TSDFT IPS Environmental Audit - Out Patient Areas / Department v1.2

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Environment - Reception Area

• Are all surfaces smooth impervious (for easy cleaning) and with coved edges?

  Yes

  No

  N/A

• Is the floor visibly clean?

  Yes

  No

  N/A

• Is the floor covering washable and impervious to moisture?

  Yes

  No

  N/A

• Is the flooring in a good state of repair?

  Yes

  No

  N/A

• Are ward or clinic televisions / display screens visibly clean?

  Yes

  No

  N/A

• Are computer systems visibly clean?

  Yes

  No

  N/A

• Are all telephones visibly clean?

  Yes

  No

  N/A

• Are free standing / desk fans visibly clean?

  Yes

  No

  N/A

• Are air vents visibly clean?

  Yes

  No

  N/A

Environment - Patient Waiting Area

• Are all surfaces smooth impervious (for easy cleaning) and with coved edges?

  Yes

  No

  N/A

• Is the floor visibly clean?

  Yes

  No

  N/A

• Is the floor covering washable and impervious to moisture?

  Yes

  No

  N/A

• Is the flooring in a good state of repair?

  Yes

  No

  N/A

• Are ward or clinic televisions / display screens visibly clean?

  Yes

  No

  N/A

• Are free standing / desk fans visibly clean?

  Yes

  No

  N/A

• Are air vents visibly clean?

  Yes

  No

  N/A

Environment - Storeroom

• Is the environment visibly clean?

  Yes

  No

  N/A

• Is the environment free from any visible damage?

  Yes

  No

  N/A

• Are all furnishings and fittings visibly clean?

  Yes

  No

  N/A

• Are all furnishings and fittings in a good state of repair?

  Yes

  No

  N/A

• Is the floor visibly clean?

  Yes

  No

  N/A

• Is the floor covering washable and impervious to moisture?

  Yes

  No

  N/A

• Is the flooring in a good state of repair?

  Yes

  No

  N/A

• Are all items of equipment or supplies stored off the floor?

  Yes

  No

  N/A

• Is the environment tidy and uncluttered?

  Yes

  No

  N/A

• Are items stored appropriately?

  Yes

  No

  N/A

Environment - Surgery / Clinic / Examination Room

• Is the environment visibly clean?

  Yes

  No

  N/A

• Is the environment free from any visible damage?

  Yes

  No

  N/A

• Is furniture made of impermeable and washable materials?

  Yes

  No

  N/A

• Are all furnishings and fittings visibly clean?

  Yes

  No

  N/A

• Are all furnishings and fittings in a good state of repair?

  Yes

  No

  N/A

• Are all surfaces smooth, impervious ( for easy cleaning ) and with coved edges?

  Yes

  No

  N/A

• Is the floor visibly clean?

  Yes

  No

  N/A

• Is the floor covering washable and impervious to moisture?

  Yes

  No

  N/A

• Is the flooring in a good state of repair?

  Yes

  No

  N/A

• Is there a dedicated hand wash basin?

  Yes

  No

  N/A

• Is the hand wash basin plug free?

  Yes

  No

  N/A

• Is the hand wash basin overflow free?

  Yes

  No

  N/A

• Is the waste offset so the water does not flow directly into it?

  Yes

  No

  N/A

• Are elbow / sensor taps available?

  Yes

  No

  N/A

• If no elbow or sensor taps, are staff aware of how to turn off the taps with a paper towel?

  Yes

  No

  N/A

• Are mixer taps or the thermostatically controlled water available?

  Yes

  No

  N/A

• Is the hand wash basin accessible?

  Yes

  No

  N/A

• Is the hand wash basin in a good state of repair?

  Yes

  No

  N/A

• Is the hand wash basin visibly clean?

  Yes

  No

  N/A

• Are hand wash basins free from extraneous items?

  Yes

  No

  N/A

• Is the soap dispensed from a single use cartridge?

  Yes

  No

  N/A

• Is the liquid soap dispenser wall mounted?

  Yes

  No

  N/A

• Is the soap dispenser visibly clean?

  Yes

  No

  N/A

• Are paper towels available from an enclosed dispenser?

  Yes

  No

  N/A

• Is the paper towel dispenser visibly clean?

  Yes

  No

  N/A

• Is there a promotional hand hygiene poster displayed?

  Yes

  No

  N/A

• Is there a hands-free domestic waste bin available for the disposal of paper towels?

  Yes

  No

  N/A

• Is the foot pedal of the domestic waste bin in good working order?

  Yes

  No

  N/A

• Is the domestic waste bin visibly clean, including lid and pedal?

  Yes

  No

  N/A

• Is the domestic waste bin in good condition?

  Yes

  No

  N/A

• Are alcohol based hand rub bottles available at the point of care?

  Yes

  No

  N/A

• Are alcohol based hand rub dispensers visibly clean?

  Yes

  No

  N/A

• Are bed and trolley bases, including cot sides, visibly clean and free from dust?

  Yes

  No

  N/A

• Is there evidence of an audit programme to check the condition of bed mattresses, couch mattresses and covers?

  Yes

  No

  N/A

• Is the examination couch cover impervious and washable?

  Yes

  No

  N/A

• Are covers to mattresses / examination couches / tilt tables in a good state of repair?

  Yes

  No

  N/A

• Do pillows have an impervious cover or are laundered on patient discharge?

  Yes

  No

  N/A

• Are pillows visibly clean and in a good state of repair?

  Yes

  No

  N/A

• Are all curtains visibly clean and on a cleaning / replacement schedule?

  Yes

  No

  N/A

• Are computer systems visibly clean?

  Yes

  No

  N/A

• Are all telephones visibly clean?

  Yes

  No

  N/A

• Are free standing / desk fans visibly clean?

  Yes

  No

  N/A

Environment - Back Corridor

• Is the environment visibly clean?

  Yes

  No

  N/A

• Is the environment free from any visible damage?

  Yes

  No

  N/A

• Is furniture made of impermeable and washable materials?

  Yes

  No

  N/A

• Are all furnishings and fittings visibly clean?

  Yes

  No

  N/A

• Are all furnishings and fittings in a good state of repair?

  Yes

  No

  N/A

• Are all surfaces smooth, impervious and with coved edges?

  Yes

  No

  N/A

• Is the floor visibly clean?

  Yes

  No

  N/A

• Is the floor covering washable and impervious to moisture?

  Yes

  No

  N/A

• Is the flooring in a good state of repair?

  Yes

  No

  N/A

• Is there a designated hand wash basin?

  Yes

  No

  N/A

• Is the hand wash basin plug free?

  Yes

  No

  N/A

• Is the hand wash basin overflow free?

  Yes

  No

  N/A

• Is the waste offset so the water does not flow directly into it?

  Yes

  No

  N/A

• Are elbow / sensor taps available?

  Yes

  No

  N/A

• If no elbow or sensor taps, are staff aware of how to turn off the taps with paper towel?

  Yes

  No

  N/A

• Are mixer taps or the thermostatically controlled water available?

  Yes

  No

  N/A

• Is the hand wash basin accessible?

  Yes

  No

  N/A

• Is the hand wash basin in a good state of repair?

  Yes

  No

  N/A

• Is the hand wash basin visibly clean?

  Yes

  No

  N/A

• Are hand wash basins free from extraneous items?

  Yes

  No

  N/A

• Is the soap dispensed from a single use cartridge?

  Yes

  No

  N/A

• Is the liquid soap dispenser wall mounted?

  Yes

  No

  N/A

• Is the soap dispenser visibly clean?

  Yes

  No

  N/A

• Are paper towels available from an enclosed dispenser?

  Yes

  No

  N/A

• Is the paper towel dispenser visibly clean?

  Yes

  No

  N/A

• Is there a promotional hand hygiene poster displayed?

  Yes

  No

  N/A

• Is there a hands-free domestic waste bin available for the disposal of paper towels?

  Yes

  No

  N/A

• Is the foot pedal of the domestic waste bin in good working order?

  Yes

  No

  N/A

• Is the domestic waste bin visibly clean, including lid and pedal?

  Yes

  No

  N/A

• Is the domestic waste bin in good condition?

  Yes

  No

  N/A

• Are alcohol based hand run bottles available at the point of care?

  Yes

  No

  N/A

• Are alcohol based hand rub dispensers visibly clean?

  Yes

  No

  N/A

• Are bed and trolley bases, including cot sides, visibly clean and free from dust?

  Yes

  No

  N/A

• Is there evidence of an audit programme to check the condition of the mattresses, couch mattresses and covers?

  Yes

  No

  N/A

• Is the examination couch cover impervious and washable?

  Yes

  No

  N/A

• Are covers to mattresses / examination couches / tilt tables in a good state of repair?

  Yes

  No

  N/A

• Do pillows have an impervious cover or are laundered on patient discharge?

  Yes

  No

  N/A

• Are pillows visibly clean and in a good state of repair?

  Yes

  No

  N/A

• Are all curtains visibly clean and on a cleaning / replacement schedule?

  Yes

  No

  N/A

• Are computer systems visibly clean?

  Yes

  No

  N/A

• Are all telephones visibly clean?

  Yes

  No

  N/A

• Are free standing / desk fans visibly clean?

  Yes

  No

  N/A

Environment - Disabled Toilets

• Is the environment visibly clean?

  Yes

  No

  N/A

• Is the environment free from any visible damage?

  Yes

  No

  N/A

• Are all surfaces smooth, impervious and with coved edges?

  Yes

  No

  N/A

• Is the floor visibly clean?

  Yes

  No

  N/A

• Is the floor covering washable and impervious to moisture?

  Yes

  No

  N/A

• Is the flooring in a good state of repair?

  Yes

  No

  N/A

• Is there a designated hand wash basin?

  Yes

  No

  N/A

• Is the hand wash basin accessible?

  Yes

  No

  N/A

• Is the hand wash basin in a good state of repair?

  Yes

  No

  N/A

• Is the hand wash basin visibly clean?

  Yes

  No

  N/A

• Are hand wash basins fee from extraneous items?

  Yes

  No

  N/A

• Is the soap dispensed from a single use cartridge?

  Yes

  No

  N/A

• Is the liquid soap dispenser wall mounted?

  Yes

  No

  N/A

• Is the soap dispenser visibly clean?

  Yes

  No

  N/A

• Are paper towels available from an enclosed dispenser?

  Yes

  No

  N/A

• Is the paper towel dispenser visibly clean?

  Yes

  No

  N/A

• Is there a hands-free clinical waste bin available for the disposal of paper towels?

  Yes

  No

  N/A

• Is the foot pedal of the clinical waste bin in good working order?

  Yes

  No

  N/A

• Is the clinical waste bin visibly clean, including lid and pedal?

  Yes

  No

  N/A

• Is the domestic waste bin in good condition?

  Yes

  No

  N/A

• Are toilets visibly clean?

  Yes

  No

  N/A

• Are the toilets in a good state of repair?

  Yes

  No

  N/A

• Are toilets fe from inappropriate items?

  Yes

  No

  N/A

• Are raised toilet seats visibly clean and stored off the floor?

  Yes

  No

  N/A

Environment - Toilets

• Is the environment visibly clean?

  Yes

  No

  N/A

• Is the environment free from any visible damage?

  Yes

  No

  N/A

• Are all surfaces smooth, impervious and with coved edges?

  Yes

  No

  N/A

• Is the floor visibly clean?

  Yes

  No

  N/A

• Is the floor covering washable and impervious to moisture?

  Yes

  No

  N/A

• Is the flooring in a good state of repair?

  Yes

  No

  N/A

• Is there a designated hand wash basin?

  Yes

  No

  N/A

• Is the hand wash basin accessible?

  Yes

  No

  N/A

• Is the hand wash basin in a good state of repair?

  Yes

  No

  N/A

• Is the hand wash basin visibly clean?

  Yes

  No

  N/A

• Are hand wash basins free from extraneous items?

  Yes

  No

  N/A

• Is the soap dispensed from a single use cartridge?

  Yes

  No

  N/A

• Is the liquid soap dispenser wall mounted?

  Yes

  No

  N/A

• Is the soap dispenser visibly clean?

  Yes

  No

  N/A

• Are paper towels available from an enclosed dispenser?

  Yes

  No

  N/A

• Is the paper towel dispenser visibly clean?

  Yes

  No

  N/A

• Is there a hands-free clinical waste available for the disposal of paper towels?

  Yes

  No

  N/A

• Is the foot pedal of the clinical waste bin in good working order?

  Yes

  No

  N/A

• Is the clinical waste bin visibly clean, including lid and pedal?

  Yes

  No

  N/A

• Is the domestic waste bin in a good condition?

  Yes

  No

  N/A

• Are toilets visibly clean?

  Yes

  No

  N/A

• Are the toilets in a good state of repair?

  Yes

  No

  N/A

• Are toilets free from inappropriate items?

  Yes

  No

  N/A

• Are raised toilet seats visibly clean and stored off the floor?

  Yes

  No

  N/A

Environment - Clean Utility

• Is the environment visibly clean?

  Yes

  No

  N/A

• Is the environment free from visible damage?

  Yes

  No

  N/A

• Is furniture made of impermeable and washable materials?

  Yes

  No

  N/A

• Are all furnishings and fittings visibly clean?

  Yes

  No

  N/A

• Are all furnishings and fittings in a good state of repair?

  Yes

  No

  N/A

• Are all surfaces smooth, impervious and with coved edges?

  Yes

  No

  N/A

• Is the floor visibly clean?

  Yes

  No

  N/A

• Is the floor covering washable and impervious to moisture?

  Yes

  No

  N/A

• Is the flooring in a good state of repair?

  Yes

  No

  N/A

• Is there a designated hand wash basin?

  Yes

  No

  N/A

• Is the hand wash basin compliant?

  Yes

  No

  N/A

• Are elbow / sensor taps available?

  Yes

  No

  N/A

• If no elbow or sensor taps, are staff aware of how to turn off the taps with a paper towel?

  Yes

  No

  N/A

• Are mixer taps or thermostatically controlled water available?

  Yes

  No

  N/A

• Is the hand wash basin accessible?

  Yes

  No

  N/A

• Is the hand wash basin in a good state of repair?

  Yes

  No

  N/A

• Is the hand wash basin visibly clean?

  Yes

  No

  N/A

• Are hand wash basins free from extraneous items?

  Yes

  No

  N/A

• Is the liquid soap dispenser wall mounted?

  Yes

  No

  N/A

• Is the soap dispenser visibly clean?

  Yes

  No

  N/A

• Are paper towels available from an enclosed dispenser?

  Yes

  No

  N/A

• Is the paper towel dispenser visibly clean?

  Yes

  No

  N/A

• Is there a promotional hand hygiene poster displayed?

  Yes

  No

  N/A

• Is there a hands-free domestic waste bin available for the disposal of paper towels?

  Yes

  No

  N/A

• Is the foot pedal of the domestic waste bin in good working order, clean and in good condition?

  Yes

  No

  N/A

• Is there a designated work surface / trolley for clinical procedures? i. e. dressings

  Yes

  No

  N/A

• Are dressing trolleys / trays structurally sound and in a good state of repair / clean?

  Yes

  No

  N/A

Environment - Dirty Utility

• Is the environment visibly clean?

  Yes

  No

  N/A

• Is the environment free from and visible damage?

  Yes

  No

  N/A

• Is furniture made of impermeable and washable materials?

  Yes

  No

  N/A

• Are all furnishings and fittings visibly clean?

  Yes

  No

  N/A

• Are all furnishings and fittings in a good state of repair?

  Yes

  No

  N/A

• Is the floor visibly clean?

  Yes

  No

  N/A

• Is the floor covering washable and impervious to moisture?

  Yes

  No

  N/A

• Is the flooring in a good state of repair?

  Yes

  No

  N/A

• Are all work surfaces smooth, impervious, with coved edges to facilitate easy cleaning?

  Yes

  No

  N/A

• Are all work surfaces visibly clean?

  Yes

  No

  N/A

• Is the dirty utility room free from clutter and inappropriate items?

  Yes

  No

  N/A

• Is there a designated hand wash basin?

  Yes

  No

  N/A

• Are mixer taps or thermostatically controlled water available?

  Yes

  No

  N/A

• Is the hand wash basin accessible?

  Yes

  No

  N/A

• Is the hand wash basin in a good state of repair?

  Yes

  No

  N/A

• Is the hand wash basin visibly clean?

  Yes

  No

  N/A

• Are hand wash basins free from extraneous items?

  Yes

  No

  N/A

• Are paper towels available from an enclosed dispenser?

  Yes

  No

  N/A

• Is there a promotional hand hygiene poster displayed?

  Yes

  No

  N/A

• Is there a hands-free domestic waste bin available for the disposal of paper towels?

  Yes

  No

  N/A

• Is the foot pedal of the domestic waste bin in good working order?

  Yes

  No

  N/A

• Is the domestic waste bin visibly clean, including lid and pedal?

  Yes

  No

  N/A

• Is the domestic waste bin in good condition?

  Yes

  No

  N/A

• Is there a dedicated deep sink for washing used equipment?

  Yes

  No

  N/A

• Is there a disposal unit available for the disposal of body fluids?

  Yes

  No

  N/A

• Are cleaning / disinfectant products available for decontamination of equipment and the environment?

  Yes

  No

  N/A

• Can staff describe which products should be used for routine cleaning and the correct dilution?

  Yes

  No

  N/A

• Are spillage kits or alternatives available for use on body fluid spillages?

  Yes

  No

  N/A

• Are staff aware of the procedures to be used when removing body fluid spillages?

  Yes

  No

  N/A

• Is personal protective equipment available?

  Yes

  No

  N/A

• Is the macerator or bedpan washer visibly clean?

  Yes

  No

  N/A

• Is the macerator or bedpan washer in good working order?

  Yes

  No

  N/A

• Are bed pans and urinals stored correctly to minimise contamination?

  Yes

  No

  N/A

• Are commodes in a good state of repair?

  Yes

  No

  N/A

• Are commodes visibly clean and ready for use, with up-to-date cleaning record?

  Yes

  No

  N/A

• Is there a system in place to check commodes are clean and ready for use?

  Yes

  No

  N/A

• Are wash bowls disposable or named single patient use?

  Yes

  No

  N/A

• Is the room free from communal items?

  Yes

  No

  N/A

• Are reusable catheter stands of an easily cleanable design?

  Yes

  No

  N/A

• Are catheter stands visibly clean?

  Yes

  No

  N/A

• Are measuring jugs either disposable or processed through a washer disinfector?

  Yes

  No

  N/A

• Is there a hands free waste bin available for the disposal of infectious / healthcare risk waste?

  Yes

  No

  N/A

Environment - Domestic Cleaning Room / Cupboard

• Is there a dedicated room for storage of cleaning equipment?

  Yes

  No

  N/A

• Is the environment visibly clean?

  Yes

  No

  N/A

• Is the environment free from any visible damage?

  Yes

  No

  N/A

• Are all furnishings and fittings visibly clean?

  Yes

  No

  N/A

• Are all furnishings and fittings in a good state of repair?

  Yes

  No

  N/A

• Are all surfaces smooth, impervious and with coved edges?

  Yes

  No

  N/A

• Is the flooring in a good state of repair?

  Yes

  No

  N/A

• Floors including edges and corners are free from dust and grit?

  Yes

  No

  N/A

• Equipment used by the domestic staff is clean, well maintained and stored in a locked area?

  Yes

  No

  N/A

• Machines used for floor cleaning are clean and dry?

  Yes

  No

  N/A

• No inappropriate materials or equipment are stored in the domestic rooms?

  Yes

  No

  N/A

• Products used for cleaning and disinfection comply with policy and are used at the correct dilution?

  Yes

  No

  N/A

• Diluted products are discarded after 24 hours?

  Yes

  No

  N/A

• Personal protective clothing is available and appropriately used?

  Yes

  No

  N/A

• Information on the colour coding system in use is available in the domestics room?

  Yes

  No

  N/A

• Hand hygiene facilities are available for domestic use?

  Yes

  No

  N/A

Environment - Water Coolers / Water Dispensers

• Are water coolers / ice machines on a portable supply e.g. mains or treated water supply?

  Yes

  No

  N/A

• Is the water cooler / ice making machine cleaned at least once a week according to the manufacturers instructions?

  Yes

  No

  N/A

• Is the water cooler / ice machine on a planned maintenance programme?

  Yes

  No

  N/A

• If used for consumption, does the ice making machine dispense ice from a nozzle directly into a receptacle on demand?

  Yes

  No

  N/A

Environment - Linen Management

• Is there a designated clean storage area fro clean linen?

  Yes

  No

  N/A

• Is the environment visibly clean?

  Yes

  No

  N/A

• Is the flooring in a good state of repair?

  Yes

  No

  N/A

• Is all linen stored off the floor?

  Yes

  No

  N/A

• Is the area / room used to store clean linen free from inappropriate items?

  Yes

  No

  N/A

• Is used linen placed directly into appropriate colour coded bags / containers at the point of use?

  Yes

  No

  N/A

• Are water-soluble bags used for soiled and / or infected linen?

  Yes

  No

  N/A

• Are used linen bags / containers less than 2/3rds full?

  Yes

  No

  N/A

• Are rigid linen skips visibly clean?

  Yes

  No

  N/A

• Is used linen stored in a designated area until collections e.g. sluice rooms, dirty utility room?

  Yes

  No

  N/A

Environment - Ward / Department Kitchen

• The floor is free from dust, grit, litter, marks, water or other liquids?

  Yes

  No

  N/A

• Inaccessible areas ( edges, corners and around furniture ) are free from dust, grit, lint and spots?

  Yes

  No

  N/A

• There are no inappropriate items or equipment in the kitchen?

  Yes

  No

  N/A

• There is no evidence of infestation or animals in the kitchen?

  Yes

  No

  N/A

• Fly screens are in place where required?

  Yes

  No

  N/A

• There is a policy regarding patient and visitor access to the kitchen?

  Yes

  No

  N/A

• Cleaning materials used in the kitchen are identifiable ( e.g. colour coded ) and are stored separately to other ward cleaning equipment and away from food?

  Yes

  No

  N/A

• Hand wash sink, liquid soap and disposable paper towels are available?

  Yes

  No

  N/A

• Hands are decontaminated and a clean plastic apron is worn to serve patients meals and drinks?

  Yes

  No

  N/A

• Fixtures and fittings are in a good state of repair?

  Yes

  No

  N/A

• Fixtures, surfaces and appliances are free of grease, dirt, dust, deposits, marks, stains and cobwebs?

  Yes

  No

  N/A

• Shelves, cupboards and drawers are clean inside and out, free from damage, dust, litter or stains and in a good state of repair?

  Yes

  No

  N/A

• Kitchen trolleys are clean and in a good state of repair?

  Yes

  No

  N/A

• Refrigerators / freezers are clean and free of ice build up?

  Yes

  No

  N/A

• There is a thermometer in the fridge and freezer?

  Yes

  No

  N/A

• There is evidence that daily temperatures are recorded and appropriate action is taken if standards are not met ( refrigerators temperature must be less than 8 degrees or as local policy freezer temperature -18 degrees?

  Yes

  No

  N/A

• Patient and staff food in the fridge is labelled with name and date?

  Yes

  No

  N/A

• There are no drugs / blood for transfusion or pathology specimens in the fridge?

  Yes

  No

  N/A

• Microwaves are visibly clean?

  Yes

  No

  N/A

• Where local policy allows a microwave to be used to heat patient food a temperature probe is used to ensure correct temperature has been reached?

  Yes

  No

  N/A

• Toasters are visibly clean?

  Yes

  No

  N/A

• Milk coolers are visibly clean?

  Yes

  No

  N/A

• Bread is stored in a clean bread bin?

  Yes

  No

  N/A

• All food products are within their expiry date?

  Yes

  No

  N/A

• All opened food is covered or stored in containers?

  Yes

  No

  N/A

• Milk is stored under refrigerator conditions?

  Yes

  No

  N/A

• Water coolers and ice machines for patient use are manis supplied?

  Yes

  No

  N/A

• Water coolers are visibly clean and on a pre-planned maintenance programme?

  Yes

  No

  N/A

• Ice machines are visibly clean and on a pre-planned maintenance programme?

  Yes

  No

  N/A

• Scoop used for ice is stored outside the machine in a lidded container?

  Yes

  No

  N/A

• There is a satisfactory system for cleaning crockery and cutlery such as central wash-up or dishwasher, achieving disinfection temperatures evidence by a maintenance programme.

  Yes

  No

  N/A

• Disposable paper roll is available for drying equipment and surfaces?

  Yes

  No

  N/A

• Waste bins are foot operated and in good working order?

  Yes

  No

  N/A

• Waste bins are clean and labelled 'for general waste'?

  Yes

  No

  N/A

Patient Equipment - Management of Equipment

• Is all equipment detailed on a cleaning schedule?

  Yes

  No

  N/A

• Are schedules completed, signed and up to date with frequencies and responsibilities identified?

  Yes

  No

  N/A

• Are items sent for service, inspection or repair, appropriately cleaned and / or disinfected, and a label or contamination status attached?

  Yes

  No

  N/A

• Is loaned equipment decontaminated prior to use unless received from an accredited sterile services department / unit?

  Yes

  No

  N/A

• Are sterile products stored above floor level?

  Yes

  No

  N/A

• Are sterile packs sealed and undamaged?

  Yes

  No

  N/A

• Are all sterile packs in date?

  Yes

  No

  N/A

• Can staff describe the symbol used to indicate single use items?

  Yes

  No

  N/A

• Are all re-usable instruments returned to a sterile services provider for decontamination?

  Yes

  No

  N/A

• Are cleaning products available for routine cleaning of equipment?

  Yes

  No

  N/A

Patient Equipment - Mobile Equipment

• Is mobile equipment such as drug trolleys, notes trolleys, mobile x-rays, ultrasound equipment visibly clean?

  Yes

  No

  N/A

• Is there a system to routinely clean mobile equipment and is this monitored?

  Yes

  No

  N/A

Patient Equipment - Monitoring and Physiological Equipment

• Is all equipment in a good state of repair?

  Yes

  No

  N/A

• Is blood pressure monitoring equipment visibly clean?

  Yes

  No

  N/A

• Are all stethoscopes visibly clean?

  Yes

  No

  N/A

• Is blood glucose monitoring equipment visibly clean?

  Yes

  No

  N/A

• Is all reusable equipment routinely cleaned between every patient with general purpose detergent or as per local policy / manufacturers instructions, where this differs?

  Yes

  No

  N/A

• Are IV stands / pumps visibly clean?

  Yes

  No

  N/A

• Are monitoring leads / straps decontaminated between patients?

  Yes

  No

  N/A

• Are tourniquets single use or decontaminated between patients?

  Yes

  No

  N/A

Patient Equipment - Resuscitation Equipment

• Are items on the resuscitation trolley visibly clean?

  Yes

  No

  N/A

• Is resuscitation equipment either single use or reprocessed through a sterile services provider?

  Yes

  No

  N/A

• Is the suction machine visibly clean and dry?

  Yes

  No

  N/A

• Are nebulisers stored clean and dry between uses?

  Yes

  No

  N/A

• Are disposable suction liners used and changed between patients?

  Yes

  No

  N/A

Patient Equipment - Manual Handling Equipment

• Is manual handling equipment stored appropriately?

  Yes

  No

  N/A

• Are manual handling slings / sheets single use or laundered after use?

  Yes

  No

  N/A

• Are hoists visibly clean and in a good state of repair?

  Yes

  No

  N/A

• Are PAT (Patient Assisted Transfer) slides stored off the floor?

  Yes

  No

  N/A

Patient Equipment - Miscellaneous Equipment

• Are aids such as walking sticks, Zimmer frames, helping hands visibly clean and stored in a suitable area?

  Yes

  No

  N/A

• Are wheelchairs visibly clean and n a good state of repair?

  Yes

  No

  N/A

• In paediatric areas toys are visibly clean?

  Yes

  No

  N/A

• Are toys made of cleanable materials?

  Yes

  No

  N/A

• Is stored patient equipment e.g. IV stands, pumps, mattresses, bariatric equipment visibly clean and ready for use, and identified as such?

  Yes

  No

  N/A

Personal Protective Equipment - Personal Protective Equipment

• Are single use plastic aprons available?

  Yes

  No

  N/A

• Are single use plastic aprons stored appropriately away from risk of contamination?

  Yes

  No

  N/A

• Are single use apron sworn as single use items and changed between every patient?

  Yes

  No

  N/A

• Is there a range of sizes of sterile and non-sterile powder free gloves available?

  Yes

  No

  N/A

• Are gloves stored appropriately?

  Yes

  No

  N/A

• Are gloves worn when in contact or anticipated contact with bodily fluids or in potential contact with contaminated items?

  Yes

  No

  N/A

• Are gloves removed after care activity and hand hygiene performed?

  Yes

  No

  N/A

• Is eye and face protection worn by staff when anticipating contact with blood and bodily fluids with a high risk of splashing in the face and eyes?

  Yes

  No

  N/A

Patient Waiting Area - RGDU / TAIRU

• Are all surfaces smooth impervious and with coved edges?

  Yes

  No

  N/A

• Is the floor visibly clean?

  Yes

  No

  N/A

• Is the floor covering washable and impervious to moisture?

  Yes

  No

  N/A

• Is the flooring in a good state of repair?

  Yes

  No

  N/A

• Are ward or clinic televisions / display screens visibly clean?

  Yes

  No

  N/A

• Are free standing / desk fans visibly clean?

  Yes

  No

  N/A

• Are air vents visibly clean?

  Yes

  No

  N/A

• Are hand hygiene facilities available?

  Yes

  No

  N/A

• Are equipment cleaning wipes available?

  Yes

  No

  N/A

• Are the air conditioning unites clean and free from dust?

  Yes

  No

  N/A

• Is there a planned programme of maintenance of the air conditioning units?

  Yes

  No

  N/A

• Are patient dressing trolleys available and free from dust / debris?

  Yes

  No

  N/A

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