Standard IC audit for wards

• Site conducted
  Address

• Conducted on

  Date

• Prepared by

• Ward

• Are you auditing environmental and room cleaning?

  Yes

  No

* Environmental and Room Cleaning

• Is there an environmental cleaning schedule and checklist?

  Yes

  No

• Has it been completed?

  Yes

  No

  N/A

• Are surfaces visibly clean without evidence of soiling?

  Yes

  No

  N/A

• Can staff demonstrate/verbally discuss correct cleaning chemicals for patients on Transmission Based Precautions?

  Yes

  No

• Is high dusting completed?

  Yes

  No

• Can staff demonstrate how to access Safety Data Sheets? (intranet and folder next to fire control panel each level)

  Yes

  No

• Are Disposable curtains 1 year, or less, old, and not visibly soiled?

  Yes

  No

  N/A

• All soft furnishings available in Patient care areas are suitable, visibly clean and not torn

  Yes

  No

• Please list issue

  Select Soft furnishings torn Soft furnishings visibly soiled

  • Soft furnishings torn
  • Soft furnishings visibly soiled

• Is there evidence cleaning is adapted for MRO patients?

  Yes

  No

  N/A

• Do staff understand the PPE requirements for patient's on Transmission Based precaution signage?

  Yes

  No

  N/A

• Are you auditing Utility, Pan room and Storage?

  Yes

  No

Utility, Pan Room and Storage

• Labelled soap stickers are on the dispensers?

  Yes

  No

  N/A

• Does the utility room have any unrelated pan room stock stored in there?

  Yes

  No

• The dirty utility has PPE available: disposable gloves, disposable aprons, face protection, eyewear and mask or face shield

  Yes

  No

  N/A

• The room has a clinical hand basin (or ABHR is available at the entry/exit of the dirty utility room)

  Yes

  No

  N/A

• There is a dedicated storage area which is clean and all working spaces are uncluttered?

  Yes

  No

  N/A

• Please list issue

  Select Stock on floor/too close to ceiling Not clean Not used appropriately

  • Stock on floor/too close to ceiling
  • Not clean
  • Not used appropriately

• Clean linen is stored to protect it from environmental contaminants such as dust, moisture & vermin

  Yes

  No

  N/A

• Clean and soiled linen are physically separated

  Yes

  No

  N/A

• Linen that is heavily soiled/wet, is contained in suitable leakproof bags

  Yes

  No

  N/A

• Blood and body fluid spill kit is readily available for use

  Yes

  No

  N/A

• Chemotherapy spill kits available

  Yes

  No

  N/A

• All items are stored above floor level by at least 250mm

  Yes

  No

  N/A

• All items are stored at least 440mm from ceiling fixtures

  Yes

  No

  N/A

• There is regular cleaning schedule for the sterile stock storage area

  Yes

  No

  N/A

• Storage containers, trolleys and cupboards are clean, dry and in good condition

  Yes

  No

  N/A

• Cardboard dispenser boxes are not topped up or reused for storage

  Yes

  No

  N/A

• All surfaces including walls, floors and ceiling lights are easy to clean, non porous and smooth

  Yes

  No

  N/A

• Bedpans and urinals are in good condition, clean and not soiled/damaged

  Yes

  No

  N/A

• Separate bins (clearly labelled) are available for clinical waste stream

  Yes

  No

  N/A

• Are you auditing Clinical Equipment?

  Yes

  No

Clinical Equipment

• Trolleys are clean and and free from rust and residue sticky tape on sides or top

  Yes

  No

• Please list issue

  Select Trolley visibly dirty Sticky tape residue present Rust present

  • Trolley visibly dirty
  • Sticky tape residue present
  • Rust present

• IV Trolleys have chlorhexidine swabs available

  Yes

  No

  N/A

• Sterile stock is free from elastic bands

  Yes

  No

• IV poles are clean and have no rust

  Yes

  No

• Select if rusty or dirty?

  Select Rusty Dirty

  • Rusty
  • Dirty

• PCA: Is the external case clean and button free of residue?

  Yes

  No

  N/A

• Has the contents of the PCA been discarded safely

  Yes

  No

  N/A

• Is medical equipment clean?

  Yes

  No

  N/A

• Do portable machines have wipes and ABHR on the them?

  Yes

  No

  N/A

• Please list issue

  Select No wipes available No ABHR available

  • No wipes available
  • No ABHR available

• Yanker Suckers are unopened and have sterile cover

  Yes

  No

  N/A

• Are you auditing Medication?

  Yes

  No

Medication

• Is IV protective bag insitu on all IV fluid bags

  Yes

  No

  N/A

• Do Mortar & Pestles have plastic covers for the pills to be crushed

  Yes

  No

  N/A

• Are solutions & creams single use

  Yes

  No

  N/A

• Please list issue

  Select Evidence products being used for more than one patient Unlabeled opened products on ward

  • Evidence products being used for more than one patient
  • Unlabeled opened products on ward

• Opened medication is discarded if not completely used - single patient use only

  Yes

  No

  N/A

• Medication is appropriately placed in treatment room; medication in fridge, medication on shelf

  Yes

  No

  N/A

• Medication is clearly labelled at point of use when in syringe

  Yes

  No

  N/A

• Please list issue

  Select Syringe contents not labeled No labels available in treatment room.

  • Syringe contents not labeled
  • No labels available in treatment room.

• Is there a SHARPS container with a lid on the MET trolley

  Yes

  No

  N/A

• Are you auditing Medication Fridge and Ice Machine?

  Yes

  No

Medication Fridge and Ice Machine

• Is there a medication fridge?

  Yes

  No

• Are there vaccines stores in the medication fridge

  Yes

  No

• Is there a specific vaccine fridge checklist in use

  Yes

  No

• Is the temperature monitored twice daily

  Yes

  No

• Refrigerators storing vaccines have temperature maintained between +2°C to +8°C

  Yes

  No

  N/A

• Has out of range temperatures been actioned?

  Yes

  No

  N/A

• Refrigerators temperature is monitored correctly for contents

  Yes

  No

  N/A

• Is there a documented procedure for action to be taken when the temperature ranges have been breached

  Yes

  No

• Are non-diabetic emergency food items stored in the medication fridge?

  Yes

  No

• Is diabetic emergency food stored in a sealed container?<br>

  Yes

  No

  N/A

• Are specimen or blood bags stored in the Medication fridge ?

  Yes

  No

• All solutions are dated when opened if required by manufacturer

  Yes

  No

  N/A

• Open insulin ampules are labelled with patient name and date opened

  Yes

  No

  N/A

• Please list issue

  Select No Dates No Label

  • No Dates
  • No Label

• Is there an Ice machine?

  Yes

  No

• Is it in working order?

  Yes

  No

• Is ice scoop present?

  Yes

  No

• Is the scoop stored in a clean hard surface closed container?

  Yes

  No

  N/A

• Is the scoop stored in the ice bin?

  Yes

  No

• Ice machines with scoops have Not For Human Consumption sign on front

  Yes

  No

• Ice machine available but not in working order

  Yes

  No

• Are you auditing PPE?

  Yes

  No

* PPE

• Gloves are readily available in a range of sizes

  Yes

  No

• Face and eye protection is available and readily accessible to staff in clinical settings

  Yes

  No

  N/A

• Impervious Gowns/ Aprons are available in the ward

  Yes

  No

• Please list issue

  Select No aprons available No impervious gowns available

  • No aprons available
  • No impervious gowns available

• Surgical masks of the correct level of protection are available on the ward

  Yes

  No

• N95/P2 masks are available (if an approved department)

  Yes

  No

  N/A

• All masks are dispensed from the original container at point of use

  Yes

  No

  N/A

• Staff (including Cleaners) can discuss when it is appropriate to don N95 mask

  Yes

  No

  N/A

• Are you auditing sharps?

  Yes

  No

Sharps

• Used disposable sharps are discarded into an approved sharps container/duckbill at the point of use

  Yes

  No

  N/A

• Kidney dish used

• If using Duckbill are lids attached

  Yes

  No

  N/A

• Replacement sharps containers are readily available

  Yes

  No

  N/A

• Sharps containers are mounted securely (on a wall, surface or trolley) to prevent tipping

  Yes

  No

  N/A

• Please list lissue

  Select Not in working order Not stored correctly

  • Not in working order
  • Not stored correctly

• Sharps container has no protuding items

  Yes

  No

• ▪ Sharp container unable to be closed<br>

  Yes

  No

• Are sharps containers overfilled?

  Yes

  No

• Please list issue

  Select Sharps containers filled above fill line Containers not sealed Full containers not stored in a locked room

  • Sharps containers filled above fill line
  • Containers not sealed
  • Full containers not stored in a locked room

• Full sharps containers closed and stored out of public access

  Yes

  No

  N/A

• Only sharps containers with Australian design stamp are in use?

  Yes

  No

  N/A

• Sharps used for cytotoxic therapy are discarded into purple cytotoxic sharps containers only

  Yes

  No

  N/A

• Safety PIVC devices are available

  Yes

  No

  N/A

• Are you auditing Hand Hygiene?

  Yes

  No

* Hand Hygiene

• Alcohol based hand rubs (ABHR) is available at the bedside

  Yes

  No

• Neutral soap is available at general hand basins

  Yes

  No

• Antimicrobial soap containing chlorhexidine 2% is available at clinical hand basins

  Yes

  No

• Are all available HH products hospital and TGA approved (only Schulke products)

  Yes

  No

• Hand washing solutions are dispensed in nonrefillable containers

  Yes

  No

• Signs promoting hand hygiene to HCW’s and visitors are clearly displayed

  Yes

  No

• Handwashing sinks clear of items

  Yes

  No

• Disposable paper towels or single use cloth towels are available at all hand basins

  Yes

  No

• There is no possibility of splash contamination from the hand basin onto any clean, dry goods stored nearby

  Yes

  No

• Moisturising lotion is available

  Yes

  No

• Are you auditing staff?

  Yes

  No

* Staff

• Staff can discuss or demonstrate how to access Infection Control information on Intranet

  Yes

  No

• Please list issue

  Select Allied health staff not aware how to access Nursing staff not aware how to access Other staff not aware how to acces

  • Allied health staff not aware how to access
  • Nursing staff not aware how to access
  • Other staff not aware how to acces

• Staff can demonstrate/discuss the procedure after an occupational exposure

  Yes

  No

• Please list

  Select Aware of first aid procedure Aware of occupation exposure kit location

  • Aware of first aid procedure
  • Aware of occupation exposure kit location

• Are you auditing maternity?

  Yes

  No

Maternity ONLY

• Staff can demonstrate what procedures are in place to minimise the risk, of accidental EBM in the advent of cross contamination

  Yes

  No

• Accidental EBM sharing has a strong and stringent procedures in place to minimise the risk and policy is in place

  Yes

  No

• Please list issue

  Policy not available

  Procedures not being followed

• All prepared feeds or EBM for baby are stored in fridge or freezer not on bench

  Yes

  No

  N/A

• Is prepared feed or EBM stored in the fridge

  Yes

  No

• Fridge used for prepared feed or EBM has temperature documented daily

  Yes

  No

  N/A

• Please list issue

  Select No temperature log available Temperature log not fully completed

  • No temperature log available
  • Temperature log not fully completed

• Is Expressed Breast Milk (EBM) stored in labelled containers in a fridge maintained at equal to, or less than, 5 degrees celcius?

  Yes

  No

  N/A

• Please list issue

  Select Fridge outside of recommended range Fridge temperature not documented No label on EBM

  • Fridge outside of recommended range
  • Fridge temperature not documented
  • No label on EBM

• All prepared feeds for baby stored in the fridge are used within 24 hours, all EBM is used within 48hrs

  Yes

  No

  N/A

• Please list issue

  Select Prepared feeds have no date or time recorded Prepared fridge feeds out of date > 24hrs EBM out of date > 48 hrs

  • Prepared feeds have no date or time recorded
  • Prepared fridge feeds out of date > 24hrs
  • EBM out of date > 48 hrs

• Is EBM stored in the freezer

  Yes

  No

• Frozen EBM is labelled with date and time collected, used within 3 months of collection. When thawed used within 24 hrs

  Yes

  No

  N/A

• All frozen prepared feeds for baby are dated and used within 3 months

  Yes

  No

  N/A

• Please list issue

  Select Prepared feeds have no time or date recorded Prepared feeds not stored in fridge or freezer (e.g out on bench) Frozen feed out of date > 3 months

  • Prepared feeds have no time or date recorded
  • Prepared feeds not stored in fridge or freezer (e.g out on bench)
  • Frozen feed out of date > 3 months

• Is freezer temperature documented daily and in range

  Yes

  No

  N/A

• Please list issue

  Select Temperature out of range Temperature not documented daily

  • Temperature out of range
  • Temperature not documented daily

• Modified solid food for babies is managed to ensure no cross contamination occurs

  Yes

  No

  N/A

• Baby bottles, teats, breast pumps are sterilised or single use only for a period of 24hrs prior to disposal

  Yes

  No

  N/A

• Neonates with potential or known MRO are segregated from other neonates via Isolette or positioning

  Yes

  No

  N/A

• Immunisation of neonate is facilitated and documentation is kept

  Yes

  No

  N/A

• Baby bathing is appropriate for purpose

  Yes

  No

  N/A

• Cleaning of shared equipment such as toys, high chairs, baby change areas has a documented cleaning schedule

  Yes

  No

  N/A

• Are you auditing a negative pressure room?

  Yes

  No

* Negative pressure room ONLY

• N95/P2 high filtration masks are available in the anteroom

  Yes

  No

• The room has a self closing door

  Yes

  No

• Don and Doff posters/visual aids and guidelines to aid appropriate sequence for PPE

  Yes

  No

• Gauges or readouts of the pressures are prominently located outside the room

  Yes

  No

  N/A

• Room cleaning schedule is available and up to date

  Yes

  No

• There is a mirror available for staff to check correct application of PPE

  Yes

  No

  N/A

• Patient tracking record in place for contact tracing

  Yes

  No

• JFH only - Staff are aware length of time for isolation room to convert to safe negative pressure level

  Yes

  No

  N/A