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Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care

The Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care [PDF 538 KB] is a companion to the Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care.  The checklist should be used: 

  1. To ensure that the facility has appropriate infection prevention policies and procedures in place and supplies to allow healthcare personnel to provide safe care.
  2. To systematically assess personnel adherence to correct infection prevention practices.
    (Assessment of adherence should be conducted by direct observation of healthcare personnel during the performance of their duties.)

Section II. Personnel and Patient-care Observations

1. Hand hygiene performed correctly:
Practice Performed
If answer is No, document plan for remediation
  1. Before contact with the patient or their immediate care environment (even if gloves are worn)
Yes      No
 
  1. Before exiting the patient’s care area after touching the patient or the patient’s immediate environment (even if gloves are worn)
Yes      No
 
  1. Before performing an aseptic task (e.g., insertion of IV or preparing an injection) (even if gloves are worn)
Yes      No
 
  1. After contact with blood, body fluids or contaminated surfaces (even if gloves are worn)
Yes      No
 
  1. When hands move from a contaminated-body site to a clean-body site during patient care (even if gloves are worn)
Yes      No
 
2. PPE is correctly used:
Practice Performed
If answer is No, document plan for remediation
  1. PPE is removed and discarded prior to leaving the patient’s room or care area
Yes      No
 
  1. Hand hygiene is performed immediately after removal of PPE
Yes      No
 
Gloves:
  1. HCP wear gloves for potential contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated equipment
Yes      No
 
  1. HCP do not wear the same pair of gloves for the care of more than one patient
Yes      No
 
  1. HCP do not wash gloves for the purpose of reuse
Yes      No
 
Gowns:
  1. HCP wear gowns to protect skin and clothing during procedures or activities where contact with blood or body fluids is anticipated
Yes      No
 
  1. HCP do not wear the same gown for the care of more than one patient
Yes      No
 
Facial protection:
  1. HCP wear mouth, nose, and eye protection during procedures that are likely to generate splashes or sprays of blood or other body fluids
Yes      No
 
  1. HCP wear a facemask (e.g., surgical mask) when placing a catheter or injecting material into the epidural or subdural space (e.g., during myelogram, epidural or spinal anesthesia)
Yes      No
 
3. Injection safety
Practice Performed
If answer is No, document plan for remediation
  1. Needles and syringes are used for only one patient (this includes manufactured prefilled syringes and cartridge devices such as insulin pens)
Yes      No
 
  1. The rubber septum on a medication vial is disinfected with alcohol prior to piercing
Yes      No
 
  1. Medication vials are entered with a new needle and a new syringe, even when obtaining additional doses for the same patient
Yes      No
 
  1. Single dose (single-use) medication vials, ampules, and bags or bottles of intravenous solution are used for only one patient
Yes      No
 
  1. Medication administration tubing and connectors are used for only one patient
Yes      No
 
  1. Multi-dose vials are dated by HCP when they are first opened and discarded within 28 days unless the manufacturer specifies a different (shorter or longer) date for that opened vial
    (Note: This is different from the expiration date printed on the vial.)
Yes      No
 
  1. Multi-dose vials are dedicated to individual patients whenever possible.
Yes      No
 
  1. Multi-dose vials to be used for more than one patient are kept in a centralized medication area and do not enter the immediate patient treatment area (e.g,. operating room, patient room/cubicle)
    (Note: If multi-dose vials enter the immediate patient treatment area they should be dedicated for single-patient use and discarded immediately after use.)
Yes      No
 
  1. All sharps are disposed of in a puncture-resistant sharps container
Yes      No
 
  1. Filled sharps containers are disposed of in accordance with state regulated medical waste rules
Yes      No
 
  1. All controlled substances (e.g., Schedule II, III, IV, V drugs) are kept locked within a secure area
Yes      No
 
4. Point-of-Care Testing (e.g., blood glucose meters, INR monitor)
Practice Performed
If answer is No, document plan for remediation
  1. New single-use, auto-disabling lancing device is used for each patient
    (Note: Lancet holder devices are not suitable for multi-patient use.)
Yes      No
 
  1. If used for more than one patient, the point-of-care testing meter is cleaned and disinfected after every use according to manufacturer’s instructions
    (Note: If the manufacturer does not provide instructions for cleaning and disinfection, then the testing meter should not be used for >1 patient.)
Yes      No
 

For additional guidance on infection prevention during point-of-care testing consult the following resource(s):

5. Environmental Cleaning
Practice Performed
If answer is No, document plan for remediation
  1. Environmental surfaces, with an emphasis on surfaces in proximity to the patient and those that are frequently touched, are cleaned and then disinfected with an EPA-registered disinfectant
Yes      No
 
  1. Cleaners and disinfectants are used in accordance with manufacturer’s instructions (e.g., dilution, storage, shelf-life, contact time)
Yes      No
 
6. Reprocessing of Reusable Instruments and Devices
Practice Performed
If answer is No, document plan for remediation
  1. Reusable medical devices are cleaned, reprocessed (disinfection or sterilization) and maintained according to the manufacturer instructions.
    (Note: If the manufacturer does not provide such instructions, the device may not be suitable for multi-patient use.)
Yes      No
 
  1. Single-use devices are discarded after use and not used for more than one patient.
    (Note: If the facility elects to reuse single-use devices, these devices must be reprocessed prior to reuse by a third-party reprocessor that it is registered with the FDA as a third-party reprocessor and cleared by the FDA to reprocess the specific device in question. The facility should have documentation from the third party reprocessor confirming this is the case.)
Yes      No
 
  1. Reprocessing area has a workflow pattern such that devices clearly flow from high contamination areas to clean/sterile areas (i.e., there is clear separation between soiled and clean workspaces)
Yes      No
 
  1. Medical devices are stored in a manner to protect from damage and contamination
Yes      No
 
7. Sterilization of Reusable Instruments and Devices
Practice Performed
If answer is No, document plan for remediation
  1. Items are thoroughly pre-cleaned according to manufacturer instructions and visually inspected for residual soil prior to sterilization
    (Note: For lumened instruments, device channels and lumens must be cleaned using appropriately sized cleaning brushes.)
Yes      No
 
  1. Enzymatic cleaner or detergent is used for pre-cleaning and discarded according to manufacturer’s instructions (typically after each use)
Yes      No
 
  1. Cleaning brushes are disposable or cleaned and high-level disinfected or sterilized (per manufacturer’s instructions) after each use
Yes      No
 
  1. After pre-cleaning, instruments are appropriately wrapped/packaged for sterilization (e.g., package system selected is compatible with the sterilization process being performed, hinged instruments are open, instruments are disassembled if indicated by the manufacturer)
Yes      No
 
  1. A chemical indicator (process indicator) is placed correctly in the instrument packs in every load
Yes      No
 
  1. A biological indicator is used at least weekly for each sterilizer and with every load containing implantable items
Yes      No
 
  1. For dynamic air removal-type sterilizers, a Bowie-Dick test is performed each day the sterilizer is used to verify efficacy of air removal
Yes      No
 
  1. Sterile packs are labeled with the sterilizer used, the cycle or load number, and the date of sterilization
Yes      No
 
  1. Logs for each sterilizer cycle are current and include results from each load
Yes      No
 
  1. After sterilization, medical devices and instruments are stored so that sterility is not compromised
Yes      No
 
  1. Sterile packages are inspected for integrity and compromised packages are reprocessed prior to use
Yes      No
 
  1. Immediate-use steam sterilization (flash sterilization), if performed, is only done in circumstances in which routine sterilization procedures cannot be performed
Yes      No
 
  1. Instruments that are flash-sterilized are used immediately and not stored
Yes      No
 
8. High-Level Disinfection of Reusable Instruments and Devices
Practice Performed
If answer is No, document plan for remediation
  1. Flexible endoscopes are inspected for damage and leak tested as part of each reprocessing cycle
Yes      No
 
  1. Items are thoroughly pre-cleaned according to manufacturer instructions and visually inspected for residual soil prior to high-level disinfection
    (Note: For lumened instruments, device channels and lumens must be cleaned using appropriately sized cleaning brushes.)
Yes      No
 
  1. Enzymatic cleaner or detergent is used and discarded according to manufacturer instructions (typically after each use)
Yes      No
 
  1. Cleaning brushes are disposable or cleaned and high-level disinfected or sterilized (per manufacturer instructions) after each use.
Yes      No
 
  1. For chemicals used in high-level disinfection, manufacturer instructions are followed for:
Yes      No
 
  1. preparation
Yes      No
 
  1. testing for appropriate concentration
Yes      No
 
  1. replacement (i.e., prior to expiration or loss of efficacy)
Yes      No
 
  1. If automated reprocessing equipment is used, proper connectors are used to assure that channels and lumens are appropriately disinfected
Yes      No
 
  1. Devices are disinfected for the appropriate length of time as specified by manufacturer instructions
Yes      No
 
  1. Devices are disinfected at the appropriate temperature as specified by manufacturer instructions
Yes      No
 
  1. After high-level disinfection, devices are rinsed with sterile water, filtered water, or tap water followed by a rinse with 70% - 90% ethyl or isopropyl alcohol
Yes      No
 
  1. Devices are dried thoroughly prior to reuse
    (Note: Lumened instruments (e.g., endoscopes) require flushing channels with alcohol and forcing air through channels.)
Yes      No
 
  1. After high-level disinfection, devices are stored in a manner to protect from damage or contamination
    (Note: Endoscopes should be hung in a vertical position)
Yes      No
 

Additional Resources and Evidence-based Guidelines

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