Audit

General appearance of the dialysis machines

The hemodialysis machine appears clean and free of dust, rust, tapes and tape residue

The machine has it's own Preventive Maintenance Log readily available for review

The cart for the PD machines appear clean, free of dust, rust, tapes and tape residue

The PD machine appears clean and free of dust, rust, tapes and tape residue

Dialysis Supply Storage Room

Tools to perform hand hygiene are available: Hand Hygiene Sink (Soap & Water) or Alcohol Based Hand Sanitizer

No supplies within 3 feet from the sink in the absence of a splash guard

All supply cabinets/lockers inside the room appear clean and free of dust, rust, tapes and tape residue

The room is free of clutter

Dust / dust bunnies not observed on high surfaces

The floor is clean

No food or drinks found in the storage room

The shelves are free of dust, rust, tapes and tape residue

All carts or shelves have solid liners on the bottom shelf

All supply carts are clean and free of dust, rust, tapes and tape residue.

All supply bins are clean and free of dust

All supplies are 18 inches from the ceiling and 10 inches from the floor

There are no expired supplies in the room

All chemical containers are labeled when it was opened and stored safely per policy

All chemicals are stored in designated storage place and not left unattended.

All personal items are placed inside the staff lockers

PROCESS OBSERVATION
1.0 Hemodialysis Catheter Connection

1.1 Mask worn?

1.2 Hand hygiene performed?

1.3 Clean gloves applied?

1.4 Catheter hub scrubbed with antiseptic?

1.5 Aseptically connected catheter to blood lines?

1.6 Gloves removed and hand hygiene performed?

PROCESS OBSERVATION
2.0 Disconnection of Hemodialysis Catheter

2.1 Mask worn?

2.2 Hand hygiene performed?

2.3 Clean gloves applied?

2.4 Aseptically disconnected catheter from blood lines?

2.5 Catheter hub scrubbed with antiseptic?

2.6 Aseptically attached new caps?

2.7 Gloves removed and hand hygiene performed?

PROCESS OBSERVATION
3.0 Changing of Hemodialysis Dressing

3.1 Dressing change performed aseptically?

3.2 Mask worn?

3.3 Hand hygiene performed and new gloves donned?

3.4 Skin antiseptic applied and allowed to dry?

3.5 Site not touched after antiseptic applied?

3.6 Antimicrobial ointment applied per policy?

3.7 Dressing applied aseptically?

3.8 Gloves removed and hand hygiene performed?

PROCESS OBSERVATION
4.0 Reverse Osmosis (RO) Water Room

4.1 Chlorine checks are documented every four hours?

4.2 Is wand off of floor for bicarbonate tank?

4.3 There is a water alarm on the floor to alert staff of flooding?

4.4 Each water system component is clearly labeled with name and function?

4.5 Written policies and procedures for water treatment system operation are utilized and current?

4.6 Logbooks include parameters for each components operation and the action taken when a component is not within set parameters?

PROCESS OBSERVATION
5.0 Maintenance of Dialysis Machine

5.1 Exterior of dialysis machines are wiped down at the end of each use with bleach?

5.2 Machines are vinegar rinsed and heat disinfected daily, and the outside of the machine is wiped down with bleach?

5.3 Machines have a weekly internal bleach clean documented?

5.4 Dialysis personnel culture dialysate from all machines on a monthly basis?

6.0 Bicarbonate Jugs

6.1 Jugs are bleached weekly (soaked for 15 minutes, rinsed with RO water, and allowed to air dry)?

6.2 Space for jug bleaching is adequate to allow dirty to clean flow?

6.3 Wands for bicarbonate jugs are bleach cleaned weekly?

6.4 Wands for bicarbonate are soaked in RO water daily?

7.0 Staff Competency

7.2 Dialysis management annually verifies competency of staff to perform connection, disconnection, and aseptic dressing changes?

8.0 Water

8.1 Water testing results are reported and reviewed at dialysis steering committee meetings and Infection Prevention Committee?

8.2 All water testing results are recorded in log sheets, reviewed, and corrective action indicated as applicable per policy?

9.0 Safety

9.1 Eye wash stations are located in rooms where chemicals are used (within ten seconds of point of use OR per organizational policy)?

9.2 PPE worn while within the splash zone (within four feet of dialyzer)

Staff Knowledge

Able to articulate the 2 methods of hand hygiene

Able to articulate at least 3 isolation precautions and site examples of infections/organisms requiring such precautions

Able to articulate where to find the infection prevention & control policies and procedures

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Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.