Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Precautions

  • Wears personal protective equipment

  • Follows standard precautions when cleaning

  • Wears proper respiratory protection if cleaning procedures are expected to generate infectious aerosols

  • Cleans and disinfects surfaces or equipment as soon as possible when there is visible soiling by blood, body fluid, or other potentially infectious materials

Regular Clean Sample #1

  • Room number

Damp Dusting

  • Inspect OR for cleanliness before case carts, supplies, instruments, and equipment are brought into the room

  • Damp dusts all horizontal surfaces before the first scheduled surgical or other invasive procedure of the day

  • Performs damp dusting methodically from top to bottom

  • Uses a clean, low-linting cloth moistened with an EPA-registered hospital-grade disinfectant

Providing a Clean, Safe Environment

  • Cleans the environmental surfaces with a detergent prior to disinfection, according to the manufacturer's IFU

  • Labels the cleaning container with the chemical name, concentration, and expiration date if the chemical is removed from the original container

  • Follow manufacturer's IFU for the dwell time of the disinfecting chemical

  • Does not use the spray or misting methods

  • Cleans progressing from clean to dirty areas

  • Cleans progressing from top to bottom areas

  • Cleans clockwise or counter-clockwise in conjunction with clean-to-dirty and top-to-bottom methods

  • Does not use dry methods of cleaning, such as sweeping

  • Cleans and disinfects noncritical items (safety belt, positioning devices) after contact with the floor

  • Does not return used cleaning materials to the cleaning solution container

  • Cleans reusable protective barriers

  • Discards disposable cleaning materials after each use

  • Changes reusable cleaning materials after each use

Post Procedure Cleaning

  • Cleans and disinfects reusable noncritical, nonporous surfaces (mattress covers, pneumatic tourniquets cuffs, blood pressure cuffs) after each patient use

  • Cleans and disinfects high-touch objects after each patient use

  • Cleans and disinfects operating and procedure rooms after the patient has left the area

  • Removes trash and used linen before beginning environmental cleaning

  • Cleans and disinfects items that are used during patient care after every patient use

  • Cleans and disinfects items that are used during a surgical or invasive procedure

  • Cleans and disinfects the floors and walls of the OR and procedure rooms, if soiled or potentially soiled, after each surgical or invasive procedure

Regular Clean Sample #2

  • Room number

Damp Dusting

  • Inspect OR for cleanliness before case carts, supplies, instruments, and equipment are brought into the room

  • Damp dusts all horizontal surfaces before the first scheduled surgical or other invasive procedure of the day

  • Performs damp dusting methodically from top to bottom

  • Uses a clean, low-linting cloth moistened with an EPA-registered hospital-grade disinfectant

Providing a Clean, Safe Environment

  • Cleans the environmental surfaces with a detergent prior to disinfection, according to the manufacturer's IFU

  • Labels the cleaning container with the chemical name, concentration, and expiration date if the chemical is removed from the original container

  • Follow manufacturer's IFU for the dwell time of the disinfecting chemical

  • Does not use the spray or misting methods

  • Cleans progressing from clean to dirty areas

  • Cleans progressing from top to bottom areas

  • Cleans clockwise or counter-clockwise in conjunction with clean-to-dirty and top-to-bottom methods

  • Does not use dry methods of cleaning, such as sweeping

  • Cleans and disinfects noncritical items (safety belt, positioning devices) after contact with the floor

  • Does not return used cleaning materials to the cleaning solution container

  • Cleans reusable protective barriers

  • Discards disposable cleaning materials after each use

  • Changes reusable cleaning materials after each use

Post Procedure Cleaning

  • Cleans and disinfects reusable noncritical, nonporous surfaces (mattress covers, pneumatic tourniquets cuffs, blood pressure cuffs) after each patient use

  • Cleans and disinfects high-touch objects after each patient use

  • Cleans and disinfects operating and procedure rooms after the patient has left the area

  • Removes trash and used linen before beginning environmental cleaning

  • Cleans and disinfects items that are used during patient care after every patient use

  • Cleans and disinfects items that are used during a surgical or invasive procedure

  • Cleans and disinfects the floors and walls of the OR and procedure rooms, if soiled or potentially soiled, after each surgical or invasive procedure

Regular Clean Sample #3

  • Room number

Damp Dusting

  • Inspect OR for cleanliness before case carts, supplies, instruments, and equipment are brought into the room

  • Damp dusts all horizontal surfaces before the first scheduled surgical or other invasive procedure of the day

  • Performs damp dusting methodically from top to bottom

  • Uses a clean, low-linting cloth moistened with an EPA-registered hospital-grade disinfectant

Providing a Clean, Safe Environment

  • Cleans the environmental surfaces with a detergent prior to disinfection, according to the manufacturer's IFU

  • Labels the cleaning container with the chemical name, concentration, and expiration date if the chemical is removed from the original container

  • Follow manufacturer's IFU for the dwell time of the disinfecting chemical

  • Does not use the spray or misting methods

  • Cleans progressing from clean to dirty areas

  • Cleans progressing from top to bottom areas

  • Cleans clockwise or counter-clockwise in conjunction with clean-to-dirty and top-to-bottom methods

  • Does not use dry methods of cleaning, such as sweeping

  • Cleans and disinfects noncritical items (safety belt, positioning devices) after contact with the floor

  • Does not return used cleaning materials to the cleaning solution container

  • Cleans reusable protective barriers

  • Discards disposable cleaning materials after each use

  • Changes reusable cleaning materials after each use

Post Procedure Cleaning

  • Cleans and disinfects reusable noncritical, nonporous surfaces (mattress covers, pneumatic tourniquets cuffs, blood pressure cuffs) after each patient use

  • Cleans and disinfects high-touch objects after each patient use

  • Cleans and disinfects operating and procedure rooms after the patient has left the area

  • Removes trash and used linen before beginning environmental cleaning

  • Cleans and disinfects items that are used during patient care after every patient use

  • Cleans and disinfects items that are used during a surgical or invasive procedure

  • Cleans and disinfects the floors and walls of the OR and procedure rooms, if soiled or potentially soiled, after each surgical or invasive procedure

Terminal Clean Sample #1

  • Room number

  • Terminally cleans and disinfects perioperative areas daily when the areas are being used and according to facility policy and procedure

  • Disinfects all floors in the perioperative and sterile processing areas

  • Terminally cleans floors with either a wet vacuum or a single-use mo and a disinfectant

  • Cleans from the cleanest to the dirtiest areas of the floor

  • Disinfects floors surfaces at the perimeter of the room before floor surfaces in the center of the room

  • Disinfects the entire floor surface, including areas under the OR bed and mobile equipment

  • Terminally cleans and disinfects all exposed surfaces, including wheels and casters of all items

  • Uses a checklist and documents that terminal cleaning was performed

Terminal Clean Sample #2

  • Room number

  • Terminally cleans and disinfects perioperative areas daily when the areas are being used and according to facility policy and procedure

  • Disinfects all floors in the perioperative and sterile processing areas

  • Terminally cleans floors with either a wet vacuum or a single-use mo and a disinfectant

  • Cleans from the cleanest to the dirtiest areas of the floor

  • Disinfects floors surfaces at the perimeter of the room before floor surfaces in the center of the room

  • Disinfects the entire floor surface, including areas under the OR bed and mobile equipment

  • Terminally cleans and disinfects all exposed surfaces, including wheels and casters of all items

  • Uses a checklist and documents that terminal cleaning was performed

Terminal Clean Sample #3

  • Room number

  • Terminally cleans and disinfects perioperative areas daily when the areas are being used and according to facility policy and procedure

  • Disinfects all floors in the perioperative and sterile processing areas

  • Terminally cleans floors with either a wet vacuum or a single-use mo and a disinfectant

  • Cleans from the cleanest to the dirtiest areas of the floor

  • Disinfects floors surfaces at the perimeter of the room before floor surfaces in the center of the room

  • Disinfects the entire floor surface, including areas under the OR bed and mobile equipment

  • Terminally cleans and disinfects all exposed surfaces, including wheels and casters of all items

  • Uses a checklist and documents that terminal cleaning was performed

Sterile Processing Areas-Centercore (pods)

  • Terminally cleans and disinfects sterile processing areas daily when the area is being used

  • Cleans the clean work areas (packaging areas, sterile storage areas) before the dirty work areas (decontamination area)

  • Damp dust all horizontal surfaces (sterilizers, countertops, shelving) daily

  • Does not commence terminal cleaning when personnel are actively decontaminating instruments

  • Cleans disinfects all work surfaces and high-touch objects

  • Removes trash from receptacles in sterile processing areas when they are full, but at least daily

Scheduled Cleaning

Cleans areas and items that are not terminally cleaned on an established schedule:

  • Sterile storage areas

  • Shelving and storage bins

  • Corridors, including stairwells and elevators

  • Walls and ceilings

  • Privacy curtains

  • Pneumatic tubes and carriers

  • Sterilizer and loading carts

  • Sterilizer service access rooms

  • Unrestricted areas lounges

  • Waiting rooms, offices

  • Environmental services closets

  • Cleans ventilation ducts, linen chutes, refrigerators, ice machines, sinks, wash basins, aerators, and faucets on a schedule per facility policy and procedure

Enhanced Cleaning Procedures, if applicable

  • Follows enhanced environmental cleaning procedures on high-touch surfaces after care of patients who are infected or colonized with multi drug-resistant organisms

  • In addition to high-touch surfaces, cleans and disinfects objects cleaned as part of routine cleaning, after the patient leaves the room or area

  • In addition to standard precautions, wears a gown and gloves

  • Uses and EPA-registered disinfectant that is effective against C-difficile to clean following the care of patients diagnosed with or suspected of infection with C-difficile

  • Does not clean rooms following the care of patients diagnosed or suspected of infection with an airborne transmissible disease (tuberculosis) until a complete air exchange occurs or wears respiratory protection (N95 mask)

  • Follow procedures for environmental cleaning after contamination with high-risk tissue per policy and procedure

  • Performs cleaning and disinfection of environmental surfaces to remove dust and debris caused by construction, renovation, remediation, repair, or demolition, if applicable, per policy and procedure

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