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INFECTION CONTROL CHECKLIST Housekeeping Department INFECTION CONTROL REVIEW I.

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Quarter 1 Not Met Met Quarter 2 Not Met Met Quarter 3 Not Met Met Page 1 Quarter 4 Not Met Met

PERSONNEL

Employees wear clean, neat, untorn and appropriate clothing Closed shoes in good repair with safety soles are worn Personal hygiene (including hair and body cleanliness) is practiced Fingernails are trimmed and clean Hair is worn in a neat fashion Strict handwashing procedures (ex: between resident areas) are followed Personnel refrain from direct resident contact except in emergency situations Utility gloves are worn to protect hands from harsh chemical cleansers/germicides Personnel oriented to infection control procedures on hiring; this is documented Injuries and suspected infections are reported immediately Personnel attend both department and facility-wide infection control inservices Personnel are informed of potential dangers and toxicities of cleaning compounds Personnel, when informed of potential dangers, follow recommended safety procedures Personnel avoid touching, or clothing touching, resident belongings or equipment

II.

1. 2. 3. 4. 5.

CLEANING PROCEDURES

Halls and floors are wet-mopped every day with a detergent germicide All resident bathroom fixtures, handwashing facilities, water fountains and service sinks are cleaned daily with a detergent germicide solution Soap/paper towel/toilet paper dispensers are restocked daily Cleaning solutions are changed every ___________________ Supplies used for dusting are changed frequently

INFECTION CONTROL CHECKLIST Housekeeping Department INFECTION CONTROL REVIEW

6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Mop heads are changed every ____________________________ Trash containers are emptied in resident areas when they are ¾ full All carpeted areas are vacuumed daily Carpeted areas are thoroughly cleaned with an infection control approved product Carpeted areas are cleaned as frequently as needed Walls/floors/fixtures/furniture are cleaned according to an established schedule Disposable liners are used for waste baskets Wastebasket liners are closed tightly in transport Cleaning agents approved by the infection control committee are used in areas known to be contaminated with pathogenic bacteria All detergents, disinfectants, germicides, solvents and acid cleaners are used in designated areas only Non-corrosive equipment is used Filters on vacuum cleaners are changed and cleaned regularly Furniture and ashtrays in visitor, staff and resident areas are cleaned regularly All housekeeping equipment cleaned with a germicide solution every _______ Supplies and equipment are stored so as to maintain infection control Quarter 1 Not Met Met Quarter 2 Not Met Met Quarter 3 Not Met Met Page 2 Quarter 4 Not Met Met

III.

1. 2. 3. 4.

RESIDENT DISCHARGE (OR NON-ISOLATION TERMINAL CLEANING)

Using detergent germicide solution on light fixtures/switches, door/cabinet handles, bedside stands, overbed tables and bed frames Wet cleaning mirrors, telephone/call bells and spraying them with germicide Soap/paper dispensers are restocked as well as other unit supplies Staff/visitor areas are wet-mopped, dusted and cleaned each day with germicide

IV.

ISOLATION

INFECTION CONTROL CHECKLIST Housekeeping Department INFECTION CONTROL REVIEW

1. 2. Gowns, gloves and masks are worn, if appropriate Bagging, double-bagged and labeling procedures are followed Quarter 1 Not Met Met Quarter 2 Not Met Met Quarter 3 Not Met Met Page 3 Quarter 4 Not Met Met

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