Medical IC Audit Checklist - Compliance Training Partners

Name*

First Last

Email*

Office*

Office Phone*

PPE

Is PPE removed before leaving the work area?

Yes

Is hand hygiene performed immediately after removal of PPE?

Yes

MASKS, PROTECTIVE EYEWEAR AND FACE SHIELDS

Do employees wear surgical masks during procedures likely to generate splashes or sprays of blood or saliva?

Yes

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

Do employees change masks between patients and during patient treatment if the mask becomes wet or visibly contaminated?

Yes

GLOVES

Do employees wear gloves for potential contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment?

Yes

Do employees change gloves between patients?

Yes

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

Do employees remove gloves that are torn, cut or punctured and perform hand hygiene before putting on new gloves?

Yes

PROTECTIVE CLOTHING

Do 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

Do employees change protective clothing if visibly soiled and immediately or as soon as possible if penetrated by blood or OPIM?

Yes

RESPIRATORY HYGIENE/COUGH ETIQUETTE

Are signs posted at entrances with instructions to patients with symptoms of respiratory infection?

Yes

Are tissue and no-touch receptables for disposal of tissue available?

Yes

Are resources available to perform hand hygiene in waiting areas?

Yes

Are face masks available for coughing patients and other symptomatic individuals who enter the office?

Yes

Are all employees educated on recognition of signs, symptoms and transmission of TB?

Yes

Is a written TB infection control plan available to all employees?

Yes

Has baseline TB testing (TST) been performed on all employees who may have contact with possible TB active patients?

Yes

HAND HYGIENE

Is hand hygiene performed when hands are visibly soiled; before and after each patient; before and after gloving; and whenever touching contaminated surfaces?

Yes

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

SHARPS SAFETY

Are engineering controls used to prevent injuries (e.g. needle re-capping device, scalpel blade remover)?

Yes

Are work practice controls used to prevent injuries (e.g. one-handed scoop technique, not breaking or bending needles)?

Yes

Do employees use either one-handed scoop technique or a mechanical device designed for holding the needle cap when re-capping needles?

Yes

Are sharps disposed of in a puncture resistant sharps container located as close as possible to the area in which items are used?

Yes

Are reusable contaminated sharps transported in a closed leak-proof container?

Yes

SAFE INJECTION PRACTICES

Are injections prepared using an aseptic technique, in a clean area free from contaminants or contact with blood, body fluids or contaminated equipment?

Yes

Are needles and syringes used for only one patient?

Yes

Is the dental cartridge syringe appropriately cleaned and heat sterilized before use on another patient?

Yes

Is the rubber septum on a medication vial disinfected with alcohol before piercing?

Yes

Are medication containers (single and multi-dose vials, ampules and bags) entered with a new needle and a new syringe?

Yes

Are single-dose vials, ampules and bags or bottle of intravenous solutions used for only one patient?

Yes

Leftover contents of single-dose vials, ampules and bags of intravenous solutions are not combined for later use.

Yes

When using multi-dose medication vials:

Are multi-dose vials dedicated to individual patients whenever possible?

Yes

Are multi-dose vials which are used for more than one patient kept in a centralized medication area?

Yes

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

Are fluid infusion and administration sets (i.e. IV bags, tubing and connections) used for one patient only?

Yes

INSTRUMENT STERILIZATION AND DISINFECTION OF PATIENT-CARE ITEMS

Is the instrument processing area separated into 4 sections: A) Receiving, cleaning and decontamination, B) Preparation/packaging, C) Sterilization and D) Storage?

Yes

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

Are single-use devices discarded after one use and never used for more than one patient?

Yes

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

Are items thoroughly cleaned and visually inspected for residual contamination before sterilization?

Yes

Is an enzymatic cleaner or detergent used for pre-cleaning and discarded according to the manufacturer’s instructions?

Yes

Are instruments appropriately packaged for sterilization after pre-cleaning?

Yes

Is a chemical indicator used internally and externally on all sterilization packaging?

Yes

Are FDA-cleared medical devices designed for sterilization (autoclaves and dry heat sterilizers) used according to the manufacturer’s instructions?

Yes

Is a biological indicator used at least weekly and with every load containing implantable devices?

Yes

Are sterile packages labeled, at a minimum, with the sterilizer used and the date of sterilization?

Yes

Are sterilization records maintained (i.e. mechanical, chemical and biological) in compliance with state and local regulations?

Yes

Are sterile packages inspected for integrity and, are compromised packages reprocessed before use?

Yes

After sterilization, are dental devices and instruments stored in such a manner that sterility is not compromised?

Yes

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

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

Are X-ray sensor holding or positioning devices heat sterilized or high-level disinfected between patients?

Yes

ENVIRONMENTAL INFECTION CONTROL

Are clinical contact surfaces either barrier covered or cleaned and disinfected after each patient, using an EPA registered intermediate level disinfectant?

Yes

Are cleaners and disinfectants used according to manufacturer’s instructions?

Yes

Is regulated medical waste handled and disposed of according to local, state and federal regulations?

Yes

Are contaminated items (e.g. bites, impressions, models) disinfected using an EPA registered intermediate level disinfectant?

Yes

HOUSEKEEPING SURFACES

Are walls, sinks and floors routinely cleaned with detergent and water or an EPA registered disinfectant/detergent?

Yes

Are mops and cloths cleaned after use and allowed to dry?

Yes

Are fresh cleaning and disinfecting solutions prepared daily?

Yes

TRAINING

Is training conducted at least annually for all employees and immediately for new employees?

Yes

Has someone in the office been designated to be in charge of infection control?

Yes

DISCLAIMER OF WARRANTY

The employer is ultimately responsible for safety and compliance in their workplace and familiarity with all rules, laws and regulations that may apply. Compliance Training Partners, L.L.C. as well as its agents, dealers and distributors cannot be held responsible for any legal actions, citations, penalties or fines that may result from failure to comply COMPLIANCE TRAINING PARTNERS, LLC AS WELL AS ITS AGENTS, DEALERS AND DISTRIBUTORS HEREBY DISCLAIMS ANY AND ALL REPRESENTATIONS, CONDITIONS AND WARRANTIES, WHETHER EXPRESS OR IMPLIED, ORAL OR WRITTEN, STATUTORY OR OTHERWISE, INCLUDING WITHOUT LIMITATION THE IMPLIED WARRANTIES OR CONDITIONS OF MERCHANTABILITY OR FITNESS FOR THE PURPOSE. At no time shall COMPLIANCE TRAINING PARTNERS, LLC, ITS AGENTS, DEALERS OR DISTRIBUTORS, be responsible for consequential, incidental or special damages, whether for loss of profits or otherwise, or for damages for fundamental breach of contract or breach of a fundamental term. COMPLIANCE TRAINING PARTNERS, LLC’S AND ITS AGENTS, DEALERS AND DISTRIBUTORS obligation to Buyer for defective services is limited to a refund of fees actually received from Buyer. At no time shall COMPLIANCE TRAINING PARTNERS, LLC’S, AND ITS AGENTS, DEALERS AND DISTRIBUTORS liability for any service provided by and supplied by it exceed the purchase price of such service. Warranty claims shall be made upon occurrence. COMPLIANCE TRAINING PARTNERS, LLC AND ITS AGENTS, DEALERS AND DISTRIBUTORS shall have no liability and no warranty of any kind for any failure or breakdown of a service not provided or controlled by it and unless it is fully paid for the services. COMPLIANCE TRAINING PARTNERS, LLC AND ITS AGENTS, DEALERS AND DISTRIBUTORS shall have no liability and no warranty of any kind for any service used for any purpose which CTP did not fully supervise, participate and/or complete. Please see our website, www.hptcinc.com for full disclaimer.

Medical Infection Control
Audit Checklist

PPE

MASKS, PROTECTIVE EYEWEAR AND FACE SHIELDS

GLOVES

PROTECTIVE CLOTHING

RESPIRATORY HYGIENE/COUGH ETIQUETTE

HAND HYGIENE

SHARPS SAFETY

SAFE INJECTION PRACTICES

When using multi-dose medication vials:

INSTRUMENT STERILIZATION AND DISINFECTION OF PATIENT-CARE ITEMS

ENVIRONMENTAL INFECTION CONTROL

HOUSEKEEPING SURFACES

TRAINING

DISCLAIMER OF WARRANTY

Your Account

Medical Infection ControlAudit Checklist

PPE

MASKS, PROTECTIVE EYEWEAR AND FACE SHIELDS

GLOVES

PROTECTIVE CLOTHING

RESPIRATORY HYGIENE/COUGH ETIQUETTE

HAND HYGIENE

SHARPS SAFETY

SAFE INJECTION PRACTICES

When using multi-dose medication vials:

INSTRUMENT STERILIZATION AND DISINFECTION OF PATIENT-CARE ITEMS

ENVIRONMENTAL INFECTION CONTROL

HOUSEKEEPING SURFACES

TRAINING

DISCLAIMER OF WARRANTY

Your Account

Medical Infection Control
Audit Checklist