Audit

NURSING
GENERAL UNIT OBSERVATION

Overall appearance: HALLWAYs ARE CLEAN, NEAT & FREE OF CLUTTER

Air vents are CLEAN. Indicate 2 rooms to be inspected. If DIRTY, attach a photo.

AIR VENT: Rm #1

Paper towels are available at all sinks

Alcohol-Based Hand Rub (ABHR) dispensers are filled and functional

Are there any boxes out in the hallway in direct contact with the floor? (Desired answer is NO). If boxes are noted, attach a photo.)

Soap and Lotion dispensers are filled and functional

Taped posters/fliers on the wall are laminated

Rooms are maintained CLOSED and not propped open

Biohazard Room

Clean Utility Room

EVS Closet

High / Low Dusting Done (Indicate below areas that need dusting)

Area that needs dusting

Area that needs dusting

Floor CLEAN, POLISHED & FREE OF CLUTTER. If noted otherwise, attach a photo

Orgqnization - approved disinfectants are available and accessible

Patient Care Team Member observed eating or drinking in areas other than the lounge.

Food / Beverages observed in the unit (other than the lounge)

EQUIPMENT

IV Poles are CLEAN.

Weighing Scale is CLEAN.

Lift Equipment is CLEAN

Computers / Computer Keyboards are CLEAN.

CRASH CART is CLEAN

Toy / Activity Supplies Cart is CLEAN (if applicable)

Isolation Cart is CLEAN

Patient Medication Refrigerator overall appearance: CLEAN. (if applicable)

CLEAN UTILITY/ SUPPLY ROOM

Overall appearance: CLEAN & NOT OVERSTOCKED. If noted otherwise, attach a photo.

Boxes of items/supplies in direct contact with the floor. (Desired answer is NO)

All equipment in the room are clean

Supplies are 10" above the floor

Supplies are 18" below the ceiling

All items are within their expiration dates (no outdated items)

DIRTY UTILITY/ BIOHAZARD ROOM

Only DIRTY supplies and equipment are in the room

Needles & sharps are all disposed safely inside the sharps container

Full sharps containers are closed and locked

Open sharps container is less than 2/3 full

Trash bins/ barrels/carts not overflowing with trash. (Desired answer is NO) If observed otherwise, attach photo

Trash bins/ barrels/ carts are clean and covered.

Chemo waste placed in yellow container with liner,

Infectious (RED BAG) waste container is clean & covered.
(Only items "dripping" in blood or bodily fluids in the container)

Broken glass (BLACK) container identified, where applicable

Hand Washing sink nearby with filled and functional soap dispenser.

ISOLATION ROOM/S

Appropriate Isolation Precaution sign posted. Indicate Rm # & Required Isolation

Hand Hygiene supplies (ABHR / soap & water) readily available

PPE available and accessible

Door is kept closed at all times for Airborne Isolation Precautions

Isolation Carts / Supply Box ONLY have isolation precaution supplies inside which may include Unused Protective Eye Wear and Disposable Stethoscopes. If observed otherwise, attach photo.

OCCUPIED PATIENT ROOMS. Indicate Rm #

Overall appearance: CLEAN, NEAT & FREE OF CLUTTER

Hand Hygiene supplies readily available and accessible

High Dusting NOT needed. If observe otherwise, Indicate areas needing high dusting and attach a photo.

Privacy curtain clean (if applicable)

Shower curtain is clean (if applicable)

Shower Stall / Tub clean (if applicable)

SHOWER ROOM / TUB ROOM

Shower stall / tub is CLEAN

Shower curtain is not visibly soiled

There are no visible evidences of mold growth

UNOCCUPIED PATIENT ROOM. Indicate the Rm #

Overall appearance: CLEAN, NEAT & FREE OF CLUTTER

High Dusting NOT needed. If observe otherwise, Indicate areas needing high dusting and attach a photo.

Shower curtain is clean (if applicable)

Shower Stall / Tub clean (if applicable)

Privacy curtain clean (if applicable)

LINEN ROOM/ CARTS (If separate from the Clean Utility/ Supply Room)

Overall all appearance: CLEAN, NEAT & FREE OF CLUTTER

Linen at the bottom shelf is hanging out. (Desired answer is NO) If observed otherwise, attach photo

Linens/Pillows on the floor

Linen Room is kept closed at all times

Linens/pillows are kept 10" above the floor

Bottom shelf of linen carts have splash guards

Linens/pillows are 18" below the ceiling

CUSTODIAN / EVS CLOSET

Door kept locked at all times

Mop sitting in water (Desired answer is NO)

EVS cart with equipment and chemicals is kept locked

Personal belongings inside the EVS closet (Desired answer is NO)

Food & Beverage in the EVS closet (Desired answer is NO)

PROCESS OBSERVATIONS

Patient Care Team performing hand hygiene upon room ENTRY

Patient Care Team performing hand hygiene upon room ENTRY

Patient Care Team performing hand hygiene upon room EXIT

Patient Care Team performing hand hygiene upon room EXIT

Patient Care Team wearing appropriate PPE in an isolation room

Cleaning & Disinfection of noncritical equipment using hospital approved disinfectants in between patient care

CATHETER ASSOCIATED UTI PREVENTION

No dependent loops or kinks observed

Urinary bag not touching the floor.

Urinary bag not overfilled (not more than 2/3 of the bag full)

Indication for urinary catheter reviewed and documented for the day

CENTRAL LINE ASSOCIATED - BSI PREVENTION

CVC dressing appears CLEAN, DRY & INTACT

CVC dressing changed according to organization's policy

Indication for CVC reviewed and documented for the day

ADDITIONAL COMMENTS

COMMENT #1: Does it need follow up?

COMMENT #2: Does it need follow up?

COMMENT #3: Does it need follow up?

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.