INFECTION CONTROL PROCEDURAL SURVEILLANCE CHECKLIST

Instructions for use of this

Checklist

This checklist is designed to facilitate a rapid audit of infection control practice within a clinical
area.

Ten groups of criteria are audited.

Grampians Regional Infection Control Group

When a particular criterion group is not available for audit at the time of audit
eg: sterile wound dressing, the section is crossed out, and obviously not included in the
final numeric score.

The final numeric score is derived as a percentage: Achieved Score

Possible Score

The final numeric score may be used as a “rule of thumb” for comparing compliance
between clinical areas (although the shortcomings of the tool are obviously the small sample
size, and the “luck of the draw” within the clinical area, as to the staff observed)

Where satisfaction of a criterion is not possible by observation, a response obtained by staff

questioning is acceptable.

The following areas are covered in this audit:

1. Handwashing

2. Environmental Cleaning (This tool is NOT intended to replace detailed Cleaning Audits)

3. Waste Disposal

4. Handling of Clean Linen

5. Handling of Soiled Linen

6. Standard Precautions

7. Single Use Policy

8. Urinary Catheter Care

9. Sterile Wound Dressing

10. Food Hygiene in the Clinical Area

 INFECTION CONTROL CHECKLIST

INFECTION CONTROL PROCEDURAL SURVEILLANCE CHECKLIST

HEALTH FACILITY:

Date: Auditor/s:

Clinical area:

Scoring System: Audit Process: Scoring Process

0 = ACCEPTABLE Observed
A/B %
A B
1 = UNACCEPTABLE Verbal Response

N/A = NOT APPLICABLE

Column A = Achieved score Achieved Score %
Possible Score
Column B = Possible score
(Do not include N/A)

0 = ACCEPTABLE 1 = UNACCEPTABLE N/A = NOT APPLICABLE O = OBSERVED V = VERBAL RESPONSE

INFECTION CONTROL CHECKLIST

Compliance Observed (O)

1. HYGENIC HANDWASHING 0 1 N/A /Verbal COMMENTS
Response (V)

1.1. Bar soap or nail brushes NOT evident on hand basins for staff
use
1.2. Staff fingernails are clean and short
1.3. Jewellery is not worn (Wedding ring excepted)
1.4. Hands are washed under warm, running water
1.5. A neutral detergent hand wash is used
1.6. All areas of both hands are washed using friction
1.7. Wash time is at least 15 seconds
1.8. Area under Wedding Ring is washed
1.9. Hands are rinsed free of soap
1.10. Hands are dried using paper towel, including under- ring area
1.11. Alcohol-gel hand agent is used between client contacts as
acceptable alternative
1.12. A poster depicting good hand washing technique is present at
one clinical hand basin
1.13. Hand washing technique is reinforced at the Staff Induction
Program
1.14. The need to wash hands after glove removal is recognised by
staff
Sub Total

0 = ACCEPTABLE 1 = UNACCEPTABLE N/A = NOT APPLICABLE O = OBSERVED V = VERBAL RESPONSE

INFECTION CONTROL CHECKLIST

Compliance Observed (O)

HYGENIC HANDWASHING Cont’d 0 1 N/A /Verbal COMMENTS
Response (V)

Carried Forward

1.15. Electric hand dryers are NOT in use in clinical areas

1.16. Reusable towels are NOT in use
1.17. A good quality moisturiser is available at staff hand washing
facilities, and is clearly labelled
1.18. There are adequate staff hand washing facilities to eliminate the
need for staff to use client’s room facilities
1.19. Used paper towel is disposed of appropriately
1.20. If “glitter” is used, removal hand wash produces clearance
1.21. Hand moisturiser is used routinely, as indicated
1.22. A procedure exists for staff to notify OH&S or Infection Control,
regarding personal hand problems such as skin break-down,
rashes, paronychia
1.23. The use of disposable gloves is encouraged for procedures
where hand contamination is expected

Score

0 = ACCEPTABLE 1 = UNACCEPTABLE N/A = NOT APPLICABLE O = OBSERVED V = VERBAL RESPONSE

INFECTION CONTROL CHECKLIST

Compliance Observed (O)

2. ENVIRONMENTAL CLEANING/ SANITATION 0 1 N/A /Verbal COMMENTS
Response (V)

2.1 There is a documented procedure for ALL cleaning within the clinical
area, including:
2.1.1. Baths, after client use
2.1.2. B/P cuffs, shared between clients
2.1.3. Sponge bowls
2.1.4. Commode chairs, after use
2.1.5. Lifting slings
2.1.6. Cleaning equipment
2.2. Surfaces and equipment are free from dust, spills and grime including:
2.2.1. Hard floors
2.2.2. Soft floors
2.2.3. Clients over-bed tables
2.2.4. Client bed-side lockers
2.2.5. Medical equipment
2.2.6. Bathrooms
2.2.7. Ward kitchens
2.3. Cleaning equipment is colour-coded to identify appropriate area of use
2.4. Equipment provided for sanitation and decontamination has been
functioning effectively during the last four weeks, and has been quickly
repaired if malfunctioning, including:
2.4.1. Pan/ urinal sanitisers
2.4.2. Utensil washers
2.4.3. Sluices
2.4.4. Staff hand basins
2.4.5. Toilets

Score

0 = ACCEPTABLE 1 = UNACCEPTABLE N/A = NOT APPLICABLE O = OBSERVED V = VERBAL RESPONSE

INFECTION CONTROL CHECKLIST

Compliance Observed (O)

3. WASTE DISPOSAL 0 1 N/A /Verbal COMMENTS
Response (V)

3.1 There is a documented procedure and flowchart to guide staff in

waste disposal, including:
3.1.1 Infectious waste
3.1.2 Offensive waste
3.1.3 Waste for recycling
3.2 Waste flow charts are posted in utility rooms, and waste storage
rooms
3.3 Details of waste disposal flows are included in the Staff Induction
Program
3.4 Foot- operated bins are provided for infectious waste
3.5 Waste bags are securely sealed when filled
3.6 Full waste bags are only stored in designated areas
3.7 Infectious waste, and other scheduled wastes are stored under secure
conditions
3.8 Rooms where Infectious waste is stored are signposted with warning
symbol
3.9 Sealed Infectious Waste bags are traceable to the clinical area of
origin
Sub Total

0 = ACCEPTABLE 1 = UNACCEPTABLE N/A = NOT APPLICABLE O = OBSERVED V = VERBAL RESPONSE

INFECTION CONTROL CHECKLIST

Compliance Observed (O)

WASTE DISPOSAL Cont’d 0 1 N/A /Verbal COMMENTS
Response (V)

Carried Forward
3.10 Recyclable waste is NOT present in “waste for disposal” containers
3.11 Sharps bins are used for the reception of all sharps:
3.11.1 In accordance with a written hospital policy
3.11.2 Securely sealed when 2/3 full
3.11.3 Contain no protruding sharps
3.11.4 Available in all areas where sharps are generated
3.11.5 Secure from public interference
3.11.6 Sealed sharps containers are traceable to the clinical area of
origin
3.11.7 Information regarding sharps disposal is provided within the
staff induction program
3.12 Biological Spills:
3.12.1 There is a readily-accessible procedure for containment and
decontamination of biological spills, eg: blood
3.12.2 The procedure for dealing with biological spills is detailed in
the staff induction program
3.12.3 A biological spill kit is available in the clinical area
3.12.4 The spill kit is complete and functional
3.12.5 Staff are aware of the location of the spill kit, and its mode of
use
Score

0 = ACCEPTABLE 1 = UNACCEPTABLE N/A = NOT APPLICABLE O = OBSERVED V = VERBAL RESPONSE

INFECTION CONTROL CHECKLIST

Compliance Observed (O)

4 HANDLING AND STORAGE OF CLEAN
/Verbal COMMENTS
LINEN 0 1 N/A
Response (V)

4.1. Clean linen is transported to, and stored in the clinical area; in such a
manner that exposure to dust and moisture is prevented
4.2. Clean linen is physically separate from soiled linen
4.3. Unnecessary supplies of clean linen are NOT taken to client rooms
and placed on client furnishings
4.4. There is a mechanism for staff to report if clean linen is not of an
adequate standard
4.5. Clean linen is NOT stored in an area which houses cleaning
equipment
Score

0 = ACCEPTABLE 1 = UNACCEPTABLE N/A = NOT APPLICABLE O = OBSERVED V = VERBAL RESPONSE

INFECTION CONTROL CHECKLIST

Compliance Observed (O)

5 HANDLING AND STORAGE OF SOILED
/Verbal COMMENTS
LINEN 0 1 N/A
Response (V)

5.1. Are adequate soiled linen skips available where bed-stripping

activities occur
5.2. Is soiled linen ever carried by hand more than a few metres
5.3. If soiled linen skips have a lid, is it foot-operated
5.4. Are soiled linen bags “closed-off” when 2/3 full
5.5. Are gloves worn when handling heavily-soiled linen
5.6. Is there a mechanism for segregating and colour-coding foul/
ordinary/ infectious linen
5.7. Is the mechanism for the segregation of different soiled linen
reinforced in the Staff Induction Program
5.8. Is soiled linen which is capable of leakage placed in bags with
impervious liners
5.9. Are soiled linen bags stored in a designated area, which is secure
from public access
5.10. Do staff wash hands following soiled linen handling

Score

0 = ACCEPTABLE 1 = UNACCEPTABLE N/A = NOT APPLICABLE O = OBSERVED V = VERBAL RESPONSE

INFECTION CONTROL CHECKLIST
 Compliance Observed (O)
6 STANDARD PRECAUTIONS 0 1 N/A /Verbal COMMENTS
Response (V)

6.1 Is the procedure for Standard Precautions available in the clinical area
6.2 Are Standard Precautions reinforced in the Staff Induction Program
6.3 Are disposable gloves/ aprons/ eye protection available in clinical area
6.4 Are containerised Pathology Specimens placed in leak-proof transit
bags for transport
6.5 Appropriate protective clothing is worn when contact with body fluids
is expected
6.6 Suitable disposable gloves are available for staff who may suffer from
latex allergy
6.7 Hands are washed after glove removal
Score

0 = ACCEPTABLE 1 = UNACCEPTABLE N/A = NOT APPLICABLE O = OBSERVED V = VERBAL RESPONSE

INFECTION CONTROL CHECKLIST

Compliance Observed (O)

7 SINGLE – USE POLICY 0 1 N/A /Verbal COMMENTS
Response (V)

7.1 Is the Non-reuse Policy reinforced in the Staff Induction Program

7.2 Is there a copy of the Single-use Policy in the clinical area
7.3 Is there evidence of re-use of disposables in the clinical area
7.4 Are non-standard items being sent for sterilisation
7.5 Is there evidence of any disinfectant “soaking ponds” in the clinical
area
7.6 Are multi-dose vials in use in clinical areas:
 If YES is their use approved, eg: insulin labelled with
client’s name, and separate from ward stock

Score

0 = ACCEPTABLE 1 = UNACCEPTABLE N/A = NOT APPLICABLE O = OBSERVED V = VERBAL RESPONSE

INFECTION CONTROL CHECKLIST

Compliance Observed (O)

8 CARE OF URINARY CATHETERS/DRAINAGE 0 1 N/A /Verbal COMMENTS
Response (V)

8.1 Are disposable gloves worn for drainage bag emptying

8.2 Are drainage bags above floor level
8.3 Is a disinfected jug or disposable container used for emptying
8.4 Are catheter specimens obtained by the aseptic – swab/puncture/
syringe method
8.5 Is the valve in the drainage bag actually preventing leakage

Score

0 = ACCEPTABLE 1 = UNACCEPTABLE N/A = NOT APPLICABLE O = OBSERVED V = VERBAL RESPONSE

INFECTION CONTROL CHECKLIST

Compliance Observed (O)

9 STERILE WOUND DRESSING 0 1 N/A /Verbal COMMENTS
Response (V)

9.1 Are sterile supplies assembled totally, prior to commencing aseptic

technique
9.2 Are hands washed prior to opening sterile supplies
9.3 Are sterile supplies opened aseptically
9.4 Is procedural hand wash adequate
9.5 Are sterile gloves donned aseptically
9.6 Is soiled dressing removed and discarded appropriately, with removal
forceps
9.7 Is wound swabbed using aseptic technique
9.8 Is sterile dressing applied aseptically
9.9 Is new dressing adequate to prevent “strike through”
9.10 Are used items disposed of appropriately
9.11 Are gloves removed in a manner which will not result in hand
contamination
9.12 Is there a post-glove removal hand wash
Score

0 = ACCEPTABLE 1 = UNACCEPTABLE N/A = NOT APPLICABLE O = OBSERVED V = VERBAL RESPONSE

INFECTION CONTROL CHECKLIST
 Compliance Observed (O)
10 FOOD HYGIENE IN THE CLINICAL AREA 0 1 N/A /Verbal COMMENTS
Response (V)

10.1 Are hand washing facilities available in the kitchen

10.2 Are disposable gloves available in the kitchen
10.3 Has the kitchen dishwasher functioned effectively over the last four
weeks
10.4 Have kitchen staff completed the Food Handler’s Course
10.5 Is kitchen cleaning equipment colour-coded
10.6 Is the correct colour-coded equipment actually being used
o
10.7 Are cold foods kept at a temperature not greater than 5 C
o
10.8 Are hot foods kept at a temperature not less than 65 C
10.9 Is all plated food placed in the refrigerator covered with glad wrap,
and dated
10.10 Does hand washing occur prior to food preparation
10.11 Is disposable or single-use towelling used for cleaning
10.12 Does the kitchen have a cleaning schedule
10.13 Is there evidence that the kitchen cleaning schedule has been
followed
Score

0 = ACCEPTABLE 1 = UNACCEPTABLE N/A = NOT APPLICABLE O = OBSERVED V = VERBAL RESPONSE

INFECTION CONTROL CHECKLIST

SUMMARY OF RESULTS

AREA SCORE

Handwashing

Environmental Cleaning

Waste Disposal

Handling of Clean Linen

Handling of Soiled Linen

Standard Precautions

Single Use Policy

Urinary Catheter Care

Sterile Wound Dressing

Food Hygiene in the Clinical Area

TOTAL

0 = ACCEPTABLE 1 = UNACCEPTABLE N/A = NOT APPLICABLE O = OBSERVED V = VERBAL RESPONSE