Title Page

  • Conducted on

  • Prepared by

  • Location

I. STANDARD PRECAUTIONS

A, HAND HYGEINE

  • a. Frequency of handwashing per HCW ( actual numbers/ shift )

  • i.e. 5 moments of moments of hand hygiene and the 7 steps of hand washing

  • b. Proportion of HCW who performs handwashing (%) – CCTV Monitored

  • c. Access to sink, soap and alcohol

B. PERSONAL PROTECTIVE EQUIPMENT (PPE'S)

  • a. Correct donning and doffing

  • b. Storage of clean and new PPE’s

II. TRANSMISSION BASED PRECAUTIONS

CONTACT

  • Adequate PPE worn

  • Regular Handwashing

DROPLET

  • Mask worn at all times ?

  • Correct PPE’s worn?

  • Room cleaning done regularly?

AIRBORNE

  • Adequate ventilation ?

  • Negative pressure room ?

III. ENVIRONMENTAL CONTROLS

CLEANING

  • Frequency of cleaning the unit/s ( check availability of SOI ) ( actual cleaning / day )

  • Adequacy/ availability of cleaning materials including housekeeping carts

DISINFECTIING

  • Adequacy and availability of disinfectants ( check availability of SOI )

  • Frequency of disinfecting the unit/s ( actual number/ day )

WASTE DISPOSAL

  • Correct segregation, handling, collection and disposal of waste ( check availability of SOI )

AIRFLOW AND VENTILATION MANAGEMENT

  • Laminar flow air is present and working?

  • Exhaust ducts is present and functioning?

  • Is ventilation adequate?

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