OR, CARD CATH, IV RADIO Terminal Cleaning Checklist NEW

• Hospital Housekeeping Officer

• Room Number

• Conducted on

  Date

Waste and Linen

• All general waste removed and receptacles relined

  Yes

  No

  N/A

• All regulated (red bags) waste removed receptacles relined

  Yes

  No

  N/A

• Receptacles cleaned and sanitized inside and out

  Yes

  No

  N/A

• Sharp receptacles removed and replaced if needed

  Yes

  No

  N/A

• All linen removed

  Yes

  No

  N/A

• Linen hamper cleaned

  Yes

  No

  N/A

Horizontal surfaces, Ceiling, Walls, and Lighting

• Lights clean free of soil and dust?

  Yes

  No

  N/A

• Tables clean free of soil and dust any tables used during procedure?

  Yes

  No

  N/A

• Countertops clean free of soil and dust (terminal only in clean core)? vc

  Yes

  No

  N/A

• Misc horizontal surfaces clean free of soil and dust (terminal only)?

  Yes

  No

  N/A

• Walls clean free of soil and dusts (terminal only) , if visible both?

  Yes

  No

  N/A

• Vents clean and free of soil and dust (terminal only)?

  Yes

  No

  N/A

• Ceiling free of visible spots?

  Yes

  No

  N/A

• Door frame, kick plate, clean free of soil and dust ( Terminal only)?

  Yes

  No

  N/A

• Door handle, light switch, and other high touch surfaces clean and sanitized?

  Yes

  No

  N/A

Operating table and attachments clean and disinfected with 2 step process including the following:

• Arm supports

  Yes

  No

  N/A

• Leg boards

  Yes

  No

  N/A

• Table frame

  Yes

  No

  N/A

• Base

  Yes

  No

  N/A

• Foot pedals and brakes

  Yes

  No

  N/A

• Casters

  Yes

  No

  N/A

• Bed Remote

  Yes

  No

  N/A

• All equipment and pieces returned to bed and reset

  Yes

  No

  N/A

Floor

• Floor swept free of dust and debris

  Yes

  No

  N/A

• Floor sanitized using an approved disinfectant within 5 feet of bed and under, unless there is visible debris outside of 5 feet (in between case only)

  Yes

  No

  N/A

TRU - D

• Was TRU-D used in room?

  Yes

  No

  N/A

SUNDAY Terminal Clean

• BI-WEEKLY - Two step process cleaning of all walls, ceiling, and windows cleaned and disinfected?

  Yes

  No

  N/A

Sign Off

• Monitoring Method Used:

  Direct Observation

  Fluorescent Gel

  Swab Cultures

  ATP System

  Agar Slide Cultures

• Hospital Housekeeper Name & Signature

  Sign