Audit

OR suite inspection

Floors & walls clean

Walls free of breaks and penetrations

Ceiling free of visible dampness or damage

No high dust present

No dust on equipment or supplies, no damaged equipment or supplies

Sterilized trays are free of dust, unopened, no tears

Supplies > 18" from ceiling and 6" above floor on lined shelving

OR suite properly stocked without clutter

No expired supplies

PPE including gloves available

ONLY sharps in sharps box

Sharps boxes <1/3 full

Nothing on top of sharps boxes

Appropriate use of red bags (no regular trash)

Computer & keyboards dust free and clean

No tape residue on equipment or on table

Patient table clean, no soil found when broken down

Stands, kick buckets clean

Wheels, furniture, lights clean (no rusty wheels)

Anesthesia

Cart clean, locked

When unlocked by appropriate staff, no expired medications found

No evidence of reuse of single dose vials

Intubation equipment sealed in unopened peel packs, clean and sterilized

OR Desk

Free of clutter

No food or drink

No laboratory samples at desk

Supply areas (sterile core)

No high dust

Blue bins without dust/debris

Bottom of all shelves lined

No expired equipment during spot check

No expired supplies during spot check

In sterile supply area: no unsterile supplies/packs

Able to determine packs are sterile

Floors clean

No boxes on the floor

Ceiling free of visible dampness/damage

Sub-sterile Rooms

Flash log present and used on each load, patient sticker or ID present

Autoclave clean

Counter tops clean and no damage/chips

Walls & floors clean

No expired equipment or supplies

SPD

Decontamination area clean

Proper chemicals present for precleaning

Washer in working order

Ultrasonic unit: on 10 minutes prior to use, use of pH neutral solution, instruments are open, unit not overloaded, metals are same types, instruments are immediately removed when complete.

Ultrasonic properly tested (see waves)

Able to determine if instruments are rust vs stains (eraser test- rust will be removed w eraser)

Steris strips dated w/in 90 days of expiration

Chemicals are not expired, dates are circled

Steris logs are up to date

Soiled Utility Rooms

Cleaning products stored properly

Mop water and buckets clean

Cleaning tools clean

Adequate supply of cleaning materials

Soiled materials segregated

Floors clean

PPE available

Red bags tied properly

Trash bins clean

Hallways/Scrub areas

All storage to one side of hall

No cleaning products in the hall

Scrub sinks, foot pads clean

X-ray aprons clean, stored properly

Radiology equipment clean and properly stickered (PM).

Staff Inspection

Hair covered

Scrub procedure monitored

PPE worn as appropriate

OR staff at bedside in proper sterile attire

No fleece sweaters, warm up clothing

No obvious signs of infection noted

OR Procedure

Pre-op hair removal prior to OR entry

Proper prep method noted

Sterile procedure not violated (maintain proper distance from sterile areas, drop only sterile supplies onto field, scrub Tech does not drop their arms during procedure below waist. MD maintains sterile field.

Other

Action Plan

Action plan due to Infection Control by:

Action plan as decided by Director or designee:



Signatures
OR Director or Designee
Infection Control Director
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.