Infection Prevention Environmental Non-Clinical Areas

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Hand hygiene observation (practices, availability, and proper use of products)

  Yes

  No

  N/A

• Under sink storage contains only cleaning supplies

  Yes

  No

  N/A

• Appropriate separation of clean and dirty (ie no risk for cross contamination between clean and dirty supplies)

  Yes

  No

  N/A

• Environment clean and uncluttered, storage areas are appropriate, and no items stored in corrugated boxes, no outdates noted

  Yes

  No

  N/A

• Areas are free of visible dust (air vents, supply carts, workstations...etc.)

  Yes

  No

  N/A

• Ceiling tiles intact

  Yes

  No

  N/A

• Lights are free of bugs?

  Yes

  No

  N/A

• Sinks are functioning properly and no signs of leaking? Caulk in good condition?

  Yes

  No

  N/A

• Surfaces free of blood, dust, stains and cracks

  Yes

  No

  N/A

• Food and beverages stored in non clinical areas?

  Yes

  No

  N/A

Questions for staff

• What does standard precautions mean to you?<br>(Using appropriate PPE to protect themselves from any potential exposure, based on the situation.)

  Safe

  At Risk

  N/A

• When is it required that you empty linen bags, sharps and trash?<br>(When its 3/4th full or wet)

  Safe

  At Risk

  N/A

• What is the process to return to work after being ill?

  Safe

  At Risk

  N/A

• How would you clean up a blood or body fluid spill?<br>

  Safe

  At Risk

  N/A

• How would you report an exposure to blood, body fluids or a needle stick?<br>(Call the exposure hotline [366-5251] and complete an online injury report [on sanford connect])

  Safe

  At Risk

  N/A

• What is your process for cleaning equipment between patient use? or equipment in the area?<br>

  Safe

  At Risk

  N/A

• How do you know what sani wipe to use when and what is the wet time?<br>(According to manufacturer's instructions)

  Safe

  At Risk

  N/A