Equipment Cleaning / Storage Audit
Item / Y / N / N/A / CommentsService Equipment Cleaning Audit Tool
1.1. IV stands and pumps are visibly clean including tape free .
1.2. Feeding pumps are visibly clean and free of tape.
1.3. Feeding pump supplies are changed according to facility policy.
1.4. Disposable suction liners are available and changed according to facility schedule.
1.5. Reusable suction containers are reprocessed between p/r/c or according to facility schedule.
1.6. Suction equipment is changed according to facility schedule.
1.7. Suction equipment is visibly clean and dry.
1.8. Suctioning catheter is only attached to the suction if frequently used.
1.8.1. If catheter attached, clean cover is in place.
1.9. Oxygen therapy equipment is visibly clean.
1.10. Oximeters are visibly clean.
1.11. Glucometers are visibly clean.
1.12. B/P cuffs are visibly clean.
1.13. B/P machine is visibly clean.
1.14. Non-mercurial thermometer handle and probes are visibly clean.
1.15. Mattress covers are fluid resistant, in good repair / free from punctures/pin holes.
1.16. Transport equipment i.e., wheelchairs, strollers, stretchers are visibly clean.
1.17. Transfer / lift equipment:
1.17.1. Base (hydraulic) unit is visibly clean
1.17.2. Slings are visibly clean
1.17.3. Sliders are visibly clean
1.17.4. Transfer belts are visibly clean.
1.18. Commode chairs (including the underside) are visibly clean.
1.19. The urine measuring/discard container for each p/r/c is visibly clean.
1.20. There is storage for p/r/c dedicated, urine containers in bathrooms which avoids contamination
1.21. Bath basins are visibly clean and dry.
1.22. Computers in p/r/c care areas are visibly clean
1.23. Display screens in p/r/c care areas are visibly clean
1.24. Carts are visibly clean
1.24.1. medication carts
1.24.2. isolation carts
1.24.3. code carts
1.24.4. treatment carts
1.24.5. other ______
1.25. There are documented procedures for equipment cleaning.
1.25.1. bathtubs
1.25.2. wheelchairs
1.25.3. B/P machines
1.25.4. B/P cuffs
1.25.5. medication carts
1.25.6. computers in p/r/c care areas
1.25.7. sliders
1.25.8. slings
1.25.9. transfer belts
1.25.10. other – area specific
1.26. There are documented schedules for equipment cleaning
1.26.1. bathtubs
1.26.2. wheelchairs
1.26.3. B/P machine
1.26.4. B/P cuffs
1.26.5. medication carts
1.26.6. computers in p/r/c care areas
1.26.7. other – area specific
1.27. Cleaning schedule / procedure specifies:
1.27.1. Clean between p/r/c, when visibly soiled and on a regular schedule.
1.27.2. Staff member assigned to cleaning
1.28. P/r/c dedicated items i.e., razors, shampoo, lotions, soaps, mouthwash, deodorant or nail care items are stored and/or labeled for personal use only
1.29. Equipment requiring maintenance/repair is visibly clean and labeled.
1.30. Clean and sterile devices are stored on shelving (whether fixed or mobile) that are:
1.30.1. made of materials that are non-porous on all surfaces
1.30.2. free of peeling paint
1.30.3. in good repair
1.30.4. easily cleanable
1.30.5. free of sharp / rough edges
1.30.6. solid on both top and bottom shelves
1.31. All medical devices on shelves are stored at least:
1.31.1. 10 inches (25 cm) off the floor
1.31.2. 18 inches (45 cm) from the ceiling
1.31.3. 2 inches (5 cm) from outside walls
1.32. Dirty service areas are free of clean supplies.
1.33. Shared reusable equipment appears visibly clean.
Total
Scoring: Compliance Rate = #Yes / # YES + No X 100
Audit completed by: ______
Audit completion date: ______
Facility: ______
Unit: ______
Approval date: February 21, 2013 3 of 3 Revision Date: Nov 9,, 2012
Equipment Cleaning / Storage Audit
Infection Prevention & Control Equipment Cleaning Audit Instructions
What you need to know:
· This audit can be done by any staff member.
· This audit is a one time “snap shot”.
· This is not an audit of housekeeping practices.
· The equipment listed on the audit is not intended to be a complete list of equipment. The equipment listed is very general and limited.
· The audit results are to be used to help determine areas for improvement. The audit results are not used to lay blame.
· Some improvements can be made immediately and can be done by anyone.
· Some changes will take time and require special project planning by the area. This will be noted in the final report.
· All staff members should have access to both the procedure and schedule for cleaning an item. If the procedure or schedule for cleaning cannot be found, comment on it in the audit.
Auditor’s Instructions:
1. Complete the audit, documenting exactly what you see at the time of the audit.
2. Check off N/A (not applicable) if an item listed is not applicable to the area you are auditing.
· Example: If IVs aren’t used in the area being audited check N/A off beside the question about IV pumps.
3. When multiples of the same item are assessed and some but not all meet the criteria, answer ‘No’ and specify details in the comment section.
4. Provide comments if more detail is needed when there is an issue – this provides valuable information regarding what changes need to be made.
5. Add reusable p/r/c care items to the applicable section marked “other” if the item is not included in the audit form.
6. Sign, date and fill in the location of the area being audited.
7. Give the completed audit to the person who approached you to do the audit, who will then forward it to site IP&C.
Site IP & C Instructions:
1. Total the score when the completed audit is received.
2. Send audit report to area manager, once audit is reviewed.
3. Ensure this report is shared with audited area’s staff.
4. Make recommendations in the final report if any improvements are required.
5. Assess audit reports after one year to determine the frequency of further audits.
6. Collaborate with area manager to resolve issues.
Thank you for completing the Infection Prevention & Control Equipment Cleaning Audit!
Return completed audit: Site / Community Infection Prevention Control / designate
Reference
CSA standard Z314.3.09 (2003, May) Specific Requirements - Warehouses & Storerooms
Approval date: February 21, 2013 3 of 3 Revision Date: Nov 9,, 2012