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Infection Control Safety Rounds
Anonymous

Infection Control Safety Rounds

Infection Control Safety Rounds for Patient Care Areas

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Free Infection Control Safety Rounds Checklist

Use this Template

Information

  • Conducted on

  • Prepared by

  • Location

Patient Room

  • Enter room number in field below

  • Is the room occupied?

  • Ceiling tiles free from staining

  • Add media

  • ABHR available/working

  • Add media

  • Soap, water and paper towels available

  • Add media

  • Sharps container is less than 3/4 full

  • Add media

  • No supplies stored under sink

  • Add media

  • Soiled linen in bag; not overfilled,mhamper covered

  • Add media

  • Refrigerator labeled to identify the approved use

  • Add media

  • Items within refrigerator according to label

  • Add media

Isolation Room

  • Correct sign in place (right sign, right reason)<br>Enter the room number and isolation type in the field below.

  • Supplies and PPE available

  • Add media

  • Staff compliant with policy

  • Add media

  • Airborne precaution: Patient placed in negative airflow room according to policy

  • Add media

  • Airborne precautions: Door closed and negative airflow functioning properly

  • Add media

  • Airborne Precautions: Inquire with Charge Nurse re:RNs on unit who are fit tested. List names of employees below.

  • Add media

  • Airborne Precaution: trash can located outside door

  • Add media

Unit

  • Non offensive odor

  • Add media

  • General appearance of cleanliness

  • Add media

  • Ceiling tiles free from staining

  • Add media

  • Flooring free from dust and dirt

  • Add media

  • Vents free from dust

  • Add media

  • Sprinkler heads free from dust

  • Add media

  • Firelight alarm free from dust

  • Add media

  • Linen carts covered

  • Add media

  • Soiled linen bag not overfilled

  • Add media

  • Mediagenic keyboards cleaned

  • Add media

  • Refrigerator labeled to identify the approved use

  • Add media

  • Items within according to label

  • Add media

  • Ice machine visibly clean

  • Add media

  • Unit furniture and textiles intact and able to be effectively cleaned and/or disinfected

  • Add media

  • Medication storage area clean

  • Add media

Standard Precautions

  • HCWs food/beverages permitted in designated areas per policy<br>(excluding areas where specimens may be present)

  • Add media

  • PPE per policy

  • Add media

Clean Utility

  • Designed to meet basic IC compliance

  • Add media

  • Clean items stored appropriately

  • Add media

  • Review for outdated items

  • Add media

Soiled Utility

  • Room appropriately labeled with name and biohazard symbol

  • Add media

  • Appears clean and disinfected on a regular basis (including floors)

  • Add media

  • Mounted sharps container less than 3/4 full

  • Add media

  • Gloves available

  • Add media

  • Splash PPE by hopper

  • Add media

  • Area for hand cleansing

  • Add media

  • Negative airflow functioning properly

  • Add media

EVS Closet/Cart

  • Clean in appearance

  • Add media

  • Free from safety concerns

  • Add media

  • Cleaning supplies appropriately labeled

  • Add media

  • Appropriate PPE available

  • Add media

  • Cart organized

  • Add media

Public Use Restroom

  • All surfaces appear clean

  • Add media

  • Hand-washing supplies available

  • Add media

  • Free from trash/debris

  • Add media

ICRA

  • ICRA permit posted

  • Add media

  • ICRA within date range

  • Add media

  • ICRA being followed

  • Add media

Waiting Area/Entry

  • If appropriate, supplies for respiratory hygiene available and posted instructions in place

  • Add media

Additional Comments and Photos

  • Add media

Infection Control Safety Rounds
Anonymous

Infection Control Safety Rounds

Infection Control Safety Rounds for Patient Care Areas

Use this Template
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.

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