Tennova Infection Control Department Dialysis Department Rounds

• Facility Name

  PRMC

  TCMC

  NKMC

• Dialysis Department Weekly Rounds

• Conducted on

  Date

• Prepaired by:

  Amanda Jolly- infection Control

  Gail Beeler- Infection Control

  Stephanie Brooks-Infection Control/Risk

• Other staff present:

• This document emailed to :

  Select Larry Harness- Dialysis Leader Kristen Kilgore- Director of Quality/Infection Control Sabrina Holbert-TCMC onsite manager Melissa Williams-IC secretary Sharon Delpuppa- TCMC Quality Penny Smith-NKMC Quality Heide Malez-Coffey- TCMC CNE

  • Larry Harness- Dialysis Leader
  • Kristen Kilgore- Director of Quality/Infection Control
  • Sabrina Holbert-TCMC onsite manager
  • Melissa Williams-IC secretary
  • Sharon Delpuppa- TCMC Quality
  • Penny Smith-NKMC Quality
  • Heide Malez-Coffey- TCMC CNE

Staff interview/ record review

• Water cultures obtained as schedule.

  Yes

  No

  N/A

• Water testing done per policy.

  Yes

  No

  N/A

• Evidence of actions taken appropriately related to cultures results per decision tree and documented

  Yes

  No

  N/A

• MRSA screening completed as appropriate.

  Yes

  No

  N/A

Hand Hygiene

• Hand hygiene: staff perform appropriately

  Yes

  No

  N/A

• Hand hygiene: sinks & appropriate hand hygiene products are available.

  Yes

  No

  N/A

Personal protective equipment

• Personal protective equipment used appropriate.

  Yes

  No

  N/A

• Personal protective equipment readily available

  Yes

  No

  N/A

Sharps containers

• Sharps containers: puncture-resistant, leakproof, labeled (red).

  Yes

  No

  N/A

Medications

• Medications: labeled appropriately with expiration dates.

  Yes

  No

  N/A

• Medications: secured

  Yes

  No

  N/A

Clean supply storage

• Designate clean storage from dirty.

  Yes

  No

  N/A

• Supplies stored off floors and supply area free of dust, dirt, etc. No cardboard boxes.

  Yes

  No

  N/A

• No expired supplies noted.

  Yes

  No

  N/A

Cleaning of patient care equipment

• Reusable patient care items and equipment are cleaned/ reprocessed and stored appropriately.

  Yes

  No

  N/A

Line care

• Dressing in good condition and

  Yes

  No

  N/A

• Use of Curos on Tego connectors.

  Yes

  No

  N/A

• Rounds completed by:

  Amanda Jolly- infection Control

  Gail Beeler- Infection Control

  Stephanie Brooks-Infection Control/Risk

• Signature of person making rounds

  Sign