Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Basic IP- HH/PPE/Disinfectant
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Sufficient and appropriate PPE is available and readily acessible
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Resuscitation bags or mouthpieces are available for staff use.
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Transmission-based precautions are implemented when MDRO (MRSA, VRE, ESBL) or C.diff is identified in patients. Signage on door is appropriate, isolation rack is mounted on patient door. Patient has dedicated noncritical medical equipment or equipment is cleaned before use on another patient.
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Staff are observed using appropriate PPE. PPE is removed and discarded prior to leaving the patient's care area. Hand hygiene is performed immediately after removal of PPE.
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Gloves are worn for potential contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated equipment.
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Gloves are not worn for the care of more than one patient, and are not washed for the purpose of reuse.
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Gowns are worn to protect skin and clothing during procedures or activities where contact with blood or body fluids is anticipated. The same gown is not worn for the care of more than one patient.<br>
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Mouth, nose, and eye protection is worn during procedures that are likely to generate splashes or sprays of blood or other body fluids.<br>
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Observed hand hygiene being performed as per policy; 15-20 sec w/ soap& water or alcohol foam<br>
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Observed hand hygiene being performed before contact with the patient or their immediate care environment (if gloves are worn - hand hygiene is performed prior to donning gloves)<br>
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Observed hand hygiene after touching the patient or the patient's immediate environment (If gloves are used, hand hygiene is performed immediately after glove removal)<br>
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Hand hygiene is performed before performing an aseptic task (e.g., insertion of IV or preparing an injection - even if gloves are worn)<br>
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Hand hygiene is correctly performed after contact with blood, body fluids, or contaminated surfaces (even if gloves are worn)<br>
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Hand hygiene is correctly performed when hands move from a contaminated body site to a clean body site during patient care<br>
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Staff were compliant with nail hygiene and wearing of jewlery per WCH Hand Hygiene Policy.<br>
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Alcohol based hand rub is available and easily accessible to employees and patients. Expired supplies are not found.<br>
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Hospital approved disinfectant and germicidal wipes are available to staff and are correctly used to clean/disinfect equipment between individual patient use. <br>
Environment
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Unit-based equipment is clean (scales, vital sign machines, etc.)<br>
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Furniture is clean, free of holes, tears, stains, splinters, and tape. <br>
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Surfaces are clean and free of dust.<br>
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Floors are clean & free of chips/cracks<br>
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Paint on walls is free of chips and holes.<br>
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Countertops and laminate surfaces are free of chips.<br>
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Air vents are free of dust.<br>
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Ceilings, ceiling tiles, and walls do not exhibit peeling areas and stains.<br>
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Bathroom facilities are clean and well maintained. <br>
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No evidence of pests/bugs in area<br>
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Sharps containers are no more than 3/4 full, are located in easily accessible and appropriate areas, are wall mounted at the proper height (52-56 inches standing height) or are secured from being knocked over.<br>
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Medical waste is properly segregated in red buckets (no trash, gloves, and other inappropriate items)<br>
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Red bin is lined with red biohazard bag and securely covered<br>
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No sterile/clean items are stored in the dirty utility room.<br>
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Dirty and Clean Utility rooms are separate.<br>
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Clean utilities positive pressure, dirty utilities negative pressure
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Clean utility/Storage rooms contain only clean supplies and equipment. <br>
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All clean equipment bagged or tagged
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Clean linen is stored on clean, covered shelves or cart.<br>
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Soiled linen is contained in blue plastic bags.<br>
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Supply area is neat, organized, and free of dust, soil, and other gross contamination.<br>
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Patient care supplies are not stored in shipping containers. No original shipping containers present. <br>
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Fluids are stored towards bottom of shelving to prevent leakage and contamination of supplies.<br>
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Nothing stored under sink. <br>
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All products are stored above floor level. Open rack storage of sterile items has a solid bottom to prevent soiling or contamination of supplies.<br>
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Clean/sterile patient supplies are stored away from splash zone (3 feet) of sinks or other potential sources of contamination.<br>
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Supplies are rotated first in first out to prevent use of expired items.<br>
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Dates for lab tubes are checked and have current date. <br>
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Eyewash stations are present (where required), properly working, and have documentation of being checked ???.<br>
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Engineered sharps safety devices are available and utilized as appropriate.<br>
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Staff can verbalize the steps they need to take in the event of an exposure to blood or other potentially infectious material.<br>
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Refrigerators for storing blood and/or specimens are labeled with a biohazard label.<br>
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Refrigerators are clean and free from spills.<br>
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Refrigerator temps are monitored.<br>
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Staff food is stored separate from patient food<br>
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No evidence of staff eating or drinking in clinical areas or areas specifically noted as "no eating/drinking" area<br>
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Ice machine (including interior of ice chute) is clean, in good repair, and free of leaks.<br>
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Kitchen facilities are clean and well maintained.<br>
Therapy
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Treatment mats are cleaned between uses.<br>
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Gait belts are not worn around the waist of staff or used on multiple patients.<br>
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Pillow cases in therapy room are changed between patients.<br>
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Pillows in therapy room are wiped down daily.<br>
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