Information
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Date Conducted:
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Prepared by:
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Audited by:
2.0 Patient Exam Rooms
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2.1. Floor and walls clean?
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2.2. Cubicle curtains unsoiled and free of tears?
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2.3. Exam table/bed is clean free of dust, rust, tapes and tape residues.
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2.4. Sink is clean and no supplies found within Splash Zone of sink in the absence of a splash guard.
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2.7. Gloves, PPE available?
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2.8. No food or drink in patient care areas?
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2.9. Vent grill is dirt free?
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2.10. Wedges for positioning cleaned and disinfected after every patient use?<br>
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2.11. Drawers well organized and clean?
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2.12. Working surfaces are clean?
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2.13. Equipment decontamination done?
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2.14. Mattress pad is without tears or puncture holes?
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2.15. Plants not present in clinical areas?
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2.17. All surfaces on the MRI table (inside the magnet bore, magnet gantry and MRI coils) is clean?
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2.19. Is equipment properly cleaned per protocol/ manufacturer's recommendation?
3.0 Waste Management
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3.1. Waste containers clean, operational and in good condition?
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3.3. Contaminated instruments or disposables placed on designated area not mixed with clean items?
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3.4. Regulated medical waste discarded appropriately & clearly segregated?
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3.6. Sharp containers secured, labeled, & no more than 2/3 full?
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3.9. Staff aware not to bend, recap or remove contaminated needle or sharps unless absolutely necessary?
4.0 Medications/ Items
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4.1. No outdated IV solutions, items and meds?
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4.2. Open vials dated and times as per policy?
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4.4. Out of date sterile supplies are not present?
5.0. Utility and Storage Room
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5.1. Floors and walls clean?
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5.2. Horizontal and vertical surfaces are clean?
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5.3. Adequate separation of clean and soiled?
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5.4. Bottom shelf is solid?
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5.5. No supplies stored 8-10" from the floor?
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5.6. No supplies stored touching the 18" from the ceiling?
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5.7. No supplies stored in the dirty utility room?
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5.8 Soiled linen is bagged accordingly?
6.0. Chemical Safety
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6.3. All containers labelled correctly?
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6.4. Unused substances disposed of?
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6.7. If required is PPE available?
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6.8. Are eye washes and showers easily accessed?
7.0. Corridors/ Hallways/ Environment
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7.1. Furniture is clean and in a good state?
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7.2. The wall is clean and dust free?
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7.3. Free of obstruction and equipment?
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7.4. Reception area is clean and work surface clean and free from clutter?
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7.5. Horizontal surfaces free from dust?
Staff Knowledge on Infection Prevention
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Staff able to articulate the care for instruments at point of care prior to transport to SPD
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Staff able to articulate how an isolation patient is identified & manage
Additional Comments
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