INTEGRIS OR Cleaning Observation

• OR Room #

• Conducted on

  Date

• Observer

• EVS Staff Member Observed

• Cleaning Type

  Terminal Clean

  End of Procedure Clean

Cleaning Process

• Hand hygiene performed before and after

  Yes

  No

  N/A

• Appropirate PPE worn

  Yes

  No

  N/A

• Clean began after patient discharge

  Yes

  No

  N/A

• Knows contact time of disinfectant

  Yes

  No

  N/A

• Previous patient supplies discarded prior to start of cleaning

  Yes

  No

  N/A

• Trash removed prior to cleaning

  Yes

  No

  N/A

• Cleaned from high to low

  Yes

  No

  N/A

• Cleans from clean to dirty (OR table is usually last)

  Yes

  No

  N/A

• Damp Dust

  Yes

  No

  N/A

• No Spray disinfectant utilized

  Yes

  No

  N/A

• Moves equipment while cleaning floor

  Yes

  No

  N/A

• Rags are changed out frequently

  Yes

  No

  N/A

• Only clean rags & mops placed in disinfectant

  Yes

  No

  N/A

Supplies Cleaned

• Ceiling

  Yes

  No

  N/A

• Overhead Lights

  Yes

  No

  N/A

• Walls

  Yes

  No

  N/A

• Vents

  Yes

  No

  N/A

• Room Light Switch

  Yes

  No

  N/A

• Door Handles & push plate

  Yes

  No

  N/A

• Anesthesia Equipment

  Yes

  No

  N/A

• Anesthesia supply cart

  Yes

  No

  N/A

• Monitor equipment

  Yes

  No

  N/A

• Specialized equipment

  Yes

  No

  N/A

• Back Table

  Yes

  No

  N/A

• Scrub table

  Yes

  No

  N/A

• Mayo Table

  Yes

  No

  N/A

• IV poles

  Yes

  No

  N/A

• Warmers

  Yes

  No

  N/A

• Computers and all accessories

  Yes

  No

  N/A

• Chairs

  Yes

  No

  N/A

• Step Stools

  Yes

  No

  N/A

• Trash cans & biohazard containers

  Yes

  No

  N/A

• OR Table and all accessories

  Yes

  No

  N/A