C Diff Cleaning Audit Tool - Minnesota Department of Health



Clostridium Difficile Cleaning Audit Tool for Infection Prevention and ControlFacility:____________________________________ Observer:_______________________________Unit/Department:___________________Role:____________________ Date:___________Cleaning StepPlease indicate ALL that apply. Document routine PRACTICE and not policy.ObservationAudit- √ if observedFrequencyD= Daily T= Terminal P= After Each Use Routine ProductQ= Quat B= Bleach O= OtherW= WipeS= SprayRoutine use of bleach for CDI resident?Y/NProcess vary by unit or day of week? Y/NWho does the task?Env ServiceUnit SupportResident Care staffCentral EquipmentOther1. High Dust1a. Ledges: shoulder and higher1b. Vents1c. Lights (resident room)1d. Lights (bathroom)1e. TV – rotate and clean all surfaces1f. TV cabinet1g. TV Screen and wires1h. Go to ES cart and gently shake dust into waste bag2. Damp dust – Cloth and squirt bottle or bucket of disinfectant – damp wipe all surfaces in room2a. Ledges (shoulder high)2b. Door handles/knobs2c. Door hinges 2d. Light switches2e. Call button2f. TV remote2g. Telephone2h. Resident storage cabinets and drawers3. Bed (top to bottom, head to foot, and left to right) Bring bed up to highest position3a. Raise mattress and disinfect top, sides and bottom3b. Disinfect exposed frame, springs or bed panels3c. Headboard: disinfect top, front and back3d. Disinfect side rails, undercarriage and lower ledges3e. Disinfect all bed controls3f. Disinfect the foot-board (top, front, back)3g. Allow moisture to dry before placing linen on bed3h. Pillows4. Overbed Table4a. Disinfect surfaces and legs4b. Wipe out drawer4c. Wipe off mirror5. Bedside Table5a. Disinfect surface and legs5b. Wipe out drawer6. Glass surfaces7. Bathroom7a. Use toilet chemical, don’t flush7b. Light switches7c. Ledges/shelves 7d. Door handles/knobs7e. Sink and faucets7f. Toilet surfaces7g. Cabinets if present7h. Handrails7i. Emergency call pull cord7j. Dirty linen storage located in bathroom?7k. Linen bin (lid and stand)7l. Paper towel dispensor7m. Bathroom cupboards7n. Towel rack/rod7o. Soap dispensers8. Shower stall and faucets8a. After running water, leave shower head dangling down (do not loop)8b. Wipe walls, curtain, check for signs of mildew /mold8c. Soap dispensers8d. Shower curtains/ doors9. Floor Cleaning 9a. Place mop head in detergent/ disinfectant9b. Mop (farthest from door) ? of room9c. Mop shower floor9d. Bathroom floor9e. Flip mop head- do remainder of room9f. Frequency9g. Neutral product for routine rm 9h. Quat MDRO/procedure rooms 10. Resident Equipment10a. Commode10b. BP cuff10c. Thermometer10d. Leads10e. Oximeter10f. Wheelchair10g. flashlight10h. IV pump10i. Safe resident moving10j. Slip sheets10k. Glucometers10l. Electronic monitors10m. Other (List)10n. Anesthesia carts10o. Suction and O2 regulator/knobs11. Computers11a. Keyboards11b. Keyboard covers 11c. Screen11d. PC11e. Stand or Wall mounted brackets11f. Computer wires12. Enteric Precaution (when diluted bleach used)**12a. Cleaning with Quat detergent product 12b. Quat allowed to dry 12c. All surfaces disinfected with dilute bleach solution12d. Resident equipment disinfected using bleach on room exit 12e. Diluted bleach disposed <= 24 hrs13. Misc. Items13a. Courtesy chair/bed13b. Menus/Hospital info book13c. Biohazard can13d. Toys13e. Books13f. Dry erase marker and eraser13g. Step stool13h. Scissors13i. Whirlpool 14. Inroom sink- if present14a. Basin14b. Faucet14c. Paper towel dispensor14d. Soap dispensor14e. Lotion dispensor** Complete if manually diluted bleach product is used.1.Do you have handwashing sinks located on the unit? Y / N How many?________2.Are handwashing sinks located within 15 feet of most resident rooms? Y / N3.Do you have separate handwashing sinks in resident rooms? Y / N4.If handwashing sinks are not conveniently located, do staff use resident bathroom sink? Y / N5.Are there alternate hand hygiene options available (e.g. Resurgent Hand Hygiene stations)? Y /N6.Is Quik-Care foam located at room entrances and other locations for ease of use? Y / N7.Is there a separate sprayer in resident bathrooms for commode/bedpan cleaning? Y / NIf no, are resident sinks used for this purpose? Y / N8.How many minutes are ES staff allocated for:Daily cleaning of each resident room __________Routine terminal clean after discharge ________Special projects ___________9.How frequently are privacy curtains changed?Once per yearEvery 6 monthsEvery 3-6 monthsEvery 1-3 monthsAfter each resident dischargeOnly when visibly soiled10.Do you have in-room supply cabinets (nurse servers)? Y / NIf yes, are they used to store supplies between residents? Y / NWho cleans supply cabinets? ___________How frequently? _______________11.Are the amounts of supplies & linens stored in resident rooms kept to a minimum? Y / N 12.Are supplies and linens stored in resident rooms discarded at discharge when resident has been in Contact Precautions? Y / N13.Are there med drawers in the resident room?If yes, how frequently are they cleaned? ________________Who cleans the med drawers? _____________________14.Is there a cleaning/disinfecting protocol for Pyxis machines?Who cleans?___________How frequently? __________What product? ___________15.How frequently is bed linen changed? __________16.Do you use single use cleaning cloths? Y / N17.Do you use microfiber clothes and mops? Y / N18.Is a two-step cleaning/disinfecting process used for all surfaces and equipment? Y / NUsing a single detergent/disinfectant product? Y / NWhich product?___________19.Have you ever implemented Enteric Precautions and bleach disinfecting?Using a stable detergent/ bleach product (e.g. Dispatch)? Y / NIf you dilute a bleach disinfectant, what is the concentration of the final dilution?_________How do you verify concentration?______________How frequently is the diluted bleach disinfectant changed?_____________20.Are disinfectant wipes located in each resident room? Y / NIf not in each resident room, are they conveniently located on the unit for staff use? Y / NWhich product?_________________What is the dry time for the product? _______________21.Have observational audits confirmed compliance with disinfection of equipment (including personal stethoscopes) between residents? Y / N22.Do physicians and other staff wear white lab coats on the unit? Y / NHow frequently are the lab coats washed?______________23.Are cloth stethoscope sleeves allowed? Y / N24.Do you have hands-free communication devices? Y / NIf no, are cell phones used in contact precautions rooms? Y / N25.Are OR suites terminally cleaned on weekends or if the room is not used during the day as per AORN/CDC standard? Y / NType of emergency pull cord used: Plastic Y / NRope Y / NHow frequently are shower curtains changed? _______________Other opportunities observed? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Minnesota Department of HealthInfectious Disease Epidemiology, Prevention and ControlPO Box 64975, St. Paul, MN 55164651-201-5414 health.state.mn.usTo obtain this information in a different format, call: 651-201-5414. ................
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