Title Page
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Document No.
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Environmental Stress Cracking: Infusion Pump Audit
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Health Service
- Eastern Health
- Monash Health
- Barwon Health
- Austin Health
- Ballarat
- Alfred
- Eye & Ear
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Box Hill Hospital
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Monash Medical Centre
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University Hospital Geelong
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Austin Hospital
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Ballarat Base Hospital
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The Alfred
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The Royal Victorian Eye and Ear Hospital
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Conducted on
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Personnel
- Anthony Black
- Caroline Marshall
- Shevaun O'Loghlen
- Jennifer Chen
- Nicholas Keogh
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Location
Department 1
Department:
Cleaning / Disinfectant
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What is the principal cleaning / disinfectant used?
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Provide brand
- Clinell Green
- V-Wipe
- Pro- Wipes
- Tuffy
- Other
- Clinell Red
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Provide additional details
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How frequently are the high touch items cleaned?
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Provide details including dilution.
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How frequently are the high touch items cleaned?
-
Provide additional details, type, where the technology is used and frequency of use?
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How frequently are the high touch items cleaned?
-
Has the cleaning regime changed recently for this category of equipment? (> 12 months)
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What was the previous principal cleaning / disinfectant used?
-
Provide brand
- Clinell Green
- V-Wipe
- Pro- Wipes
- Tuffy
- Other
- Clinell Red
-
Provide additional details
-
How frequently was this category of equipment previously cleaned?
-
Provide details including dilution.
-
How frequently was this category of equipment previously cleaned?
-
Provide additional details, type, where the technology was used and frequency of use?
-
How frequently were the high touch items cleaned?
-
Provide any additional details as required?
-
Has the cleaning regime change, resulted in revised staff training procedures?
-
Please provide details of training provided including competency and the craft groups that received the new training?
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Have there been a change in cleaning services within the previous 12 months. <br>In-house service to external contracted service<br>external service to in-house service<br>change in external provider.<br>
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Please provide additional details?
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Have any items been reported as showing environmental stress cracking? <br>N/A (no damage reported) <br>Low (Damage reported every 8 - 12 months)<br>Minor (Damage reported every 6 - 8 months)<br>Medium (Damage reported every 3 - 6months)<br>High (Damage reported every 1- 3 months)<br>
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Provide additional details
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Environmental Stress Cracking
ESC may be:
• Brittle cracking with no indication of yielding or indentation.
• Fine hairline cracks.
• Multiple initiation points.
• Repeated cracking in the same item. -
Infusion Pump
Patient Lifter
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Provide brand and model no:
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In what year was this equipment purchased?
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Add photos
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ESC<br>1 – Minor (1 or 2 small cracks)<br>2 – Major (multiple cracking)<br>3 – Severe (extensive cracking and resulting material loss and damage
Department 2
Department:
Cleaning / Disinfectant
-
What is the principal cleaning / disinfectant used?
-
Provide brand
- Clinell Green
- V-Wipe
- Pro- Wipes
- Tuffy
- Other
- Clinell Red
-
Provide additional details
-
How frequently are the high touch items cleaned?
-
Provide details including dilution.
-
How frequently are the high touch items cleaned?
-
Provide additional details, type, where the technology is used and frequency of use?
-
How frequently are the high touch items cleaned?
-
Has the cleaning regime changed recently for this category of equipment? (> 12 months)
-
What was the previous principal cleaning / disinfectant used?
-
Provide brand
- Clinell Green
- V-Wipe
- Pro- Wipes
- Tuffy
- Other
- Clinell Red
-
Provide additional details
-
How frequently was this category of equipment previously cleaned?
-
Provide details including dilution.
-
How frequently was this category of equipment previously cleaned?
-
Provide additional details, type, where the technology was used and frequency of use?
-
How frequently were the high touch items cleaned?
-
Provide any additional details as required?
-
Has the cleaning regime change, resulted in revised staff training procedures?
-
Please provide details of training provided including competency and the craft groups that received the new training?
-
Have there been a change in cleaning services within the previous 12 months. <br>In-house service to external contracted service<br>external service to in-house service<br>change in external provider.<br>
-
Please provide additional details?
-
Have any items been reported as showing environmental stress cracking? <br>N/A (no damage reported) <br>Low (Damage reported every 8 - 12 months)<br>Minor (Damage reported every 6 - 8 months)<br>Medium (Damage reported every 3 - 6months)<br>High (Damage reported every 1- 3 months)<br>
-
Provide additional details
-
Environmental Stress Cracking
ESC may be:
• Brittle cracking with no indication of yielding or indentation.
• Fine hairline cracks.
• Multiple initiation points.
• Repeated cracking in the same item. -
Infusion Pump
Patient Lifter
-
Provide brand and model no:
-
In what year was this equipment purchased?
-
Add photos
-
ESC<br>1 – Minor (1 or 2 small cracks)<br>2 – Major (multiple cracking)<br>3 – Severe (extensive cracking and resulting material loss and damage
Department 3
Department:
Cleaning / Disinfectant
-
What is the principal cleaning / disinfectant used?
-
Provide brand
- Clinell Green
- V-Wipe
- Pro- Wipes
- Tuffy
- Other
- Clinell Red
-
Provide additional details
-
How frequently are the high touch items cleaned?
-
Provide details including dilution.
-
How frequently are the high touch items cleaned?
-
Provide additional details, type, where the technology is used and frequency of use?
-
How frequently are the high touch items cleaned?
-
Has the cleaning regime changed recently for this category of equipment? (> 12 months)
-
What was the previous principal cleaning / disinfectant used?
-
Provide brand
- Clinell Green
- V-Wipe
- Pro- Wipes
- Tuffy
- Other
- Clinell Red
-
Provide additional details
-
How frequently was this category of equipment previously cleaned?
-
Provide details including dilution.
-
How frequently was this category of equipment previously cleaned?
-
Provide additional details, type, where the technology was used and frequency of use?
-
How frequently were the high touch items cleaned?
-
Provide any additional details as required?
-
Has the cleaning regime change, resulted in revised staff training procedures?
-
Please provide details of training provided including competency and the craft groups that received the new training?
-
Have there been a change in cleaning services within the previous 12 months. <br>In-house service to external contracted service<br>external service to in-house service<br>change in external provider.<br>
-
Please provide additional details?
-
Have any items been reported as showing environmental stress cracking? <br>N/A (no damage reported) <br>Low (Damage reported every 8 - 12 months)<br>Minor (Damage reported every 6 - 8 months)<br>Medium (Damage reported every 3 - 6months)<br>High (Damage reported every 1- 3 months)<br>
-
Provide additional details
-
Environmental Stress Cracking
ESC may be:
• Brittle cracking with no indication of yielding or indentation.
• Fine hairline cracks.
• Multiple initiation points.
• Repeated cracking in the same item. -
Infusion Pump
Patient Lifter
-
Provide brand and model no:
-
In what year was this equipment purchased?
-
Add photos
-
ESC<br>1 – Minor (1 or 2 small cracks)<br>2 – Major (multiple cracking)<br>3 – Severe (extensive cracking and resulting material loss and damage
