IPC Inpatient Checklist

• Conducted on

  Date

• Prepared by

• Site

• MRNs (If applicable)

General

• Eating, drinking, and storing food in dedicated pantry room or area

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

Dress Code

• All staff in the department are complying with their dress code

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Doctors wear clean lab coat with buttons closed

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

Hand Hygiene

• There are dedicated hand wash sinks with adequate supplies (soap & paper towels)

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Adequate number of alcohol based hand rub dispensers are available

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Soap is never added to partially empty soap dispensers

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Liquid soap dispensers are cleaned with soap and water and disinfected with chlorine daily before refill

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Finger nails are kept short, clean, and free from nail polish

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Staff do not wear jewelry or rings

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Compliance with hand wash/alcohol rub according to five moments

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

PPE

• Adequate and proper PPE are available

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Surgical mask wear on entering patients’ rooms

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Proper PPE wear according to the procedure done

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Proper PPE donning and removal

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

Patients Hygiene

• Daily shower with antiseptic soap containing chlorhexidine (e.g. Cyteal®)

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

Blood Sampling / Cannulation Aseptic Technique

• Preparation of supplies/tray (Using one trial medication bag)

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Doing hand hygiene with alcohol based hand rub solution

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Wearing gloves (sterile in cannulation)

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Using disposable tourniquet

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Proper skin preparation: Using sterile gauze soaked with Cyteal® then drying, followed by alcohol swab and waiting for dryness

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Compliance with the “No Touch Technique”

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• No recapping for the used syringes or needles

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Proper waste segregation

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Removal of gloves and alcohol rub

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

Parenteral Medications

• Medication carts are maintained clean and dry

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Aseptic technique is used during parenteral medications withdrawal

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Multi-dose vials are labeled with the date and time of opening

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

• Multi-dose vials are discarded 28 days after first use unless the manufacturer specifies otherwise Only ONE multi-dose vial is used at a time

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

• Single-dose/single-use vials are used within one hour from initial opening, with any remaining contents discarded

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Medications are injected as soon as feasible and within 1 hour after drawing up into syringes

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

Isolation Precautions

• Isolation sign is placed on the door and is clearly visible to all who enter the room

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• PPE according to type of isolation are available & used upon entry to room:

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Airborne: High efficiency mask (N95) and discarded after leaving the room

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Droplet: Surgical mask and discarded after leaving the room

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Contact: Clean gloves and long sleeves gown and discarded before leaving the room.

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

Reprocessing of Medical Instruments and Equipment

• Rinsing of contaminated instruments and equipment and collection in covered container immediately after use

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Glucometers are wiped between patients with alcohol swab

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Stethoscopes and blood pressure cuffs are disinfected between patients

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

• Laryngoscopes are sterilized between patients

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Oxygen humidifier is sterilized between patients & every 24 hours for same patient

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Sterile water is used to fill humidifiers

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Suction bottles and tubing are reprocessed daily for the same patient

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

Storage of Supplies / Medications

• All supplies are clean, dry and stored in a proper way

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

• No supplies or items are stored on the floor or under the sinks

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

• Refrigerators are clean and contain only drugs

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Refrigerators’ temperature is recorded daily

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

• No expired supplies / medications are observed

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

Blood Exposure Management

• Proper blood exposure management as per policy

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

Linen Management

• Proper collection of used linen from patients’ rooms

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

• Proper transport of linen from department to laundry using covered carts

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

• Linen is changed daily, when contaminated, and between patients

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

• Mattresses and pillows are covered with protective water proof cover

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

Environmental Safety

• Proper environmental surfaces cleaning and disinfection (daily and when contaminated)

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

• Equipment surfaces and computers’ keyboards are cleaned and disinfected by the approved disinfectant (daily and when contaminated)

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

• Proper management of blood spillage

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

Waste Management

• Proper waste segregation using colored bags and sharp containers

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

• Proper time of collection of waste bags

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Waste bags are tied, labelled, and placed in the dirty utility room

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

Playing Room

• Patients are given instructions for hand hygiene before and after playing

  Select 0 1 2 3 4 5 N/A

  • 0
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  • N/A

• Toys are cleaned and disinfected between patient uses, and as per policy (Toys’ units “twice/week”, stationary toys “daily”)

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

HVAC

• Ducts & Filters of air conditioning system are cleaned as per policy

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A

• Monitoring for air pressure in isolation rooms

  Select 0 1 2 3 4 5 N/A

  • 0
  • 1
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  • N/A