Title Page

  • Site conducted
  • Conducted on

  • Prepared by

  • Ward

  • Are you auditing environmental and room cleaning?

* Environmental and Room Cleaning

  • Is there an environmental cleaning schedule and checklist?

  • Has it been completed?

  • Are surfaces visibly clean without evidence of soiling?

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

  • Is high dusting completed?

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

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

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

  • Please list issue

  • Is there evidence cleaning is adapted for MRO patients?

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

  • Are you auditing Utility, Pan room and Storage?

Utility, Pan Room and Storage

  • Labelled soap stickers are on the dispensers?

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

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

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

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

  • Please list issue

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

  • Clean and soiled linen are physically separated

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

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

  • Chemotherapy spill kits available

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

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

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

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

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

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

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

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

  • Are you auditing Clinical Equipment?

Clinical Equipment

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

  • Please list issue

  • IV Trolleys have chlorhexidine swabs available

  • Sterile stock is free from elastic bands

  • IV poles are clean and have no rust

  • Select if rusty or dirty?

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

  • Has the contents of the PCA been discarded safely

  • Is medical equipment clean?

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

  • Please list issue

  • Yanker Suckers are unopened and have sterile cover

  • Are you auditing Medication?

Medication

  • Is IV protective bag insitu on all IV fluid bags

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

  • Are solutions & creams single use

  • Please list issue

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

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

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

  • Please list issue

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

  • Are you auditing Medication Fridge and Ice Machine?

Medication Fridge and Ice Machine

  • Is there a medication fridge?

  • Are there vaccines stores in the medication fridge

  • Is there a specific vaccine fridge checklist in use

  • Is the temperature monitored twice daily

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

  • Has out of range temperatures been actioned?

  • Refrigerators temperature is monitored correctly for contents

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

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

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

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

  • All solutions are dated when opened if required by manufacturer

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

  • Please list issue

  • Is there an Ice machine?

  • Is it in working order?

  • Is ice scoop present?

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

  • Is the scoop stored in the ice bin?

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

  • Ice machine available but not in working order

  • Are you auditing PPE?

* PPE

  • Gloves are readily available in a range of sizes

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

  • Impervious Gowns/ Aprons are available in the ward

  • Please list issue

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

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

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

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

  • Are you auditing sharps?

Sharps

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

  • Kidney dish used

  • If using Duckbill are lids attached

  • Replacement sharps containers are readily available

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

  • Please list lissue

  • Sharps container has no protuding items

  • ▪ Sharp container unable to be closed<br>

  • Are sharps containers overfilled?

  • Please list issue

  • Full sharps containers closed and stored out of public access

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

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

  • Safety PIVC devices are available

  • Are you auditing Hand Hygiene?

* Hand Hygiene

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

  • Neutral soap is available at general hand basins

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

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

  • Hand washing solutions are dispensed in nonrefillable containers

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

  • Handwashing sinks clear of items

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

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

  • Moisturising lotion is available

  • Are you auditing staff?

* Staff

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

  • Please list issue

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

  • Please list

  • Are you auditing maternity?

Maternity ONLY

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

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

  • Please list issue

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

  • Is prepared feed or EBM stored in the fridge

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

  • Please list issue

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

  • Please list issue

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

  • Please list issue

  • Is EBM stored in the freezer

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

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

  • Please list issue

  • Is freezer temperature documented daily and in range

  • Please list issue

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

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

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

  • Immunisation of neonate is facilitated and documentation is kept

  • Baby bathing is appropriate for purpose

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

  • Are you auditing a negative pressure room?

* Negative pressure room ONLY

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

  • The room has a self closing door

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

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

  • Room cleaning schedule is available and up to date

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

  • Patient tracking record in place for contact tracing

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

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