Audit

STANDARD PRECAUTIONS

Proper PPE use (gloves, mask, gown, etc)?

Personal Hygiene no artificial nails, hair pulled back, jewelry appropriate)?

STAFF KNOWLEDGE CHECK-What is the process if BBP exposure (splash, needlestick) occurs? (1-STIX/OHS)?

ISOLATION

Review Isolation list/Possible SSI's with charge RN or Resource RN

Isolation Signage/PPE/MD order in EPIC align and correctly applied?

Staff wearing PPE? (tally mark if multiple observations done)

How many observations performed while in unit?

Families and visitors wearing appropriate isolation PPE?

STAFF KNOWLEDGE CHECK: Ambulating patient on isolation?

STAFF KNOWLEDGE CHECK: Family/visitor PPE requirements?

PREVENTION BUNDLES

Conduct one visual bundle round (CLABSI, CAUTI, Ventilator, SSI)

HAND HYGIENE

1 Hand Hygiene Observation

1 Hand Hygiene Coaching

ENVIRONMENTAL CLEANLINESS

CLEAN and DIRTY items clearly separated?

NO food or drink outside of approved designated areas; hydration stations identified and utilized?

Nutrition room has labeled, non-expired foods in the refrigerator?

Nutrition room has no staff or family food stored in refrigerator?

Human milk room has appropriate PPE and disinfectant wipes available for use?

Staff using PPE and disinfectants appropriately while entering/exiting human milk room?

Soiled Utility Room check (waste stream, soiled instrument process)?

STAFF KNOWLEDGE CHECK-How do you know this equipment has been cleaned and it is safe to use?

STAFF KNOWLEDGE CHECK-How often do you clean high touch areas?

STAFF KNOWLEDGE CHECK-Can staff identify high touch areas?

STAFF KNOWLEDGE CHECK-Contact time Purple Sani-wipes (2 min) and Clorox bleach disinfectant wipes (3 min)?

ENVIRONMENTAL CLEANING CHECK: ATP

Patient Room

Room #

Isolation Room?

Swab #/Location

Location

RUL?

Re-test RUL?

ADDITIONAL FINDINGS
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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.