TSDFT IPS Quarterly Audit

• Conducted on

  Date

• Prepared by

• Location
  Address

Corridors, Nurses Station etc.

• The environment, furniture, floors, fixtures and fittings are visibly clean?

  Yes

  No

  N/A

• All high / low surfaces are dust and cobweb free?

  Yes

  No

  N/A

• Computers / display screens / telephones are visibly clean?

  Yes

  No

  N/A

• Fans are clean and free from dust?

  Yes

  No

  N/A

• Air vents are clean and free from dust?

  Yes

  No

  N/A

• The hands free bin is visibly clean?

  Yes

  No

  N/A

• The hand wash basin and surrounding area is clean?

  Yes

  No

  N/A

• There is a hand hygiene poster displayed at every hand wash basin on the ward?

  Yes

  No

  N/A

Patient Bays

• The environment, furniture, floor, fixtures and fittings are visibly clean?

  Yes

  No

  N/A

• All high / low surfaces are dust and cobweb free?

  Yes

  No

  N/A

• Curtains / blinds are stain, dust and cobweb free?

  Yes

  No

  N/A

• Fans are clean and free from dust?

  Yes

  No

  N/A

• Air vents are clean and free from dust?

  Yes

  No

  N/A

• Patient call bells are visibly clean?

  Yes

  No

  N/A

• Patient audio-visual systems are visibly clean?

  Yes

  No

  N/A

• Work station is visibly clean e.g. phones, keyboards etc.?

  Yes

  No

  N/A

• Hands free bin is visibly clean?

  Yes

  No

  N/A

• The hand wash basin and surrounding area is clean?

  Yes

  No

  N/A

• Check 2 mattresses for strike-through.

  Safe

  At Risk

  N/A

• There are 5 moments of hand hygiene posters displayed in each bay / side room?

  Yes

  No

  N/A

Clean Utility

• The environment, floor, fixtures and fittings are visibly clean?

  Yes

  No

  N/A

• The hands free bin is visibly clean?

  Yes

  No

  N/A

• The dressing trolley / trays are visibly clean?

  Yes

  No

  N/A

• The hand wash basin is clean and free from clutter?

  Yes

  No

  N/A

Patient Side Rooms

• The environment, furniture, floor, fixtures and fittings are visibly clean?

  Yes

  No

  N/A

• All high / low surfaces are dust and cobweb free?

  Yes

  No

  N/A

• Curtains / blinds are stain, dust and cobweb free?

  Yes

  No

  N/A

• Fans are clean and free from dust?

  Yes

  No

  N/A

• Air vents are clean and free from dust?

  Yes

  No

  N/A

• Patient call bells are visibly clean?

  Yes

  No

  N/A

• Patient audio visual systems are visibly clean?

  Yes

  No

  N/A

• The hands free bin is visibly clean?

  Yes

  No

  N/A

• The hand wash basin and surrounding area is clean?

  Yes

  No

  N/A

Patient Side Rooms Ensuite

• The toilet, shower, hand wash basin, handrails and surrounding area is clean?

  Yes

  No

  N/A

• Wall tiles / fixtures are clean and free from mould?

  Yes

  No

  N/A

• Shower curtains are clean, dry and mould free?

  Yes

  No

  N/A

• The hands free bin is visibly clean?

  Yes

  No

  N/A

Shower Rooms / Toilets

• Shower rooms / washrooms are visibly clean?

  Yes

  No

  N/A

• There is no evidence of inappropriate storage of communal items, e.g. single use creams, shampoo, shower gel etc.?

  Yes

  No

  N/A

• Shower rooms are not used for equipment storage?

  Yes

  No

  N/A

• Wall tiles / fixtures are clean and free from mould?

  Yes

  No

  N/A

• Shower curtains are clean, dry and mould free?

  Yes

  No

  N/A

• The toilet, hand wash basin, handrails and surrounding area is clean and free from extraneous items?

  Yes

  No

  N/A

• The hands free bin is visibly clean?

  Yes

  No

  N/A

Dirty Utility

• The environment, floor, fixtures and fittings are visibly clean?

  Yes

  No

  N/A

• The dirty utility room is free from clutter and inappropriate or communal items?

  Yes

  No

  N/A

• The hands free bin is visibly clean?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• The hand wash basin and surrounding area is visibly clean?

  Yes

  No

  N/A

Ward / Department Kitchen

• The environment, floor, fixtures and fittings are visibly clean?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• The hands free basin is visibly clean?

  Yes

  No

  N/A

• Kitchen trolleys are clean?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Toasters are visibly clean?

  Yes

  No

  N/A

• Microwaves are visibly clean?

  Yes

  No

  N/A

• The hand wash basin and surrounding area is clean?

  Yes

  No

  N/A

Management of Patient Equipment

• Mobile equipoment such as drug trolleys, mobile x-rays and ultrasound etc. are visibly clean?

  Yes

  No

  N/A

• Aids such as walking sticks, Zimmer frames and wheelchairs etc. are visibly clean?

  Yes

  No

  N/A

• In paediatric areas toys are visibly clean?

  Yes

  No

  N/A

• Patient equipment e.g. IV stands, pumps, mattresses and bariatric equipment is visibly clean?

  Yes

  No

  N/A

• Blood pressure monitoring equipment is visibly clean?

  Yes

  No

  N/A

• Blood glucose monitoring equipment is visibly clean?

  Yes

  No

  N/A

CQC Questions

• Is emergency equipment clean, in date and easily accessible, with a daily signed checking schedule, that is up-to-date? (Daily if not sealed)

  Yes

  No

  N/A

• Has equipment been signed off as clean, and is it actually clean? e.g. Hoists, bedside lockers, commodes, side tables, beds etc.

  Yes

  No

  N/A

• Are gloves and aprons used at appropriate times, and removed between clinical sessions?

  Yes

  No

  N/A

• Is hand hygiene education material clearly visible?

  Yes

  No

  N/A

• Ask 3 staff are they familiar with the 5 moments of hand hygiene?

  Yes

  No

  N/A

• Do staff use gel dispensers or wash their hands appropriately between each patient / task?

  Yes

  No

  N/A

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