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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