Audit

1.0 General Area: Hand Hygiene

1.1. Hand sanitizer is available and accessible for the patients and visitors in all waiting areas?

1.2. Available liquid soap within all treatment rooms?

1.3. Wall mounted paper towels available near each sink?

1.4. Clinical staff able to demonstrate good handwashing techniques?

1.5. Staff able to apply 5 moments of hand hygiene?

2.0 Patient Exam Rooms

2.1. Floor and walls clean?

2.2. Cubicle curtains unsoiled and free of tears?

2.3. Exam table/bed is clean free of dust, rust, tapes and tape residues.

2.4. Sink is clean and no supplies found within 3 feet of the sink in the absence of a splash guard.

2.5. Liquid soap and paper towel dispenser are stocked and working?

2.6. Alcohol hand sanitizers are available?

2.7. Gloves, PPE available?

2.8. No food or drink in patient care areas?

2.9. Vent grill is dirt free?

2.10. Wedges for positioning cleaned and disinfected after every patient use?

2.11. Drawers well organized and clean?

2.12. Working surfaces are clean?

2.13. Equipment decontamination done?

(Ultrasound) Pelvic Probe cleaned and disinfected per protocol

Ultrasound Tech can articulate cleaning and disinfection; transport and storage processes for pelvic probe.

2.14. Mattress pad is without tears or puncture holes?

2.15. Plants not present in clinical areas?

2.16. (MRI) Cleaning equipment not containing any ferrous or ferromagnetic material?

2.17. All surfaces on the MRI table (inside the magnet bore, magnet gantry and MRI coils is clean?

2.18. Cleaning schedule is followed and updated?

2.19. Is equipment properly cleaned per protocol/ manufacturer's recommendation?

3.0 Waste Management

3.1. Waste containers clean, operational and in good condition?

3.2 Waste containers covered and with labels?

3.3. Contaminated instruments or disposables placed on designated area not mixed with clean items?

3.4. Regulated medical waste discarded appropriately?

3.5. Waste clearly segregated?

3.6. Sharp containers secured and labeled appropriately?

3.7. Sharp bins not mixed with any general/biomedical waste?

3.8. Sharp containers are no more than 2/3 full?

3.9. Staffs are aware not to bend, recap ore remove contaminated needle or sharps unless it is absolutely necessary?

4.0 Medications/ Items

4.1. No outdated IV solutions, items and medicines?

4.2. Open vials dated and times as per policy?

4.3. Safe injection practices followed as per policy?

4.4. Out of date sterile supplies are not present?

5.0. Utility and Storage Room

5.1. Floors and walls clean?

5.2. Horizontal and vertical surfaces are clean?

5.3. Adequate separation of clean and soiled?

5.4. Bottom shelf is solid?

5.5. No supplies stored 10" from the floor?

5.6. No supplies stored touching the 18" from the ceiling?

5.7. No supplies stored in the dirty utility room?

5.8 Soiled linen is bagged accordingly?

6.0. Chemical Safety

6.1. Material Safety Data Sheets available for all chemicals?

6.2. Risk assessments completed for hazardous substance?

6.3. All containers labelled correctly?

6.4. Unused substances disposed of?

6.5. Do special storage conditions apply?

6.6. Workers trained in the use of hazardous substance?

6.7. If required is PPE available?

6.8. Are eye washes and showers easily accessed?

7.0. Corridors/ Hallways/ Environment

7.1. Furniture is clean and in a good state?

7.2. The wall is clean and dust free?

7.3. Free of obstruction and equipment?

7.4. Reception area is clean and work surface clean and free from clutter?

Staff Knowledge on Infection Prevention

Staff able to articulate the hand hygiene the 5 moments of hand hygiene

Staff able to articulate the care for instruments at point of care prior to transport to SPD

Staff able to articulate how an isolation patient is identified

Additional Comments

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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.