Environmental rounds inspection for infection prevention and control checklist
Eoc rounds for routine patient care inspections
What does this form include?
This form contains 14 sections:
Patient Rooms
- Floors & walls clean
- Walls free of breaks & penetrations
- Bathrooms clean/free of odor
- Sink(s) clean
- Furniture clean & in good condition
- Windows & windowsills clean
- Window coverings clean/without dust
- No high dust present
- Ceiling tiles free of visible dampness/damage
- PPE, gloves available
- Nothing on top of sharps boxes
- ONLY sharps in sharps boxes
- Sharps box < 3/4 full
- Appropriate use of red bags
- Bed clean, linen free of tears
- Alcohol hand hygiene product stocked
- Soap and paper towels at all sinks
Clean Utility/Storage Rooms
- Clean storage contains clean items only
- Ability to determine if equipment is clean
- Floors and walls clean
- No dust on supplies or equipment
- Bins clean & without dust
- Supplies stored 6" above floor
- Supplies stored 18" away from ceiling/fire sprinkler
- No supplies under the sink
- Counter tops in good condition
- Shelving/drawers & cabinets clean
- Sterilized trays free of dust, unopened, no tears
- No expired supplies or equipment (check for PM tags)
- Linen covered
Soiled Utility Rooms
- Floors & walls clean
- Free of patient supplies (clean) & sterile trays
- Hopper clean
- Counter tops clean/in good condition
- Soiled equipment stored appropriately
- Linen bagged appropriately
- Red bag trash appropriate
- Biohazard trash bins & linen bins clean
- PPE available in soiled utility
General Unit
- No food or drinks at station
- Computers & keyboards free of soil/dust
- Laboratory samples segregated from food
- Station free of clutter
- Trash not overfilled
- Floors & baseboards clean
- Desk surfaces in good condition
- Chairs/furniture clean, operational and in good condition
- Staff restroom clean with hand washing supplies
- Alcohol hand rub accessible, full w/in unit (assess if there need to be more locations)
- Tub/shower room clean
- Ceiling tiles are clean, in good condition
- Sink areas are clean, stocked with soap and paper towels
- Ice machine clean, no leaks
- Walls clean, no holes
- Cleaning products available for use
Patient Kitchen
- General area clean
- Refrigerator & freezer clean, no odor
- Daily temperature log complete
- Refrigerator temp 0-41 degrees, freezer less than 0 (to -30) degrees
- All food is labeled w/name, date
- Food containers are closed
Medications
- No expired IV solutions or medications
- No unattended medications
- Medication prep areas are clean, alcohol prep is present
Safety
- Observed hand hygiene
- Staff know how to access IC policies
- Specimens bagged/labeled/handled appropriately
- Safety devices available
- Safety devices are being used appropriately
- Staff can demonstrate use of safety devices
Due to Infection Control by: Actions by Department Director or designee:
Infection Control Director
Environmental Services Director
Engineering
Security
Unit Director or their designee
Use this template