Medical Infection Control Audit Checklist "*" indicates required fields Step 1 of 13 7% Name* First Last Email* Office* Office Phone* PPEIs PPE removed before leaving the work area? Yes No Is hand hygiene performed immediately after removal of PPE? Yes No MASKS, PROTECTIVE EYEWEAR AND FACE SHIELDSDo employees wear surgical masks during procedures likely to generate splashes or sprays of blood or saliva? Yes No Do 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? Yes No Do employees change masks between patients and during patient treatment if the mask becomes wet or visibly contaminated? Yes No GLOVESDo employees wear gloves for potential contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment? Yes No Do employees change gloves between patients? Yes No Do employees wear puncture and chemical-resistant utility gloves when cleaning instruments and performing housekeeping tasks involving blood or OPIM (other potentially infectious materials)? Yes No Do employees remove gloves that are torn, cut or punctured and perform hand hygiene before putting on new gloves? Yes No 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? Yes No Do employees change protective clothing if visibly soiled and immediately or as soon as possible if penetrated by blood or OPIM? Yes No RESPIRATORY HYGIENE/COUGH ETIQUETTEAre signs posted at entrances with instructions to patients with symptoms of respiratory infection? Yes No Are tissue and no-touch receptables for disposal of tissue available? Yes No Are resources available to perform hand hygiene in waiting areas? Yes No Are face masks available for coughing patients and other symptomatic individuals who enter the office? Yes No Are all employees educated on recognition of signs, symptoms and transmission of TB? Yes No Is a written TB infection control plan available to all employees? Yes No Has baseline TB testing (TST) been performed on all employees who may have contact with possible TB active patients? Yes No HAND HYGIENEIs hand hygiene performed when hands are visibly soiled; before and after each patient; before and after gloving; and whenever touching contaminated surfaces? Yes No Is 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)? Yes No SHARPS SAFETYAre engineering controls used to prevent injuries (e.g. needle re-capping device, scalpel blade remover)? Yes No Are work practice controls used to prevent injuries (e.g. one-handed scoop technique, not breaking or bending needles)? Yes No Do employees use either one-handed scoop technique or a mechanical device designed for holding the needle cap when re-capping needles? Yes No Are sharps disposed of in a puncture resistant sharps container located as close as possible to the area in which items are used? Yes No Are reusable contaminated sharps transported in a closed leak-proof container? Yes No 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? Yes No Are needles and syringes used for only one patient? Yes No Is the dental cartridge syringe appropriately cleaned and heat sterilized before use on another patient? Yes No Is the rubber septum on a medication vial disinfected with alcohol before piercing? Yes No Are medication containers (single and multi-dose vials, ampules and bags) entered with a new needle and a new syringe? Yes No Are single-dose vials, ampules and bags or bottle of intravenous solutions used for only one patient? Yes No Leftover contents of single-dose vials, ampules and bags of intravenous solutions are not combined for later use. Yes No When using multi-dose medication vials:Are multi-dose vials dedicated to individual patients whenever possible? Yes No Are multi-dose vials which are used for more than one patient kept in a centralized medication area? Yes No Are 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? Yes No Are fluid infusion and administration sets (i.e. IV bags, tubing and connections) used for one patient only? Yes No 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? Yes No Are 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)? Yes No Are single-use devices discarded after one use and never used for more than one patient? Yes No Are 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)? Yes No Are items thoroughly cleaned and visually inspected for residual contamination before sterilization? Yes No Is an enzymatic cleaner or detergent used for pre-cleaning and discarded according to the manufacturer’s instructions? Yes No Are instruments appropriately packaged for sterilization after pre-cleaning? Yes No Is a chemical indicator used internally and externally on all sterilization packaging? Yes No Are FDA-cleared medical devices designed for sterilization (autoclaves and dry heat sterilizers) used according to the manufacturer’s instructions? Yes No Is a biological indicator used at least weekly and with every load containing implantable devices? Yes No Are sterile packages labeled, at a minimum, with the sterilizer used and the date of sterilization? Yes No Are sterilization records maintained (i.e. mechanical, chemical and biological) in compliance with state and local regulations? Yes No Are sterile packages inspected for integrity and, are compromised packages reprocessed before use? Yes No After sterilization, are dental devices and instruments stored in such a manner that sterility is not compromised? Yes No Are reusable, heat sensitive, semi-critical items that cannot be replaced by heat stable or disposable high level disinfected according to the manufacturer’s instructions? Yes No Are 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. Yes No Are X-ray sensor holding or positioning devices heat sterilized or high-level disinfected between patients? Yes No ENVIRONMENTAL INFECTION CONTROLAre clinical contact surfaces either barrier covered or cleaned and disinfected after each patient, using an EPA registered intermediate level disinfectant? Yes No Are cleaners and disinfectants used according to manufacturer’s instructions? Yes No Is regulated medical waste handled and disposed of according to local, state and federal regulations? Yes No Are contaminated items (e.g. bites, impressions, models) disinfected using an EPA registered intermediate level disinfectant? Yes No HOUSEKEEPING SURFACESAre walls, sinks and floors routinely cleaned with detergent and water or an EPA registered disinfectant/detergent? Yes No Are mops and cloths cleaned after use and allowed to dry? Yes No Are fresh cleaning and disinfecting solutions prepared daily? Yes No TRAININGIs training conducted at least annually for all employees and immediately for new employees? Yes No Has someone in the office been designated to be in charge of infection control? Yes No DISCLAIMER 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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