Detailed Infection Control Audit Checklist Step 1 of 13 7% NameEmailOfficeOffice PhonePPEIs PPE removed before leaving the work area?YesNoIs hand hygiene performed immediately after removal of PPE?YesNo MASKS, PROTECTIVE EYEWEAR AND FACE SHIELDSDo employees wear surgical masks during procedures likely to generate splashes or sprays of blood or saliva?YesNoDo employees wear eye protection with solid side shields or a face shield during procedures that are likely to generate splashes or sprays of blood or saliva?YesNoDo employees change masks between patients and during patient treatment if the mask becomes wet or visibly contaminated?YesNo GLOVESDo employees wear gloves for potential contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment?YesNoDo employees change gloves between patients?YesNoDo employees wear puncture and chemical-resistant utility gloves when cleaning instruments and performing housekeeping tasks involving blood or OPIM (other potentially infectious materials)?YesNoDo employees remove gloves that are torn, cut or punctured and perform hand hygiene before putting on new gloves?YesNo PROTECTIVE CLOTHINGDo employees wear protective clothing (e.g. reusable or disposable gown, lab coat, or uniform) that is long sleeved and covers personal clothing as well as skin (e.g. forearms) likely to be soiled with blood, saliva or OPIM?YesNoDo employees change protective clothing if visibly soiled and immediately or as soon as possible if penetrated by blood or OPIM?YesNo RESPIRATORY HYGIENE/COUGH ETIQUETTEAre signs posted at entrances with instructions to patients with symptoms of respiratory infection?YesNoAre tissue and no-touch receptables for disposal of tissue available?YesNoAre resources available to perform hand hygiene in waiting areas?YesNoAre face masks available for coughing patients and other symptomatic individuals who enter the office?YesNoAre all employees educated on recognition of signs, symptoms and transmission of TB?YesNoIs a written TB infection control plan available to all employees?YesNoHas baseline TB testing (TST) been performed on all employees who may have contact with possible TB active patients?YesNo HAND HYGIENEIs hand hygiene performed when hands are visibly soiled; before and after each patient; before and after gloving; and whenever touching contaminated surfaces?YesNoIs a surgical scrub performed before putting on sterile surgical gloves, which must be used in all surgical procedures (e.g. biopsy, periodontal surgery, apical surgery, implant surgery, and surgical extractions)?YesNo SHARPS SAFETYAre engineering controls used to prevent injuries (e.g. needle re-capping device, scalpel blade remover)?YesNoAre work practice controls used to prevent injuries (e.g. one-handed scoop technique, not breaking or bending needles)?YesNoDo employees use either one-handed scoop technique or a mechanical device designed for holding the needle cap when re-capping needles?YesNoAre sharps disposed of in a puncture resistant sharps container located as close as possible to the area in which items are used?YesNoAre reusable contaminated sharps transported in a closed leak-proof container?YesNo SAFE INJECTION PRACTICESAre injections prepared using an aseptic technique, in a clean area free from contaminants or contact with blood, body fluids or contaminated equipment?YesNoAre needles and syringes used for only one patient?YesNoIs the dental cartridge syringe appropriately cleaned and heat sterilized before use on another patient?YesNoIs the rubber septum on a medication vial disinfected with alcohol before piercing?YesNoAre medication containers (single and multi-dose vials, ampules and bags) entered with a new needle and a new syringe?YesNoAre single-dose vials, ampules and bags or bottle of intravenous solutions used for only one patient?YesNoLeftover contents of single-dose vials, ampules and bags of intravenous solutions are not combined for later use.YesNo When using multi-dose medication vials:Are multi-dose vials dedicated to individual patients whenever possible?YesNoAre multi-dose vials which are used for more than one patient kept in a centralized medication area?YesNoAre multi-dose vials dated when first opened and discarded within 28 days unless the manufacturer specifies a shorter or longer date for the opened vial?YesNoAre fluid infusion and administration sets (i.e. IV bags, tubing and connections) used for one patient only?YesNo INSTRUMENT STERILIZATION AND DISINFECTION OF PATIENT-CARE ITEMSIs the instrument processing area separated into 4 sections: A) Receiving, cleaning and decontamination, B) Preparation/packaging, C) Sterilization and D) Storage?YesNoAre reusable critical and semi-critical dental items and devices cleaned and heat sterilized according to the manufacturer’s instructions before using on patients (e.g. high speed handpieces, low speed motors and handpiece components, endodontic instruments, airwater syringe tips)?YesNoAre single-use devices discarded after one use and never used for more than one patient?YesNoAre work practice controls that minimize contact with sharp instruments used and appropriate PPE worn if manual cleaning is necessary (e.g. puncture resistant utility gloves)?YesNoAre items thoroughly cleaned and visually inspected for residual contamination before sterilization?YesNoIs an enzymatic cleaner or detergent used for pre-cleaning and discarded according to the manufacturer’s instructions?YesNoAre instruments appropriately packaged for sterilization after pre-cleaning?YesNoIs a chemical indicator used internally and externally on all sterilization packaging?YesNoAre FDA-cleared medical devices designed for sterilization (autoclaves and dry heat sterilizers) used according to the manufacturer’s instructions?YesNoIs a biological indicator used at least weekly and with every load containing implantable devices?YesNoAre sterile packages labeled, at a minimum, with the sterilizer used and the date of sterilization?YesNoAre sterilization records maintained (i.e. mechanical, chemical and biological) in compliance with state and local regulations?YesNoAre sterile packages inspected for integrity and, are compromised packages reprocessed before use?YesNoAfter sterilization, are dental devices and instruments stored in such a manner that sterility is not compromised?YesNoAre reusable, heat sensitive, semi-critical items that cannot be replaced by heat stable or disposable high level disinfected according to the manufacturer’s instructions?YesNoAre X-ray sensors heat sterilized between patients and covered with a FDA cleared barrier? If this is not done they are cleaned and disinfected between patients with an EPA registered intermediate-level disinfectant, then covered with and FDA cleared barrier.YesNoAre X-ray sensor holding or positioning devices heat sterilized or high-level disinfected between patients?YesNo ENVIRONMENTAL INFECTION CONTROLAre clinical contact surfaces either barrier covered or cleaned and disinfected after each patient, using an EPA registered intermediate level disinfectant?YesNoAre cleaners and disinfectants used according to manufacturer’s instructions?YesNoIs regulated medical waste handled and disposed of according to local, state and federal regulations?YesNoAre burs, polishing points, rag wheels, etc., sterilized or disinfected between patients or disposable replacements used?YesNoIs PPE used when handling items in the dental laboratory?YesNoAre contaminated items (e.g. bites, impressions, models) disinfected using an EPA registered intermediate level disinfectant?YesNoAre laboratory cases disinfected, and labeled as such, before being sent out?YesNo HOUSEKEEPING SURFACESAre walls, sinks and floors routinely cleaned with detergent and water or an EPA registered disinfectant/detergent?YesNoAre mops and cloths cleaned after use and allowed to dry?YesNoAre fresh cleaning and disinfecting solutions prepared daily?YesNo DENTAL UNIT WATER QUALITYDental unit waterline treatment products/devices are used to ensure that water meets EPA regulatory standards for drinking water (<500 CFU/ml of heterotrophic water bacteria)?YesNoIs sterile saline or sterile water used as a coolant/irrigant when preforming surgical procedures?YesNoIs dental unit water tested quarterly, as recommended, to ensure that it is below 500 CFU of heterotrophic water bacteria?YesNoTRAININGIs training conducted at least annually for all employees and immediately for new employees?YesNoHas someone in the office been designated to be in charge of infection control?YesNoDISCLAIMER OF WARRANTYThe employer is ultimately responsible for safety and compliance in their workplace and familiarity with all rules, laws and regulations that may apply. 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