn correctly and changed in between cases?

3.5. Clean lab coat worn over scrubs outside of the surgical area?

3.6. Scrub suits and shoe covers are changed when wet/soiled?

3.7. Sponges are discarded into plastic lined receptacles?

3.8. Circulator uses gloves when in contract with items from the sterile field?

3.9. Trash and linen are dropped into containers, they are not thrown?

3.10. Contaminated instruments carried covered to decontamination room?

3.11. Scrub personnel do an initial 3-minute scrub followed by 3-minute scrubs for consecutive cases with good techniques each time?

4.0 Sterilization Process

4.1. Instruments contaminated with blood and body fluids are cleaned with disinfectant as soon as possible?

4.2. Surgical instruments that fall from the sterile field are picked up (wearing gloves) and placed in a covered receptacle?

4.3. If there is any doubt as to the sterility of equipment and supplies it is considered non-sterile?

4.4. All sterile packages are checked for integrity?

4.5. Autoclave is monitored by Bowie Dick Test and Biological Spore Test?

5.0. Storage Room

5.1. Floors and walls clean?

5.2. Horizontal and vertical surfaces are clean?

5.3. Adequate separation of clean and soiled?

5.4. Bottom shelf is solid?

5.5. No supplies stored 6" from the floor?

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

5.7. No supplies stored in the dirty utility room?

5.8. Soiled linen is bagged accordingly?

5.9. Are shoe covers, caps, masks and appropriate dress worn in sterile and sub sterile areas?

5.10. Are the above items available for visitor who enters these areas?

5.11. Are the doors to these areas kept closed?

6.0. Chemical Safety

6.1. Material Safety Data Sheets available for all chemicals?

6.2. Risk assessments completed for hazardous substance?

6.3. All containers labelled correctly?

6.4. Unused substances disposed of?

6.5. Do special storage conditions apply?

6.6. Workers trained in the use of hazardous substance?

6.7. If required is PPE available?

6.8. Are eye washes and showers easily accessed?

7.0. Air Quality Control

7.1. Air conditioning filters changed on schedule and unobstructed?

7.2. Non OR rooms kept at a constant temp between 20 and 24 degrees Celsius?

7.3. Is OR kept between 18 and 20 degree celsius?

7.4. Humidity level is kept between 30 and 60%?

7.5. Linen is kept from being shaken?

Additional Comments

Additional Comments


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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.