Stanford Children's Health-Infection Prevention & Control Rounding Audit

• Conducted on

  Date

• Prepared by

• Location
  Address

STANDARD PRECAUTIONS

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

ISOLATION

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• How many observations performed while in unit?

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Families and visitors wearing appropriate isolation PPE?

  Yes

  No

  N/A

• STAFF KNOWLEDGE CHECK: Ambulating patient on isolation?

  Yes

  No

  N/A

• STAFF KNOWLEDGE CHECK: Family/visitor PPE requirements?

  Yes

  No

  N/A

PREVENTION BUNDLES

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

  Yes

  No

  N/A

HAND HYGIENE

• 1 Hand Hygiene Observation

  Yes

  No

  N/A

• 1 Hand Hygiene Coaching

  Yes

  No

  N/A

ENVIRONMENTAL CLEANLINESS

• CLEAN and DIRTY items clearly separated?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Nutrition room has no staff or family food stored in refrigerator?<br>

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• STAFF KNOWLEDGE CHECK-Can staff identify high touch areas?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

ENVIRONMENTAL CLEANING CHECK: ATP

• Patient Room

Room #

• Isolation Room?

  Yes

  No

  N/A

• Swab #/Location

Location

• RUL?

  PASS (0-25)

  WARNING (26-50)

  FAIL (>51)

• Re-test RUL?

  PASS (0-25)

  WARNING (26-50)

  FAIL (>51)

ADDITIONAL FINDINGS

• Add media

  Media