ISPT WARD Room Checklist

• Conducted on

  Date

• Prepared by

• Location
  Address

STANDARD PRECAUTIONS

Hand Hygiene

• High visibility signs on educational literature on hand hygiene

  Yes

  No

  N/A

• Availability of hand washing area (with soap & water) and/or touch-free/ personal hand sanitizers and hand dryers/disposable hand towels in the following areas and if station staff are performing hand washing regularly*

  Yes

  No

  N/A

• Station 1

  Yes

  No

  N/A

• Station 2

  Yes

  No

  N/A

• Station 3

  Yes

  No

  N/A

• Station 4

  Yes

  No

  N/A

• Station 5

  Yes

  No

  N/A

Use of PPE

• Removal of all jewelry, watches followed by hand washing

  Yes

  No

  N/A

• Proper sequencing of DONNING PPE upon room entry for Level 2 as follows: N95 mask - googles/face shield

  Yes

  No

  N/A

• Remove and replace any soiled or non-fitting mask. N95 mask loops are hooked appropriately around the ear

  Yes

  No

  N/A

If doing aerosol-generating procedures using N95. Filtering facepiece respirators are fitted to the nose, extend chin and the respirator strap placed at the crown of the head and base of the neck and user seal check performed

• Googles/ face shield

  Yes

  No

  N/A

• Hand hygiene performed prior to putting on gloves

  Yes

  No

  N/A

• Clean gloves cover the cuff (wrist) of isolation gown

  Yes

  No

  N/A

• During Doffing, always wash hands after removing N95

  Yes

  No

  N/A

• Remove all used PPEs as soon as duty ends properly discarding at the designated area before exiting

  Yes

  No

  N/A

• Used PPEs are placed in appropriate waste disposal area and properly sanitized

  Yes

  No

  N/A

Use of Needle sticks and Sharp Objects

• Proper orientation of health workers on the use and disposal of sharps including reporting and monitoring of needle pricks

  Yes

  No

  N/A

• Practice aseptic techniques during usage of needles (with IV insertion or blood extractions)

  Yes

  No

  N/A

• Never recap used needles but discard in proper sharps disposal

  Yes

  No

  N/A

TRANSMISSION-BASED PRECAUTIONS

• Appropriate patient placement in a single patient space, observing at least 6 meter distancing of ward beds

  Yes

  No

  N/A

• Limit to 1 watcher per patient

  Yes

  No

  N/A

• At least 1 meter of physical distancing for station consults. Floors has markers

  Yes

  No

  N/A

• Patients and watchers wear masks at all times

  Yes

  No

  N/A

• Proper cough etiquette is observed at all times

  Yes

  No

  N/A

• Limit watcher movement inside the wards

  Yes

  No

  N/A

• Equipments commonly used for multiple patients is cleaned and disinfected every after patient use (ex.nebulizer, suction machine)

  Yes

  No

  N/A

• Avoid ambubagging, instead directly attached patient to mechanical ventilation when immediately available

  Yes

  No

  N/A

• Use aerosol boxes and nebulization chambers (should be present at the station at all times)

  Yes

  No

  N/A

ENVIRONMENTAL CONTROLS (STATION)

• Clean and disinfect all surfaces (tables, chairs, floors and other high contact areas) every 4 hours at least

  Yes

  No

  N/A

• Fans, curtains, blinds, telephones and computer keyboards are being cleaned

  Yes

  No

  N/A

• Waste is covered and segregated

  Yes

  No

  N/A

• Station toilet are being cleaned and free from extraneous items

  Yes

  No

  N/A

• Availability of PPE disposal container with cover

  Yes

  No

  N/A

• Has designated person to regularly collect and dispose wastes and used PPEs

  Yes

  No

  N/A

• Disposal of sharps to properly designed sharps container

  Yes

  No

  N/A

• Proper usage of work areas; eating of staff should be done at pantry area or other designated area when available

  Yes

  No

  N/A

ENVIRONMENTAL CONTROL (WARD)

• Ventilate the room to maintain >12 Air Exchanges

  Yes

  No

  N/A

• Waste containers are properly covered and labeled

  Yes

  No

  N/A

PATIENT CARE (IF APPLICABLE)

• Catheter Associated Urinary Tract Infection Checklist

  Yes

  No

  N/A

• Ventilator Associated Pneumonia Checklist

  Yes

  No

  N/A

• Surgical Site Infection Surveillance Checklist

  Yes

  No

  N/A

• Prevention of Central Line Associated Blood Stream Infection Checklist

  Yes

  No

  N/A

moments of hand hygiene include:

• before touching the patient

  Yes

  No

  N/A

• before aseptic procedure

  Yes

  No

  N/A

• after body fluid exposure risk

  Yes

  No

  N/A

• after touching the patient’s surroundings

  Yes

  No

  N/A

• after touching the patient

  Yes

  No

  N/A

• after doffing of PPEs

  Yes

  No

  N/A