SMH UCLA INFECTION PREVENTION CLINICAL PHARMACY

• UCLA SMH INFECTION PREVENTION CLINICAL PHARMACIES

• Conducted on

  Date

• Prepared by

• Personnel

HAND HYGIENE

• Before hood cleaning

  Yes

  No

  N/A

• After hood cleaning

  Yes

  No

  N/A

• Before compounding

  Yes

  No

  N/A

• After compounding

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• PPE for compounding (Shoe covers, head cover, surgical mask, gown, sterile gloves) properly worn.

• Sterile gloves doffed when exit the compounding area & hand hygiene performed.

  Yes

  No

  N/A

• Hand hygiene performed, PPE donned in segregated compounding area, sterile gloves donned.

  Yes

  No

  N/A

• Correct PPE used for cleaning hood

  Yes

  No

  N/A

STERILE TECHNIQUE Including Hood Cleaning

• Cleaning log properly maintained.

  Yes

  No

  N/A

• If gloves become contaminated while working in the compounding area, gloves are disinfected with 70% isopropyl alcohol.

  Yes

  No

  N/A

• Sterile water for cleaning not open >24h.

  Yes

  No

  N/A

ENVIRONMENTAL HYGIENE

• Waste contained (includes any type of waste, receptacles not overflowing, bags of waste not on floor, etc.)

  Yes

  No

  N/A

• Work surfaces clean and free of debris

  Yes

  No

  N/A

• Personal belongings stored in designated area, away from work space

  Yes

  No

  N/A

• No eating in satellite pharmacies nor drinks other than bottled water

  Yes

  No

  N/A

• Furniture, tables, etc. in good repair

  Yes

  No

  N/A

• LEECHES-staff can speak to:

  Yes

  No

  N/A

• Refrigerator temperature monitoring

  Yes

  No

  N/A

• Where the leeches come from

  Yes

  No

  N/A

• The process for maintaining them (LEECHES)

  Yes

  No

  N/A

STAFF INTERVIEWS

• When do you practice hand hygiene?

  Yes

  No

  N/A

• When do you don PPE and what PPE do you use?

  Yes

  No

  N/A

• What is the procedure for cleaning the hood?

  Yes

  No

  N/A

• Can you show me your hood cleaning log?

  Yes

  No

  N/A

• Do staff come to work when they are sick?

  Yes

  No

  N/A

• How do you practice respiratory etiquette?

  Yes

  No

  N/A

• How often is the pharmacy cleaned by EVS and can you show me the EVS cleaning log?

  Yes

  No

  N/A

NOTES