Title Page
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Conducted on
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Conducted by
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Location
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Patient education: (sample 2 patients)
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Sampled patients have PFE files in the room
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Infection control education for the two above was done and documented in patient education tool/file
Patient Isolation (sample any 2 patients requiring isolation)
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There is an isolation poster on the patient door
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During patient care, appropriate PPE is used
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The patient is aware they are on isolation
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Soluble bags are used for linen
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For COVID patient, disposable cutlery is used
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Any additional comments
Instrument reprocessing
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Instruments contain use by date
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All instruments reprocessed at CSSD
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The instruments are stored in a temperature and humidity sensitive area
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Correct reprocessing process used (I.e Clean – spray – package – send to CSSD)
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Any additional comments
Housekeeping/Linen Management
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Clean area of operation
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Linen handled appropriately (transportation with colour coded trolleys/storage of clean linen and handling of dirty linen done correctly)
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Waste disposal managed correctly (3/4 full bins, segregation observed)
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Cleaning and decontamination solution labelled with use by date (within 24hours)
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Sluice room looks clean and well arranged
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Chemical dilution charts available for reference at sluice room (eg for haztab)
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Any additional comments
Hand Hygiene
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Sanitizers available and well labelled with correct sticker(PAO=3months)
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liquid soap available and well labelled with correct sticker (PAO=1 month)
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Evidence of monthly HH audits and education in the last 3 months (check the file)
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2 sampled Staff are aware of 5 moments for hand hygiene
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2 sampled staff know the right technique for HH
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Any additional comments
Injection Safety
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Water proof puncture resistant sharps container in use in accessible locations
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Sharps container is within ¾ full
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Labelling of the container is done (contains date and name of unit)
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2 sampled staff are aware of the PEP procedure
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Any additional comments
