Nursing Department:


1. Staff able to find or state the location of the hospital's Infection Control Policies & Procedures

2. Able to name three types of isolation / precautions and their indications.

3. Able to state the CDC recommended personal protective equipment (PPE) for a specific type of isolation / precaution: (name one of the isolation precautions)

4. Staff able to articulate the required isolation precaution for an organism based on hospital policy: (name an organism).

5. If a patient is on isolation, state the reason for isolation. If no patient is on isolation, state the reasons for: (name one of the isolation precautions).

6. Able to list three steps in preparing an isolation patient for transport to another part of the hospital.

7. Able to describe which way the air flows in a negative airflow room and anteroom.

8. State who checks negative pressure rooms? How often? Where is this recorded?

9. Staff able to articulate steps to check a negative airflow room for correct operation. What is the correct procedure if the room doesn't check out?

10. Able to state the Hand Hygiene policy including the fingernail standards for healthcare workers.

11. Able to name steps to cleanup a biohazard spill of blood or body fluids.

12. Able to state the approved hospital procedure for needle recapping and disposal .

13. Able to identify biohazardous waste containers; list three examples of biohazard waste.

14. Able to state the types of infections commonly seen, or targeted organisms commonly treated, in the unit?

15. Able to articulate the unit's performance improvement activities to reduce hospital onset infections happening in the unit? In the hospital?

16. Able to describe three actions to take if exposed to blood or body fluids.

17. Able to state three steps to take if a patient or visitor in a waiting area is suspected of having a contagious respiratory disease.

18. Able to state the the contact/dwell time or both hydrogen peroxide and bleach wipes.

FRONT DESK (Main Nurse's Station)

19. Able to state process which identifies patients/visitors with respiratory illnesses?

20. Able to state if patient/visitor is requested to wear a surgical mask or provide Kleenex tissues and hand sanitizer as needed when respiratory infection is suspected.

21. For Emergency Department: Staff able to state that patients with respiratory illnesses are moved out of communal areas as soon as possible.

22. Is CDC Cover your Cough signage visible?

23. Is hand sanitizer available for Unit CCP/ registration staff / patients / visitors?


24. Clean/sterile supplies are stored on racks or carts, not on floors, not under sinks or plumbing, and no closer than 18" to the ceiling.

25. Clean linen is stored in carts and always covered, no items are stored on top of the carts.

26. Soiled linen is collected and transported to designated dirty utility area in a covered leak resistant container.

27. Clean and dirty utility rooms are separate. Clean items are not stored in dirty areas; dirty items are not stored in clean areas.

28. Personal Protective Equipment (PPE) –gloves, gowns, aprons, goggles, masks, and face shields are available for procedures and tasks requiring their use.

29. Handwashing stations: available, clean, and stocked with disposable towels and soap. Alcohol-based hand sanitizer dispensers full and functional.

30. A correctly labeled hospital-approved disinfectant is available for cleaning equipment, exam tables, and environmental surfaces between each patient's use.

31. Biohazardous / waste containers do not hold regular waste. Regular trash containers do not hold biohazard waste

32. Correctly labeled sharps containers are available at sharps generation points.

33. Sharps containers are not overfilled.

34. Supplies, medications in med refrigerators, food in patient nutrition refrigerators are not expired.

35. Refrigerator thermometers read 36 to 45 degrees, and the refrigerator log is up to date.

36. Patient food trays are in food carts, patient rooms, or collection carts to be returned to nutrition services.

37. All appliances for preparation/storage of food/medications are visibly clean.

38. Gaskets in refrigerators are clean and not broken.

39. All utensils and coffee stirrers in nourishment area are individually wrapped or hygienically stored (vertical position to prevent contamination)

40. Nothing is stored inside of nourishment area cabinets unless it pertains to nourishment supplies.

41. Staff personal belongings and hand lotions are not stored in patient care areas.

42. Items are not stored in inappropriate or unsafe locations (on trash containers, shred bins, portable X-ray machines; blocking hallways, doors, or exits).

43. Ceiling tiles are clean and not stained

44. High level dusting has been done throughout unit (no dust on top of picture frames/clocks/PYxis)

45. Sterile supplies and vacutainers are not expired.

46. Nothing is stored under sinks.

47. Medication carts / PYxis are clean. Medication bins inside the pyxis machine are clean.

48. Patient care mobile computers / WOWs are clean and uncluttered.

49. Equipment and chairs do not have tears or cracks.

50. Equipment throughout unit does not contain tape.

51. All open vials of medications have an expiration date from the manufacturer with no obvious signs of contamination, and are dated when opened: insulin expires 28 days after opening.

52. The CPR/Crash Cart is clean (dust free).



53. Staff is observed performing correct hand hygiene: a) washing hands for at least 15 seconds with alcohol foam or soap and water, b) using towel to turn off faucets and touch door handles, and c) between patient contacts.

56. Isolation sign/s visible outside the patient's room and is in the electronic medical record of an isolation patient being transported.

54. Staff able to articulate whether Physician Isolation Orders are required for patients requiring isolation precautions.

55. Isolation carts and anterooms are available and adequately stocked .

61. Direct patient care staff have no artificial fingernails; nails extend < 1/4" from fingertip.

60. Food, and drinks are not consumed, cosmetics and contact lenses are not applied in patient care areas or workstations.

57. Staff correctly observe isolation precautions posted for patients.

58. Staff correctly documents isolation precautions posted for patients including an isolation header and an individualized care plan.

59. Patients on airborne isolation are located in a negative airflow room and have a current log of daily negative airflow room checks per hospital policy.

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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.