ANESTHESIA INFECTION CONTROL CHECKLIST
ANESTHESIA INFECTION PREVENTION CHECKLIST
OR :__________________SUITE___________OBSERVER:___________________________
NAME:________________________________DATE:________________TIME:___________
|MET |NOT MET |MEASURE |
| | |Hands are washed prior to entering the OR |
| | |Hand hygiene performed: |
| | |prior to accessing/preparing clean supplies/medications |
| | |prior to gloving and when removing gloves |
| | |between dirty and clean steps of a procedure |
| | |Full barrier protection is worn for central line insertions and Central Line bundle is followed and documented |
| | |Gloves are worn when inserting IVs |
| | |LMA/laryngoscopes are handled with gloves (hands sanitized first) |
| | |Gloves are removed after inserting or removing LMA/laryngoscope |
| | |Cover jackets are buttoned to the top and are removed at end of case when there is patient contact or contact |
| | |with body substances |
| | |Hair and head jewelry are totally covered by cap; no rings present, mask tied |
| | |Medications are drawn up and labeled at time of procedure |
| | |Used medication vials are stored on top of medication cart during procedure and discarded prior to next case |
| | |Medication labels are stored in a clean location |
| | |Unused medications (drawn up syringes) are not transferred for use on next case |
| | |IV ports and medication stoppers are disinfected prior to entering |
| | |IV tubing does not hang below level of knees |
| | |CHG/alcohol prep used for skin prior to IV insertion |
| | |Single use items (medications/supplies) are discarded between patients |
| | |Topical ointments/tape are dispensed in a clean manner to avoid contamination |
| | |Sprays are handled in a clean manner to avoid contamination |
| | |Set up changed between patients (new towel) |
| | |Items dropped on floor are discarded |
| | |Medication/anesthesia cart surfaces and drawer handles are disinfected between patients |
| | |Keyboard and mouse are disinfected between patients |
| | |Medications for next case are drawn up over a clean towel after hand hygiene performed, placed in ziplock bag |
| | |and stored in anesthesia cart drawer. |
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