Caresettingprocessimprovementtool :Gpsurgery/Healthcentre

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InfectionPreventionQualityImprovementTools

CareSettingProcessImprovementTool:GPSurgery/HealthCentre

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FunctionalArea: StartDate: OverallAuditors: Module:ManagementofInfectionPreventionandControl

Date: Auditors:

Standard:Infectionpreventionandcontrolismanagedeffectively,givenhighpriorityandseenasanintegralpartofthebusinesswithinthesurgery/healthcentre

QuestionSet:ManagementofInfectionPreventionandControl-GeneralManagementObservation:1

QuestionGuidance / Yes / No / N/A / Comment
1 / Isthereanamedleadpersonresponsibleforinfectionpreventionandcontrol?(12,77,78,
82) / Askwhotheleadpersonis.Thismaybealinknurse.
2 / Doesthejobdescriptionofthenamedleadpersonoutlineresponsibilitiesinrespectofinfectionpreventionandcontrol?(77,78,82) / Reviewthejobdescription.Checkforitemssuchasaudit,actionplanforrisk,education,surveillance.
3 / Areinfectionpreventionandcontrolrelatedtopicsagendaitemsatstaff/businessmeetings?(77,78,82) / Askforminutes.
4 / Arethereuptodatelocalcontacttelephonenumbersavailabletoobtainadvicepertainingtoinfectionpreventionandcontrol?(82) / Askforthelistofcontactnumbers.Checkthattheyarethemostuptodate.
5 / Isthereevidenceofaprocessforreportinguntowardincidentsinrelationtoinfectionpreventionandcontrol?(77,78,82) / Asktoseeincidentrecords.
6 / Isthereevidencethatauditshavebeenundertakenandpracticechangedtoimproveinfectionpreventionandcontrol?(14) / Asktoseemostrecentauditandactionplan.Thismustincludehandhygieneaudits.
7 / Ismandatorysurveillancedatafedbacktostaff?(82) / Checkminutesofmeetingstoensuresurveillanceisdiscussedandactionresultingfromrootcauseanalysisisdocumented.
8 / Aretherelocalriskassessmentswhichdocumentchallengestoeffectiveinfectionprevention?(82) / Lookforriskassessmentsprocessese.g.riskregister,incidentbook,Datix.CheckRootCauseAnalysisandActionplansdevelopedtoaddressidentifiedrisks.

QuestionSetComments/Recommendations forManagementofInfectionPreventionandControl-GeneralManagement

QuestionSet:ManagementofInfectionPreventionandControl-StaffHealthObservation:1

QuestionGuidance

YesNoN/A Comment

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QuestionSet:ManagementofInfectionPreventionandControl-StaffHealthObservation:1

QuestionGuidance / Yes / No / N/A / Comment
1 / Dooccupationalhealthpoliciesrequirestafftobeofferedimmunisationinlinewithcurrentnationalguidance?(39,45,48,77,
78,82) / Randomlyselecttwomembersofstaffandaskwhethertheirimmunisationstatushasbeenassessed.
2 / Isthereapolicyonstaffexclusionfromworkwithregardstoinfectionprevention?(47,48,
77,78,82) / Checkpolicy.Checkstaffareawareoftheneedtoremainoffworkfor48hoursafterresolutionofillnessessuchasdiarrhoea/vomiting/Group AStreptococcalinfection.
3 / Arestaffawareoftheprocedureformanaginganinoculationcontaminationinjury?(20,81) / Asktwomembersofstafftodescribetheprocedure.
4 / Isthereapolicy/posteravailableforthemanagementofaninoculationcontaminationinjury?(48) / Visibleevidenceofstaffguidance.

QuestionSetComments/Recommendations forManagementofInfectionPreventionandControl-StaffHealth

QuestionSet:ManagementofInfectionPreventionandControl-StaffTrainingObservation:1

QuestionGuidance / Yes / No / N/A / Comment
1 / Isinfectionpreventionandcontrolincludedinallstaffinductionprogrammes?(77,78,82) / Checktrainingincludes:HandHygiene,PPE,Handling
DisposalofSharps,DecontaminationofEquipment,Managementofblood/bodyfluidspillage,Waste,SpecimenHandling.
2 / Havestaffreceivedmandatorytrainingininfectionpreventionandcontrolinlinewithlocalpolicyandtrainingneedsanalysis?(77,78,82) / ChecktrainingrecordsdetailInfectionpreventionandcontroltraining.
3 / Isthereaprocessinplacetoensureallnonattendeesatmandatorytrainingarefollowedup?(77,78,82) / Asktoseeprocessforfollowupofnonattendeestomandatorytrainingprogram.

QuestionSetComments/Recommendations forManagementofInfectionPreventionandControl-StaffTraining

QuestionSet:ManagementofInfectionPreventionandControl-Policies,ProceduresandGuidelinesObservation:1

QuestionGuidance

YesNoN/A Comment

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QuestionSet:ManagementofInfectionPreventionandControl-Policies,ProceduresandGuidelinesObservation:1

QuestionGuidance / Yes / No / N/A / Comment
1 / Areuptodateinfectionpreventionandcontrolpoliciesandguidelinesavailableandaccessiblebystaff?(77,78,82) / Checkstaffcanaccessguidelinesandthatalldocumentsaredatedwithinthelasttwoyears.Alsocheckthatthefollowingareincluded:Handhygiene,personalprotectiveequipment,sharpshandlinganddisposal,decontaminationofequipment,managementofblood/bodyfluidspillage,wastemanagement.
2 / Aresystemsinplacetoensureinfectionpreventioninputissoughtpriortopurchaseofequipment?(77,78,82) / Checkpolicy/localprocedureforpurchasingnewequipment.Checkforevidencethatinfectionpreventionteamhasbeenconsultedpriortopurchaseofanynewequipment.
3 / Aretherecomprehensivewrittencleaningstandardsandprocedures?(85,86) / Checkcleaningschedules;ensureresponsibilityforcleaningallareasisclearlyidentified.
4 / Arethereclearlyoutlinedstaffresponsibilitiesforcleaningdedicatedareas/equipment?(77,84,85,86,95) / Identifywhoisresponsibleforcleaningspecificpiecesofequipment.Checkcleaningschedulefordetails.
5 / Arecleaningprocessesandoutcomesauditedregularly?(85,86) / Checkauditrecordsandactionplansifnoncompliant.
6 / Areuptodatecleaningschedulesclearlydisplayed?(85,86) / Asktoseethedepartmentcleaningprogrammeandspecifications.
7 / Doestheestablishmenthavesuitableequipmenttocleancarpets?(52,85) / Checkforacarpetcleaner/steamer.

QuestionSetComments/Recommendations forManagementofInfectionPreventionandControl-Policies,ProceduresandGuidelines

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12DepartmentofHealth(2006)InfectionControlGuidanceforCareHomes.London:DepartmentofHealth.

14DepartmentofHealth(2007)EssentialStepstosafe,cleancare.Reducinghealthcareassociatedinfections(HCAI)inprimarycaretrusts,mentalhealthtrusts,learningdisabilityorganisations,independent

healthcarefacilities,carehomes,hospices,GPpracticesandambulanceservices.London:DepartmentofHealth.

20PrattRJ,PelloweC,WilsonJA,LovedayHP,HarperPJ,JonesSRLJ,McDougallCM,WilcoxMH.(2007)Epic2:NationalEvidenceBasedGuidelinesforpreventingHealthcare-AssociatedInfectioninNHS

HospitalsinEngland.JournalofHospitalInfection.65(1)Supplement1.

39DepartmentofHealth(2006)"ImmunisationagainstInfectiousDisease"-"TheGreenBook"DepartmentofHealthTSOLondon

45DepartmentofHealth(2007)Healthclearancefortuberculosis,hepatitisB,hepatitisCandHIV:NewHealthcareWorkers.London:DepartmentofHealth;2007

47DepartmentofHealth(2004)HepatitisC:ActionplanforEngland.London:DepartmentofHealth;2004

48DepartmentofHealth(2000)HepatitisBinfectionhealthcareworkers:guidanceonimplementationofHealthServiceCircular2000/020.London:DepartmentofHealth

52ThenationalspecificationsforcleanlinessintheNHS:AframeworkforsettingandmeasuringperformanceoutcomesApril2007.

77Standards-March2008HealthcareAssociatedInfection(HAI):QualityImprovementScotland,2008.

78DraftInfectionPreventionandControlStandards:AConsultationDocument:HealthInformationandQualityAuthority,RepublicofIreland2009

81DepartmentofHealth(1998)GuidanceforClinicalHealthCareWorkers:ProtectionAgainstInfectionwithBlood-borneVirusRecommendationsoftheExpertAdvisoryGrouponAIDSandtheAdvisoryGrouponHepatitis

82DepartmentofHealth(2009)CodeofPracticefortheNHSonthepreventionandcontrolofhealthcareassociatedinfectionsandrelatedguidance:DepartmentofHealth.

84ControloftheEnvironmentPolicyandProcedure.In:InfectionControlTeamHPS,editor:NHSNationalServicesScotland,2009

85TheNHSCleaningManual:NPSA,2009

86TheNHSScotlandNationalCleaningServicesSpecification.In:ForceHAIT,editor:NHSNationalServicesScotland

95ManagementofBloodandOtherBodyFluidSpillagesPolicyandProcedure.In:InfectionControlTeamHPS,editor:NHSNationalServicesScotland,2009

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Module:Environment

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Date: Auditors: Standard:Theenvironmentisdesignedandmanagedtominimisereservoirsformicro-organismsandreducetheriskofcrossinfectiontopatients,staffandvisitors.

QuestionSet:Environment-Reception/WaitingAreaObservation:1

RoomFunction:Lobby/Reception/Entrance

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
1 / Istheenvironmentvisiblyclean?(15,20,52,
53,80,84,86) / Checkwalls,windows,ceilings,fansandlightfittingsarefreefromdust/debris/insectsetc.
2 / Istheenvironmentfreefromanyvisibledamage?(20,53,77,80,84,85,95) / Checkforflakingpaint,damagedwalls/ceilings/windowframesandsurfaces.Checkforevidenceofactiontakentorepair.
3 / Isfurnituremadeofimpermeableandwashablematerials?(53,84,85,95) / Checkfurniture.
4 / Areallfurnishingsandfittingsvisiblyclean?(20,31,52,84,85,86) / Checkallareasareclean,behindandundersurfaces.
5 / Areallfurnishingsandfittingsinagoodstateofrepair?(84,85,95) / Wherethereisdamage,checkforevidenceofactiontakentoensurerepairorreplacement.
6 / Areallsurfacessmooth,impervious(foreasycleaning)andwithcovededges?(20,
53,80,84) / Checkallsurfaces.
7 / Isthefloorvisiblyclean?(20,52,84,85,86) / Checktheedgesandcornersarecleanandfreeofdustandgrit.
8 / Istheflooringinagoodstateofrepair?(52,
53) / Checkforripsandtears.
9 / Istheenvironmenttidyanduncluttered? / Checkallareasareaccessibleforcleaning.
10 / Arealltelephonesvisiblyclean?(20,84,85,
86) / Checkreceiver.
11 / Arecomputersystemsvisiblyclean?(20,
84,85,86) / Checkuptothree.

QuestionSetComments/Recommendations forEnvironment-Reception/WaitingArea

QuestionSet:Environment-ManagementofToysObservation:1

QuestionGuidance / Yes / No / N/A / Comment
1 / Isthereaprocedureforthemanagementoftoys?(9,10) / Askastaffmembertolocatetheprocedure.

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QuestionSet:Environment-ManagementofToysObservation:1

QuestionGuidance / Yes / No / N/A / Comment
2 / Istherearecordofcleaningwhichincludesfrequenciesofcleaning? / Checkdocumentation.
3 / Isthereadesignatedstorageareafortoys? / Checkarea.
4 / Isthestoragearea/toyboxvisiblyclean? / Checkarea/box.
5 / Aretoysvisiblyclean? / Checktoys.
6 / Aretoysmadeofacleanablematerial?(77,
78,82) / Checktoys.
7 / Arechildren`sbookscleanandundamaged?(9,10,82) / Checkpagesfortorn/dirtypagesandchewededges.

QuestionSetComments/Recommendations forEnvironment-ManagementofToys

QuestionSet:Environment-ToiletsObservation:1

RoomFunction:Toilet

RoomNo.:1

Room:

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QuestionSet:Environment-ToiletsObservation:1

RoomFunction:Toilet

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
9 / Isthehandwashbasininagoodstateofrepair?(15) / Checktherearenocracksorchips.
10 / Isthehandwashbasinvisiblyclean?(52,
84) / Checkplugholesandoverflowsforcleanliness
buildupoflimescale.
11 / Arehandwashbasinsfreefromextraneousitems?(53) / e.g.mugs,medicinepotsetc.
12 / Isthesoapdispensedfromasingleusecartridge?(53,80,90,92,94) / Checkcartridge,thereshouldbeenoughsoapforthenexttwouses.
13 / Istheliquidsoapdispenserwallmounted? / Checkthatthesoapdispenseriswallmounted.
14 / Isthesoapdispenservisiblyclean?(90) / Checkthenozzleforbuildupofsoapanddebris.
15 / Arepapertowelsavailablefromanencloseddispenser?(53,80,90) / Papertowelsshouldbesofttissuewithenoughinthedispenserforthenexttwowashes.
16 / Isthepapertoweldispenservisiblyclean?(90) / Checkundersideofdispenser.
17 / Isthereapromotionalhandhygieneposterdisplayed?(90) / Checkforposter.Itshouldbelaminated,cleanandrelevanttotheroom.
18 / Isthereahands-freedomesticwastebinavailableforthedisposalofpapertowels?(53,56,80) / Visuallycheck.
19 / Isthefootpedalofthedomesticwastebiningoodworkingorder?(53,80) / Checkthefootpedalopensthelid.
20 / Isthedomesticwastebinvisiblyclean,includinglidandpedal?(23,85,86) / Checkbinsarecleanexternallyandinternally.
21 / Isthedomesticwastebiningoodcondition?(23,85,86) / Checkforrusti.e.underneathlid.
22 / Arefacilitiesavailableforthedisposalofsanitarywaste? / Checkforsanitarybin.
23 / Aretoilet(s)visiblyclean?(20,52,84,85,
86) / Checkunderneaththetoiletseat.
24 / Arethetoilet(s)inagoodstateofrepair? / Checkfordamage.
25 / Isthereamechanismtoensurethattoiletcleaningcanbecarriedoutasneeded?(20,
82,84,85,86) / Checkforsupplyofdetergentwipesorothercleaner.

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QuestionSet:Environment-ToiletsObservation:1

RoomFunction:Toilet

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
26 / Aretoiletbrushesandholdersvisiblyclean?(20,84,85,86) / Checktwoforevidence.
27 / Areraisedtoiletseatsvisiblycleanandstoredoffthefloor?(20,84) / Checkunderneaththeraisedseat.

QuestionSetComments/Recommendations forEnvironment-Toilets

QuestionSet:Environment-ToiletsObservation:1

RoomFunction:Toilet

RoomNo.:2

Room:

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QuestionSet:Environment-ToiletsObservation:1

RoomFunction:Toilet

RoomNo.:2

Room:

QuestionGuidance / Yes / No / N/A / Comment
12 / Isthesoapdispensedfromasingleusecartridge?(53,80,90,92,94) / Checkcartridge,thereshouldbeenoughsoapforthenexttwouses.
13 / Istheliquidsoapdispenserwallmounted? / Checkthatthesoapdispenseriswallmounted.
14 / Isthesoapdispenservisiblyclean?(90) / Checkthenozzleforbuildupofsoapanddebris.
15 / Arepapertowelsavailablefromanencloseddispenser?(53,80,90) / Papertowelsshouldbesofttissuewithenoughinthedispenserforthenexttwowashes.
16 / Isthepapertoweldispenservisiblyclean?(90) / Checkundersideofdispenser.
17 / Isthereapromotionalhandhygieneposterdisplayed?(90) / Checkforposter.Itshouldbelaminated,cleanandrelevanttotheroom.
18 / Isthereahands-freedomesticwastebinavailableforthedisposalofpapertowels?(53,56,80) / Visuallycheck.
19 / Isthefootpedalofthedomesticwastebiningoodworkingorder?(53,80) / Checkthefootpedalopensthelid.
20 / Isthedomesticwastebinvisiblyclean,includinglidandpedal?(23,85,86) / Checkbinsarecleanexternallyandinternally.
21 / Isthedomesticwastebiningoodcondition?(23,85,86) / Checkforrusti.e.underneathlid.
22 / Arefacilitiesavailableforthedisposalofsanitarywaste? / Checkforsanitarybin.
23 / Aretoilet(s)visiblyclean?(20,52,84,85,
86) / Checkunderneaththetoiletseat.
24 / Arethetoilet(s)inagoodstateofrepair? / Checkfordamage.
25 / Isthereamechanismtoensurethattoiletcleaningcanbecarriedoutasneeded?(20,
82,84,85,86) / Checkforsupplyofdetergentwipesorothercleaner.
26 / Aretoiletbrushesandholdersvisiblyclean?(20,84,85,86) / Checktwoforevidence.
27 / Areraisedtoiletseatsvisiblycleanandstoredoffthefloor?(20,84) / Checkunderneaththeraisedseat.

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QuestionSetComments/Recommendations forEnvironment-Toilets

QuestionSet:Environment-ToiletsObservation:1

RoomFunction:Toilet

RoomNo.:3

Room:

QuestionGuidance / Yes / No / N/A / Comment
1 / Istheenvironmentvisiblyclean?(15,20,52,
53,80,84,86) / Checkwalls,windows,ceilings,fansandlightfittingsarefreefromdust/debris/insectsetc.
2 / Istheenvironmentfreefromanyvisibledamage?(20,53,77,80,84,85,95) / Checkforflakingpaint,damagedwalls/ceilings/windowframesandsurfaces.Checkforevidenceofactiontakentorepair.
3 / Areallsurfacessmooth,impervious(foreasycleaning)andwithcovededges?(20,
53,80,84) / Checkallsurfaces.
4 / Isthefloorvisiblyclean?(20,52,84,85,86) / Checktheedgesandcornersarecleanandfreeofdustandgrit.
5 / Isthefloorcoveringwashableandimpervioustomoisture?(20,53,80,84) / Isthefloorcoveringappropriatefortheroom.
6 / Istheflooringinagoodstateofrepair?(52,
53) / Checkforripsandtears.
7 / Isthereadesignatedhandwashbasin?(15,
53,80,82,90) / Visuallycheck.
8 / Isthehandwashbasinaccessible?(53,80,
90) / Checkforobstructionse.g.equipment.
9 / Isthehandwashbasininagoodstateofrepair?(15) / Checktherearenocracksorchips.
10 / Isthehandwashbasinvisiblyclean?(52,
84) / Checkplugholesandoverflowsforcleanliness
buildupoflimescale.
11 / Arehandwashbasinsfreefromextraneousitems?(53) / e.g.mugs,medicinepotsetc.
12 / Isthesoapdispensedfromasingleusecartridge?(53,80,90,92,94) / Checkcartridge,thereshouldbeenoughsoapforthenexttwouses.
13 / Istheliquidsoapdispenserwallmounted? / Checkthatthesoapdispenseriswallmounted.
14 / Isthesoapdispenservisiblyclean?(90) / Checkthenozzleforbuildupofsoapanddebris.
15 / Arepapertowelsavailablefromanencloseddispenser?(53,80,90) / Papertowelsshouldbesofttissuewithenoughinthedispenserforthenexttwowashes.

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QuestionSet:Environment-ToiletsObservation:1

RoomFunction:Toilet

RoomNo.:3

Room:

QuestionGuidance / Yes / No / N/A / Comment
16 / Isthepapertoweldispenservisiblyclean?(90) / Checkundersideofdispenser.
17 / Isthereapromotionalhandhygieneposterdisplayed?(90) / Checkforposter.Itshouldbelaminated,cleanandrelevanttotheroom.
18 / Isthereahands-freedomesticwastebinavailableforthedisposalofpapertowels?(53,56,80) / Visuallycheck.
19 / Isthefootpedalofthedomesticwastebiningoodworkingorder?(53,80) / Checkthefootpedalopensthelid.
20 / Isthedomesticwastebinvisiblyclean,includinglidandpedal?(23,85,86) / Checkbinsarecleanexternallyandinternally.
21 / Isthedomesticwastebiningoodcondition?(23,85,86) / Checkforrusti.e.underneathlid.
22 / Arefacilitiesavailableforthedisposalofsanitarywaste? / Checkforsanitarybin.
23 / Aretoilet(s)visiblyclean?(20,52,84,85,
86) / Checkunderneaththetoiletseat.
24 / Arethetoilet(s)inagoodstateofrepair? / Checkfordamage.
25 / Isthereamechanismtoensurethattoiletcleaningcanbecarriedoutasneeded?(20,
82,84,85,86) / Checkforsupplyofdetergentwipesorothercleaner.
26 / Aretoiletbrushesandholdersvisiblyclean?(20,84,85,86) / Checktwoforevidence.
27 / Areraisedtoiletseatsvisiblycleanandstoredoffthefloor?(20,84) / Checkunderneaththeraisedseat.

QuestionSetComments/Recommendations forEnvironment-Toilets

QuestionSet:Environment-BabyChangingRoomObservation:1

RoomFunction:BabyChangingRoom

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
1 / Istheenvironmentvisiblyclean?(15,20,52,
53,80,84,86) / Checkwalls,windows,ceilings,fansandlightfittingsarefreefromdust/debris/insectsetc.

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QuestionSet:Environment-BabyChangingRoomObservation:1

RoomFunction:BabyChangingRoom

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
2 / Istheenvironmentfreefromanyvisibledamage?(20,53,77,80,84,85,95) / Checkforflakingpaint,damagedwalls/ceilings/windowframesandsurfaces.Checkforevidenceofactiontakentorepair.
3 / Areallsurfacessmooth,impervious(foreasycleaning)andwithcovededges?(20,
53,80,84) / Checkallsurfaces.
4 / Isthefloorvisiblyclean?(20,52,84,85,86) / Checktheedgesandcornersarecleanandfreeofdustandgrit.
5 / Isthefloorcoveringwashableandimpervioustomoisture?(20,53,80,84) / Isthefloorcoveringappropriatefortheroom.
6 / Istheflooringinagoodstateofrepair?(52,
53) / Checkforripsandtears.
7 / Isthereadesignatedhandwashbasin?(15,
53,80,82,90) / Visuallycheck.
8 / Isthehandwashbasininagoodstateofrepair?(15) / Checktherearenocracksorchips.
9 / Isthehandwashbasinvisiblyclean?(52,
84) / Checkplugholesandoverflowsforcleanliness
buildupoflimescale.
10 / Arehandwashbasinsfreefromextraneousitems?(53) / e.g.mugs,medicinepotsetc.
11 / Isthesoapdispensedfromasingleusecartridge?(53,80,90,92,94) / Checkcartridge,thereshouldbeenoughsoapforthenexttwouses.
12 / Istheliquidsoapdispenserwallmounted? / Checkthatthesoapdispenseriswallmounted.
13 / Isthesoapdispenservisiblyclean?(90) / Checkthenozzleforbuildupofsoapanddebris.
14 / Arepapertowelsavailablefromanencloseddispenser?(53,80,90) / Papertowelsshouldbesofttissuewithenoughinthedispenserforthenexttwowashes.
15 / Isthereahands-freedomesticwastebinavailableforthedisposalofpapertowels?(53,56,80) / Visuallycheck.
16 / Isthefootpedalofthedomesticwastebiningoodworkingorder?(53,80) / Checkthefootpedalopensthelid.
17 / Isthedomesticwastebinvisiblyclean,includinglidandpedal?(23,85,86) / Checkbinsarecleanexternallyandinternally.
18 / Isthedomesticwastebiningoodcondition?(23,85,86) / Checkforrusti.e.underneathlid.

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QuestionSet:Environment-BabyChangingRoomObservation:1

RoomFunction:BabyChangingRoom

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
19 / Isthereinformationdisplayedforparentsonhowtocleanthechangingareaafteruse? / Checkforinformation.
20 / Arecleaningmaterialsavailableforparentstouse? / Checkmaterials.
21 / Aresoftplasticchangingmatsintact? / Checktherearenosplitsintheplasticandthefoamisnotvisible.
22 / Isthereafootoperatedpedalbindesignatedforthedisposalofnappies?(23,53,90) / Checkthepedalworks.
23 / Isthefootpedalofthenappywastebiningoodworkingorder? / Checkthefootpedalopensthelid.
24 / Isthenappywastebinvisiblyclean,includinglidandpedal?(23,85,86) / Checkbinsarecleanexternallyandinternally.
25 / Isthenappywastebiningoodcondition?(23,85,86) / Checkforrusti.e.underneathlid.

QuestionSetComments/Recommendations forEnvironment-BabyChangingRoom

QuestionSet:Environment-TreatmentRoomObservation:1

RoomFunction:TreatmentRoom

RoomNo.:1

Room:

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QuestionSet:Environment-TreatmentRoomObservation:1

RoomFunction:TreatmentRoom

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
7 / Isthefloorvisiblyclean?(20,52,84,85,86) / Checktheedgesandcornersarecleanandfreeofdustandgrit.
8 / Isthefloorcoveringwashableandimpervioustomoisture?(20,53,80,84) / Isthefloorcoveringappropriatefortheroom.
9 / Istheflooringinagoodstateofrepair?(52,
53) / Checkforripsandtears.
10 / Isthereadesignatedhandwashbasin?(15,
53,80,82,90) / Visuallycheck.
11 / Isthehandwashbasinplugfree?(15) / Checkthehandwashbasindoesnothaveaplug.
12 / Isthehandwashbasinoverflowfree?(15) / CheckthehandwashbasindoesNOThaveanoverflow.
13 / Isthewasteoffsetsothewaterdoesnotflowdirectlyintoit?(15) / CheckthewaterfromthetapdoesNOTflowdirectlyintotheplughole.
14 / Areelbow/sensortapsavailable?(15) / Visuallycheck.
15 / Ifnoelboworsensortaps,arestaffawareofhowtoturnoffthetapswithapapertowel?(15) / Observepracticeoraskamemberofstafftodescribeprocedure.
16 / Aremixertapsorthermostaticallycontrolledwateravailable?(15) / Testwatertemperature.
17 / Isthehandwashbasinaccessible?(53,80,
90) / Checkforobstructionse.g.equipment.
18 / Isthehandwashbasininagoodstateofrepair?(15) / Checktherearenocracksorchips.
19 / Isthehandwashbasinvisiblyclean?(52,
84) / Checkplugholesandoverflowsforcleanliness
buildupoflimescale.
20 / Arehandwashbasinsfreefromextraneousitems?(53) / e.g.mugs,medicinepotsetc.
21 / Isthesoapdispensedfromasingleusecartridge?(53,80,90,92,94) / Checkcartridge,thereshouldbeenoughsoapforthenexttwouses.
22 / Istheliquidsoapdispenserwallmounted? / Checkthatthesoapdispenseriswallmounted.
23 / Isthesoapdispenservisiblyclean?(90) / Checkthenozzleforbuildupofsoapanddebris.
24 / Arepapertowelsavailablefromanencloseddispenser?(53,80,90) / Papertowelsshouldbesofttissuewithenoughinthedispenserforthenexttwowashes.

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QuestionSet:Environment-TreatmentRoomObservation:1

RoomFunction:TreatmentRoom

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
25 / Isthepapertoweldispenservisiblyclean?(90) / Checkundersideofdispenser.
26 / Isthereapromotionalhandhygieneposterdisplayed?(90) / Checkforposter.Itshouldbelaminated,cleanandrelevanttotheroom.
27 / Isthereahands-freedomesticwastebinavailableforthedisposalofpapertowels?(53,56,80) / Visuallycheck.
28 / Isthefootpedalofthedomesticwastebiningoodworkingorder?(53,80) / Checkthefootpedalopensthelid.
29 / Isthedomesticwastebinvisiblyclean,includinglidandpedal?(23,85,86) / Checkbinsarecleanexternallyandinternally.
30 / Isthedomesticwastebiningoodcondition?(23,85,86) / Checkforrusti.e.underneathlid.
31 / Arealcohol-basedhandrubbottleswallmountedintreatmentrooms?(90) / Checkalltreatmentrooms.
32 / Isthereadesignatedworksurface/trolleyforclinicalprocedures?i.e.dressings(20,84) / Checkvisually.
33 / Aredressingtrolleys/traysstructurally
soundandinagoodstateofrepair?(20,84) / Visuallycheck.
34 / Aredressingtrolley/traysvisiblyclean?(20,
84) / Checkthatthereisnotape/debrisorbulldogclipspermanentlyattached.Checkforvisiblecleanlinessandwhereshelvesoftrolley`sareremovable,checkbothsurfaces.
35 / Areallproductsstoredabovefloorlevel?(84) / Visuallycheck.
36 / Istheresufficientstoragespace? / Checktherearenoitemsstoredonthefloorandtopsofcupboards.
37 / Areallworksurfacesfreefromclutter? / Visuallycheck.
38 / Areshelvesusedtostoresterileproductsvisiblyclean?(20,52,84,85,86) / Checkbehinditems.
39 / Areallcupboardsvisiblyclean? / Checktwocupboards.
40 / Isthedrugrefrigeratorusedforthestorageofdrugsonly? / Checkforitemsotherthandrugsintherefrigeratore.g.specimens,food.
41 / Istheexaminationcouchcoverimperviousandwashable?(84,85,86) / Checkcouchforrips/tears.

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QuestionSet:Environment-TreatmentRoomObservation:1

RoomFunction:TreatmentRoom

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
42 / Isthecouch/chairvisiblyclean? / Checkframeaswellastopsurface.
43 / Isthecouch/chairinagoodstateofrepair? / Checkfordamage.
44 / Arethedisposablecouchroll/sheetschangedinbetweenpatients? / Checkwithmemberofstaffthatcouchrollischangedinbetweenpatientuse.
45 / Arecouchrollsstoredofftheflooronacouchrollholder? / Visuallycheck.
46 / Areallcurtainsvisiblycleanandonacleaning/replacementschedule?(52,84,85,
86) / Checklocalprotocolforcleaningandreplacement.Changeevery6months.
47 / Areindividualfabricitemslaunderedaftersingleuse? / Checkvisuallyforblankets/pillowcases/sheetsoraskmemberofstafftodescribeprocedure.
48 / Isthereahandsfreewastebinavailableforthedisposalofoffensivewaste?(23,53,90) / Visuallycheck.
49 / Isthefootpedaloftheoffensivewastebiningoodworkingorder?(53,80) / Checkthefootpedalopensthelid.
50 / Istheoffensivewastebinvisiblyclean,includinglidandpedal?(23,85,86) / Checkbinsarecleanexternallyandinternally.
51 / Istheoffensivewastebiningoodcondition?(23,85,86) / Checkforrusti.e.underneathlid.
52 / Isthereahandsfreewastebinavailableforthedisposalofinfectious/healthcareriskwaste?(23,53,90) / Visuallycheck.
53 / Isthefootpedaloftheinfectious/healthcareriskwastebiningoodworkingorder?(53,
80) / Checkthefootpedalopensthelid.
54 / Istheinfectious/healthcareriskwastebinvisiblyclean,includinglidandpedal?(23,
85,86) / Checkbinsarecleanexternallyandinternally.
55 / Istheinfectious/healthcareriskwastebiningoodcondition?(23,85,86) / Checkforrusti.e.underneathlid.

QuestionSetComments/Recommendations forEnvironment-TreatmentRoom

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CareSettingProcessImprovementTool:GPSurgery/HealthCentre

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QuestionSet:Environment-ConsultingRoomObservation:1

RoomFunction:Consulting/ExaminationRoom

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
1 / Istheenvironmentvisiblyclean?(15,20,52,
53,80,84,86) / Checkwalls,windows,ceilings,fansandlightfittingsarefreefromdust/debris/insectsetc.
2 / Istheenvironmentfreefromanyvisibledamage?(20,53,77,80,84,85,95) / Checkforflakingpaint,damagedwalls/ceilings/windowframesandsurfaces.Checkforevidenceofactiontakentorepair.
3 / Isfurnituremadeofimpermeableandwashablematerials?(53,84,85,95) / Checkfurniture.
4 / Isthefurniturevisiblyclean? / Checkthefurniture,especiallytheundersideoftables.
5 / Isthefurnitureinagoodstateofrepair? / Checkforripsandtears.
6 / Areallsurfacessmooth,impervious(foreasycleaning)andwithcovededges?(20,
53,80,84) / Checkallsurfaces.
7 / Isthefloorvisiblyclean?(20,52,84,85,86) / Checktheedgesandcornersarecleanandfreeofdustandgrit.
8 / Istheflooringinagoodstateofrepair?(52,
53) / Checkforripsandtears.
9 / Isthereadesignatedhandwashbasin?(15,
53,80,82,90) / Visuallycheck.
10 / Isthehandwashbasinplugfree?(15) / Checkthehandwashbasindoesnothaveaplug.
11 / Isthehandwashbasinoverflowfree?(15) / CheckthehandwashbasindoesNOThaveanoverflow.
12 / Isthewasteoffsetsothewaterdoesnotflowdirectlyintoit?(15) / CheckthewaterfromthetapdoesNOTflowdirectlyintotheplughole.
13 / Areelbow/sensortapsavailable?(15) / Visuallycheck.
14 / Ifnoelboworsensortaps,arestaffawareofhowtoturnoffthetapswithapapertowel?(15) / Observepracticeoraskamemberofstafftodescribeprocedure.
15 / Aremixertapsorthermostaticallycontrolledwateravailable?(15) / Testwatertemperature.
16 / Isthehandwashbasinaccessible?(53,80,
90) / Checkforobstructionse.g.equipment.
17 / Isthehandwashbasininagoodstateofrepair?(15) / Checktherearenocracksorchips.

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QuestionSet:Environment-ConsultingRoomObservation:1

RoomFunction:Consulting/ExaminationRoom

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
18 / Isthehandwashbasinvisiblyclean?(52,
84) / Checkplugholesandoverflowsforcleanliness
buildupoflimescale.
19 / Arehandwashbasinsfreefromextraneousitems?(53) / e.g.mugs,medicinepotsetc.
20 / Isthesoapdispensedfromasingleusecartridge?(53,80,90,92,94) / Checkcartridge,thereshouldbeenoughsoapforthenexttwouses.
21 / Istheliquidsoapdispenserwallmounted? / Checkthatthesoapdispenseriswallmounted.
22 / Isthesoapdispenservisiblyclean?(90) / Checkthenozzleforbuildupofsoapanddebris.
23 / Arepapertowelsavailablefromanencloseddispenser?(53,80,90) / Papertowelsshouldbesofttissuewithenoughinthedispenserforthenexttwowashes.
24 / Isthepapertoweldispenservisiblyclean?(90) / Checkundersideofdispenser.
25 / Isthereapromotionalhandhygieneposterdisplayed?(90) / Checkforposter.Itshouldbelaminated,cleanandrelevanttotheroom.
26 / Isthereahands-freedomesticwastebinavailableforthedisposalofpapertowels?(53,56,80) / Visuallycheck.
27 / Isthefootpedalofthedomesticwastebiningoodworkingorder?(53,80) / Checkthefootpedalopensthelid.
28 / Isthedomesticwastebinvisiblyclean,includinglidandpedal?(23,85,86) / Checkbinsarecleanexternallyandinternally.
29 / Isthedomesticwastebiningoodcondition?(23,85,86) / Checkforrusti.e.underneathlid.
30 / Arealcoholbasedhandrubbottlesavailableatthepointofcare?(55,90) / Checkitiswithinreach,thismaybeapersonaldispenser.
31 / Istheresufficientstoragespace? / Checktherearenoitemsstoredonthefloorandtopsofcupboards.
32 / Areallareasfreefromclutterandinappropriateitems? / Checktheareacaneasilybecleaned.
33 / Istheexaminationcouchcoverimperviousandwashable?(84,85,86) / Checkcouchforrips/tears.
34 / Arethedisposablecouchroll/sheetschangedinbetweenpatients? / Checkwithmemberofstaffthatcouchrollischangedinbetweenpatientuse.
35 / Isthecouch/chairvisiblyclean? / Checkframeaswellastopsurface.

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QuestionSet:Environment-ConsultingRoomObservation:1

RoomFunction:Consulting/ExaminationRoom

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
36 / Isthecouch/chairinagoodstateofrepair? / Checkfordamage.
37 / Arecouchrollsstoredofftheflooronacouchrollholder? / Visuallycheck.
38 / Areallcurtainsvisiblycleanandonacleaning/replacementschedule?(52,84,85,
86) / Checklocalprotocolforcleaningandreplacement.Changeevery6months.
39 / Areindividualfabricitemslaunderedaftersingleuse? / Checkvisuallyforblankets/pillowcases/sheetsoraskmemberofstafftodescribeprocedure.
40 / Isthereahandsfreewastebinavailableforthedisposalofoffensivewaste?(23,53,90) / Visuallycheck.
41 / Isthefootpedaloftheoffensivewastebiningoodworkingorder?(53,80) / Checkthefootpedalopensthelid.
42 / Istheoffensivewastebinvisiblyclean,includinglidandpedal?(23,85,86) / Checkbinsarecleanexternallyandinternally.
43 / Istheoffensivewastebiningoodcondition?(23,85,86) / Checkforrusti.e.underneathlid.
44 / Isthereahandsfreewastebinavailableforthedisposalofinfectious/healthcareriskwaste?(23,53,90) / Visuallycheck.
45 / Isthefootpedaloftheinfectious/healthcareriskwastebiningoodworkingorder?(53,
80) / Checkthefootpedalopensthelid.
46 / Istheinfectious/healthcareriskwastebinvisiblyclean,includinglidandpedal?(23,
85,86) / Checkbinsarecleanexternallyandinternally.
47 / Istheinfectious/healthcareriskwastebiningoodcondition?(23,85,86) / Checkforrusti.e.underneathlid.

QuestionSetComments/Recommendations forEnvironment-ConsultingRoom

QuestionSet:Environment-ConsultingRoomObservation:1

RoomFunction:Consulting/ExaminationRoom

RoomNo.:2

Room:

QuestionGuidance

YesNoN/A Comment

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QuestionSet:Environment-ConsultingRoomObservation:1

RoomFunction:Consulting/ExaminationRoom

RoomNo.:2

Room:

QuestionGuidance / Yes / No / N/A / Comment
1 / Istheenvironmentvisiblyclean?(15,20,52,
53,80,84,86) / Checkwalls,windows,ceilings,fansandlightfittingsarefreefromdust/debris/insectsetc.
2 / Istheenvironmentfreefromanyvisibledamage?(20,53,77,80,84,85,95) / Checkforflakingpaint,damagedwalls/ceilings/windowframesandsurfaces.Checkforevidenceofactiontakentorepair.
3 / Isfurnituremadeofimpermeableandwashablematerials?(53,84,85,95) / Checkfurniture.
4 / Isthefurniturevisiblyclean? / Checkthefurniture,especiallytheundersideoftables.
5 / Isthefurnitureinagoodstateofrepair? / Checkforripsandtears.
6 / Areallsurfacessmooth,impervious(foreasycleaning)andwithcovededges?(20,
53,80,84) / Checkallsurfaces.
7 / Isthefloorvisiblyclean?(20,52,84,85,86) / Checktheedgesandcornersarecleanandfreeofdustandgrit.
8 / Istheflooringinagoodstateofrepair?(52,
53) / Checkforripsandtears.
9 / Isthereadesignatedhandwashbasin?(15,
53,80,82,90) / Visuallycheck.
10 / Isthehandwashbasinplugfree?(15) / Checkthehandwashbasindoesnothaveaplug.
11 / Isthehandwashbasinoverflowfree?(15) / CheckthehandwashbasindoesNOThaveanoverflow.
12 / Isthewasteoffsetsothewaterdoesnotflowdirectlyintoit?(15) / CheckthewaterfromthetapdoesNOTflowdirectlyintotheplughole.
13 / Areelbow/sensortapsavailable?(15) / Visuallycheck.
14 / Ifnoelboworsensortaps,arestaffawareofhowtoturnoffthetapswithapapertowel?(15) / Observepracticeoraskamemberofstafftodescribeprocedure.
15 / Aremixertapsorthermostaticallycontrolledwateravailable?(15) / Testwatertemperature.
16 / Isthehandwashbasinaccessible?(53,80,
90) / Checkforobstructionse.g.equipment.
17 / Isthehandwashbasininagoodstateofrepair?(15) / Checktherearenocracksorchips.

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InfectionPreventionQualityImprovementTools

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QuestionSet:Environment-ConsultingRoomObservation:1

RoomFunction:Consulting/ExaminationRoom

RoomNo.:2

Room:

GPP-Gen

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QuestionSet:Environment-ConsultingRoomObservation:1

RoomFunction:Consulting/ExaminationRoom

RoomNo.:2

Room:

QuestionSetComments/Recommendations forEnvironment-ConsultingRoom

QuestionSet:Environment-ConsultingRoomObservation:1

RoomFunction:Consulting/ExaminationRoom

RoomNo.:3

Room:

QuestionGuidance

YesNoN/A Comment

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InfectionPreventionQualityImprovementTools

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QuestionSet:Environment-ConsultingRoomObservation:1

RoomFunction:Consulting/ExaminationRoom

RoomNo.:3

Room:

QuestionGuidance / Yes / No / N/A / Comment
1 / Istheenvironmentvisiblyclean?(15,20,52,
53,80,84,86) / Checkwalls,windows,ceilings,fansandlightfittingsarefreefromdust/debris/insectsetc.
2 / Istheenvironmentfreefromanyvisibledamage?(20,53,77,80,84,85,95) / Checkforflakingpaint,damagedwalls/ceilings/windowframesandsurfaces.Checkforevidenceofactiontakentorepair.
3 / Isfurnituremadeofimpermeableandwashablematerials?(53,84,85,95) / Checkfurniture.
4 / Isthefurniturevisiblyclean? / Checkthefurniture,especiallytheundersideoftables.
5 / Isthefurnitureinagoodstateofrepair? / Checkforripsandtears.
6 / Areallsurfacessmooth,impervious(foreasycleaning)andwithcovededges?(20,
53,80,84) / Checkallsurfaces.
7 / Isthefloorvisiblyclean?(20,52,84,85,86) / Checktheedgesandcornersarecleanandfreeofdustandgrit.
8 / Istheflooringinagoodstateofrepair?(52,
53) / Checkforripsandtears.
9 / Isthereadesignatedhandwashbasin?(15,
53,80,82,90) / Visuallycheck.
10 / Isthehandwashbasinplugfree?(15) / Checkthehandwashbasindoesnothaveaplug.
11 / Isthehandwashbasinoverflowfree?(15) / CheckthehandwashbasindoesNOThaveanoverflow.
12 / Isthewasteoffsetsothewaterdoesnotflowdirectlyintoit?(15) / CheckthewaterfromthetapdoesNOTflowdirectlyintotheplughole.
13 / Areelbow/sensortapsavailable?(15) / Visuallycheck.
14 / Ifnoelboworsensortaps,arestaffawareofhowtoturnoffthetapswithapapertowel?(15) / Observepracticeoraskamemberofstafftodescribeprocedure.
15 / Aremixertapsorthermostaticallycontrolledwateravailable?(15) / Testwatertemperature.
16 / Isthehandwashbasinaccessible?(53,80,
90) / Checkforobstructionse.g.equipment.
17 / Isthehandwashbasininagoodstateofrepair?(15) / Checktherearenocracksorchips.

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QuestionSet:Environment-ConsultingRoomObservation:1

RoomFunction:Consulting/ExaminationRoom

RoomNo.:3

Room:

GPP-Gen

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QuestionSet:Environment-ConsultingRoomObservation:1

RoomFunction:Consulting/ExaminationRoom

RoomNo.:3

Room:

QuestionSetComments/Recommendations forEnvironment-ConsultingRoom

QuestionSet:Environment-StoreRoomObservation:1

RoomFunction:StoreRoom

RoomNo.:1

Room:

QuestionGuidance

YesNoN/A Comment

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QuestionSet:Environment-StoreRoomObservation:1

RoomFunction:StoreRoom

RoomNo.:1

Room:

QuestionSetComments/Recommendations forEnvironment-StoreRoom

QuestionSet:Environment-DirtyUtilityObservation:1

RoomFunction:DirtyUtility/Sluice

RoomNo.:1

Room:

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QuestionSet:Environment-DirtyUtilityObservation:1

RoomFunction:DirtyUtility/Sluice

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
5 / Areallfurnishingsandfittingsinagoodstateofrepair?(84,85,95) / Wherethereisdamage,checkforevidenceofactiontakentoensurerepairorreplacement.
6 / Areallsurfacessmooth,impervious(foreasycleaning)andwithcovededges?(20,
53,80,84) / Checkallsurfaces.
7 / Isthefloorvisiblyclean?(20,52,84,85,86) / Checktheedgesandcornersarecleanandfreeofdustandgrit.
8 / Isthefloorcoveringwashableandimpervioustomoisture?(20,53,80,84) / Isthefloorcoveringappropriatefortheroom.
9 / Istheflooringinagoodstateofrepair?(52,
53) / Checkforripsandtears.
10 / Areallworksurfacessmooth,impervious,withcovededgestofacilitateeasycleaning?(20,53,80,84) / Checkallworksurfaces.
11 / Areallworksurfacesvisiblyclean?(53) / Checkallworksurfacesthroughouttheroomaredustfree,cleananddry.
12 / Isthedirtyutilityroomfreefromclutterandinappropriateitems?(20,84) / Checkthatinappropriateitemsarenotstoredinthesluicewhichmightbecomeinadvertentlycontaminated.
13 / Isthereadesignatedhandwashbasin?(15,
53,80,82,90) / Visuallycheck.
14 / Isthehandwashbasinplugfree?(15) / Checkthehandwashbasindoesnothaveaplug.
15 / Isthehandwashbasinoverflowfree?(15) / CheckthehandwashbasindoesNOThaveanoverflow.
16 / Isthewasteoffsetsothewaterdoesnotflowdirectlyintoit?(15) / CheckthewaterfromthetapdoesNOTflowdirectlyintotheplughole.
17 / Areelbow/sensortapsavailable?(15) / Visuallycheck.
18 / Ifnoelboworsensortaps,arestaffawareofhowtoturnoffthetapswithapapertowel?(15) / Observepracticeoraskamemberofstafftodescribeprocedure.
19 / Aremixertapsorthermostaticallycontrolledwateravailable?(15) / Testwatertemperature.
20 / Isthehandwashbasinaccessible?(53,80,
90) / Checkforobstructionse.g.equipment.

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QuestionSet:Environment-DirtyUtilityObservation:1

RoomFunction:DirtyUtility/Sluice

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
21 / Isthehandwashbasininagoodstateofrepair?(15) / Checktherearenocracksorchips.
22 / Isthehandwashbasinvisiblyclean?(52,
84) / Checkplugholesandoverflowsforcleanliness
buildupoflimescale.
23 / Arehandwashbasinsfreefromextraneousitems?(53) / e.g.mugs,medicinepotsetc.
24 / Isthesoapdispensedfromasingleusecartridge?(53,80,90,92,94) / Checkcartridge,thereshouldbeenoughsoapforthenexttwouses.
25 / Istheliquidsoapdispenserwallmounted? / Checkthatthesoapdispenseriswallmounted.
26 / Isthesoapdispenservisiblyclean?(90) / Checkthenozzleforbuildupofsoapanddebris.
27 / Arepapertowelsavailablefromanencloseddispenser?(53,80,90) / Papertowelsshouldbesofttissuewithenoughinthedispenserforthenexttwowashes.
28 / Isthepapertoweldispenservisiblyclean?(90) / Checkundersideofdispenser.
29 / Isthereapromotionalhandhygieneposterdisplayed?(90) / Checkforposter.Itshouldbelaminated,cleanandrelevanttotheroom.
30 / Isthereahands-freedomesticwastebinavailableforthedisposalofpapertowels?(53,56,80) / Visuallycheck.
31 / Isthefootpedalofthedomesticwastebiningoodworkingorder?(53,80) / Checkthefootpedalopensthelid.
32 / Isthedomesticwastebinvisiblyclean,includinglidandpedal?(23,85,86) / Checkbinsarecleanexternallyandinternally.
33 / Isthedomesticwastebiningoodcondition?(23,85,86) / Checkforrusti.e.underneathlid.
34 / Arealcoholbasedhandrubdispensersvisiblyclean?(90) / Checkthereisnobuilduponthenozzle.Thedispensershouldbefunctioningwithenoughsolutioninthedispenserforthenexttwouses.
35 / Isthereadedicateddeepsinkforwashingusedequipment?(53) / Visuallycheck.
36 / Isthereadisposalunitavailablefordisposalofbodyfluids?(20,53,80) / Visuallycheck.

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QuestionSet:Environment-DirtyUtilityObservation:1

RoomFunction:DirtyUtility/Sluice

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
37 / Arecleaning/disinfectantproductsavailablefordecontaminationofequipmentandtheenvironment?(60) / Checktherearecleaninganddisinfectantproductsavailableasperpolicyandthatthereareinstructionsonusee.g.poster.
38 / Canstaffdescribewhichproductsshouldbeusedforroutinecleaning? / Checkresponsesoftwostaffagainstlocalguidance.
39 / Arespillagekitsoralternativeavailableforuseonbodyfluidspillages?(20,60,84) / Kit:Checkexpirydateandthatitcontainsabrush/scrapper.Alternative:Checkexpiryofhypochlorite.
40 / Arestaffawareoftheprocedurestobeusedwhenremovingbodyfluidspillages?(60,85,
86) / Askamemberofstafftodescribetheprocedure.
41 / Areallpostersabletobecleaned? / Checkpostersarewipe-ablei.e.laminated.
42 / Ispersonalprotectiveequipmentavailable?(20) / Checkforgloves,apronsandeyeprotection.
43 / Isthereahandsfreewastebinavailableforthedisposalofoffensivewaste?(23,53,90) / Visuallycheck.
44 / Isthefootpedaloftheoffensivewastebiningoodworkingorder?(53,80) / Checkthefootpedalopensthelid.
45 / Istheoffensivewastebinvisiblyclean,includinglidandpedal?(23,85,86) / Checkbinsarecleanexternallyandinternally.
46 / Istheoffensivewastebiningoodcondition?(23,85,86) / Checkforrusti.e.underneathlid.
47 / Isthereahandsfreewastebinavailableforthedisposalofinfectious/healthcareriskwaste?(23,53,90) / Visuallycheck.
48 / Isthefootpedaloftheinfectious/healthcareriskwastebiningoodworkingorder?(53,
80) / Checkthefootpedalopensthelid.
49 / Istheinfectious/healthcareriskwastebinvisiblyclean,includinglidandpedal?(23,
85,86) / Checkbinsarecleanexternallyandinternally.
50 / Istheinfectious/healthcareriskwastebiningoodcondition?(23,85,86) / Checkforrusti.e.underneathlid.

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QuestionSetComments/Recommendations forEnvironment-DirtyUtility

QuestionSet:Environment-DomesticRoomObservation:1

RoomFunction:Cleaners/DomesticsRoom

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
1 / Isthereadedicatedroomforstorageofcleaningequipment?(53,80) / Checkthatequipmentisstoredinadedicatedstore
[separatefromotheritems]e.g.linen,sterilesupplies.
2 / Istheenvironmentvisiblyclean?(15,20,52,
53,80,84,86) / Checkwalls,windows,ceilings,fansandlightfittingsarefreefromdust/debris/insectsetc.
3 / Istheenvironmentfreefromanyvisibledamage?(20,53,77,80,84,85,95) / Checkforflakingpaint,damagedwalls/ceilings/windowframesandsurfaces.Checkforevidenceofactiontakentorepair.
4 / Isfurnituremadeofimpermeableandwashablematerials?(53,84,85,95) / Checkfurniture.
5 / Areallfurnishingsandfittingsvisiblyclean?(20,31,52,84,85,86) / Checkallareasareclean,behindandundersurfaces.
6 / Areallfurnishingsandfittingsinagoodstateofrepair?(84,85,95) / Wherethereisdamage,checkforevidenceofactiontakentoensurerepairorreplacement.
7 / Areallsurfacessmooth,impervious(foreasycleaning)andwithcovededges?(20,
53,80,84) / Checkallsurfaces.
8 / Isthefloorvisiblyclean?(20,52,84,85,86) / Checktheedgesandcornersarecleanandfreeofdustandgrit.
9 / Isthefloorcoveringwashableandimpervioustomoisture?(20,53,80,84) / Isthefloorcoveringappropriatefortheroom.
10 / Istheflooringinagoodstateofrepair?(52,
53) / Checkforripsandtears.
11 / Areallworksurfacessmooth,impervious,withcovededgestofacilitateeasycleaning?(20,53,80,84) / Checkallworksurfaces.
12 / Areallworksurfacesvisiblyclean?(53) / Checkallworksurfacesthroughouttheroomaredustfree,cleananddry.
13 / Isthereadesignatedhandwashbasin?(15,
53,80,82,90) / Visuallycheck.
14 / Aremixertapsorthermostaticallycontrolledwateravailable?(15) / Testwatertemperature.

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QuestionSet:Environment-DomesticRoomObservation:1

RoomFunction:Cleaners/DomesticsRoom

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
15 / Isthehandwashbasinaccessible?(53,80,
90) / Checkforobstructionse.g.equipment.
16 / Isthehandwashbasininagoodstateofrepair?(15) / Checktherearenocracksorchips.
17 / Isthehandwashbasinvisiblyclean?(52,
84) / Checkplugholesandoverflowsforcleanliness
buildupoflimescale.
18 / Isthesoapdispensedfromasingleusecartridge?(53,80,90,92,94) / Checkcartridge,thereshouldbeenoughsoapforthenexttwouses.
19 / Istheliquidsoapdispenserwallmounted? / Checkthatthesoapdispenseriswallmounted.
20 / Isthesoapdispenservisiblyclean?(90) / Checkthenozzleforbuildupofsoapanddebris.
21 / Arepapertowelsavailablefromanencloseddispenser?(53,80,90) / Papertowelsshouldbesofttissuewithenoughinthedispenserforthenexttwowashes.
22 / Isthepapertoweldispenservisiblyclean?(90) / Checkundersideofdispenser.
23 / Isthereapromotionalhandhygieneposterdisplayed?(90) / Checkforposter.Itshouldbelaminated,cleanandrelevanttotheroom.
24 / Isthereahands-freedomesticwastebinavailableforthedisposalofpapertowels?(53,56,80) / Visuallycheck.
25 / Isthefootpedalofthedomesticwastebiningoodworkingorder?(53,80) / Checkthefootpedalopensthelid.
26 / Isthedomesticwastebinvisiblyclean,includinglidandpedal?(23,85,86) / Checkbinsarecleanexternallyandinternally.
27 / Isthedomesticwastebiningoodcondition?(23,85,86) / Checkforrusti.e.underneathlid.
28 / Isthereadisposalunitforthedisposalofcontaminatedwastewater?(53,80) / Checkthereisadisposalunit.
29 / Istheunitforthedisposalofcontaminatedwastewatervisiblyclean?(85) / Visuallycheck.
30 / Aremopsandbucketsstoredcleananddry?(52) / Checkstorageandcleanlinessofmopsandbuckets.
31 / Aredetachablemopbucketwringersremovedandcleaneddaily? / Removeandcheckunderneath.

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QuestionSet:Environment-DomesticRoomObservation:1

RoomFunction:Cleaners/DomesticsRoom

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
32 / Aremopheadslaunderedordisposable?(52) / Checklocalpolicyforfrequencyandthatmopheadsareinagoodstateofrepair.
33 / Isthereacolourcodingsysteminplaceforcleaningequipment?(52,53,80,85,86) / Checkequipmentiscolourcodedandpostersaredisplayedandtheavailableequipmentiscolouredasperposter.
34 / Iscleaningequipmentandmachineryleftcleananddryafteruse?(52,85,86) / Visuallycheck.
35 / Arecleaningclothslaunderedordisposable? / Observepracticeoraskamemberofstafftodescribeprocedure.

QuestionSetComments/Recommendations forEnvironment-DomesticRoom

QuestionSet:Environment-LinenObservation:1

RoomFunction:Linen

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
1 / Isthereadesignatedareaforthestorageofcleanlinenwhichisseparatetousedlinen? / Checkforlineninsluiceorbathroom.
2 / Istheenvironmentvisiblyclean?(15,20,52,
53,80,84,86) / Checkwalls,windows,ceilings,fansandlightfittingsarefreefromdust/debris/insectsetc.
3 / Istheenvironmentfreefromanyvisibledamage?(20,53,77,80,84,85,95) / Checkforflakingpaint,damagedwalls/ceilings/windowframesandsurfaces.Checkforevidenceofactiontakentorepair.
4 / Isthefloorvisiblyclean?(20,52,84,85,86) / Checktheedgesandcornersarecleanandfreeofdustandgrit.
5 / Isthefloorcoveringwashableandimpervioustomoisture?(20,53,80,84) / Isthefloorcoveringappropriatefortheroom.
6 / Istheflooringinagoodstateofrepair?(52,
53) / Checkforripsandtears.
7 / Isalllinenstoredoffthefloor? / Visuallycheck.
8 / Isthearea/roomusedtostorecleanlinenfreefrominappropriateitems?(53,80) / Checklinenareastoreforinappropriateequipment,Christmastrees,hairdressingequipmentetc.
9 / Isusedlinenplaceddirectlyintoappropriatecolourcodedbags/containersatthepointofuse?(38) / Observepracticeoraskamemberofstafftodescribeprocedure.

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QuestionSet:Environment-LinenObservation:1

RoomFunction:Linen

RoomNo.:1

Room:

QuestionGuidance / Yes / No / N/A / Comment
10 / Arewater-solublebagsusedforsoiledand/orinfectedlinen?(38) / Observepracticeoraskamemberofstafftodescribeprocedurealsocheckavailabilityofbags.
11 / Areusedlinenbags/containerslessthan
2/3rdsfull?(38) / Checklinenbags/containerscanbesecured.
12 / Arere-useablelinenbagslaunderedafteruse? / Asklaundrystaff.
13 / Arerigidlinencontainers/trolleysvisiblyclean? / Checkcleanliness.
14 / Isusedlinenstoredinadesignatedareauntilcollection,e.g.sluiceroom,dirtyutilityroom?(38,53) / Askamemberofstaffwhichroomusedlinenisstoredin.
15 / Dostaffweardisposableglovesandapronswhenhandlingsoiledlinen?(20) / Observepracticeoraskamemberofstafftodescribeprocedure.

QuestionSetComments/Recommendations forEnvironment-Linen

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9FlemingK.RandleJ.(2006)Toys-friendorfoe?Astudyofinfectionriskinapaediatricintensivecareunit.PaediatricNursingVol18(4)p14-18

10MerrimanE.CorwinP.IkramR.(2002)Toysareapotentialsourceofcross-infectioningeneralpractitioners`waitingrooms.BritishJournalofGeneralPractice,Volume52,Number475,February,pp.

138-140(3)

15DepartmentofHealth(2006)HealthTechnicalMemorandum64(HTM64):Sanitaryassemblies.London:TSO

20PrattRJ,PelloweC,WilsonJA,LovedayHP,HarperPJ,JonesSRLJ,McDougallCM,WilcoxMH.(2007)Epic2:NationalEvidenceBasedGuidelinesforpreventingHealthcare-AssociatedInfectioninNHSHospitalsinEngland.JournalofHospitalInfection.65(1)Supplement1.

23DepartmentofHealth(2006)HealthTechnicalMemorandum07-01:Safemanagementofhealthcarewaste.