INFECTION CONTROL - COMPLIANCE TOOL

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Department Name: ______Month: ______

YES
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NO
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N/A
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MEASURED CRITERIA
A. MEDICATION REFRIGERATOR:
1. Sign on FRONT of refrigerator door “Medication Only.”
2. Refrigerator is clean.
3. Should only have medications inside.
4. Thermometer should be located INSIDE refrigerator and not inside door.
B. NOURISHMENT REFRIGERATOR:
1. Sign on FRONT of refrigerator stating “Patient Food Only.”
2. Patient food items only; do not allow patient food items that have been partially eaten.
3. Food labeled, dated and covered.
4.  Temperatures recorded daily.
5.  Refrigerator is clean
C. SUPPLY STORAGE AREAS:
1. Supply areas should be clean and dust free.
2. Appropriate storage for supplies-18 inches from ceiling Nothing under sink except cleaning supplies
3. Package integrity of supplies should be intact.
4. Supply carts have solid bottoms
5. Supplies are in date
D. LINEN STORAGE AREAS:
1. Linen dust covers should be pulled over at all times.
2. Soiled linen should be bagged at point of use.
3. Linen storage area is clean and dust free
4. Linen cart should have solid bottom
E. WASTE STORAGE AREAS:
1. Doors to storage room housing biohazard bins should be closed at all times.
2.  Lids should be kept ON.
3.  Room should be clean
F. SHARPS CONTAINERS:
1. Should be readily accessible.
2. Attached to a fixed surface.
3. Should be no more than 2/3 full.
G. PERSONAL PROTECTIVE EQUIPMENT:
1. PPE cabinets (barrier boxes) should be fully stocked.
2. PPE to be removed prior to leaving patient room.
3. Employees to know procedure if their clothing is contaminated during work hours.
4. CPR Mask in each room
H. WORK PRACTICE CONTROLS:
1. Work area/nurses station is free of food and/or drink.
2. Evidence of proper hand hygiene.
3. Employees should know post-exposure protocol: verbalize incident report procedure, contact
Employee Health.
I. GENERAL:
1. Appropriate soap in all patient and medication rooms. Waterless foam alcohol-based
soap should be filled
2 Boxes off the floor
3. General surfaces to be clean and dust free.
4. Airvents should be clean.
J. ISOLATION:
1. Correct isolation sign posted.
2. Isolation cart present.
3. Precautions being followed.