Saving Lives - High Impact Intervention

Isolation Practices Audit

Location: Clinical Setting:

Date: Completed by:

####

Yes
/No
Rooms/Bays N/A Comments
Are residents being isolated in a single
1
room?
Is the door kept closed?(if no, has a risk
2
assessment been undertaken)
Appropriate signage is displayed on the
3 door to alert staff and visiting healthcare
professionals to IPC precautions?
Are staff keeping in the same work area
4
during shift?
Hand Hygiene
Are staff adhereing to the uniform policy -
5 no rings - jewellery - nail varnish-false nails-
wearing of long sleeves?
There are adequate hand washing facilities
6 available, accessible and clean within the
room?
Are hands decontaminated immediately
before and after each episode of resident
7
contact using the correct hand hygiene
technique?
The appropriate hand hygiene product is
8 used on entering and leaving the single
room?
Are residents hand wipes available in the
9
room?
Personal Protective Equipment
Personal protective equipment is readily
10
available inside the single room?
Is PPE worn as a single use item for each
11 task and changed between every episode
of care?
PPE is removed and disposed of
12
appropriately before leaving the room?
Equipment
Is the room clean, free from clutter and
13
excess equipment?
Is a designated commode and/or ensuite
14
toilet in use?
Is the commode/toilet clean and ready for
15
use?
16
Are hoists decontaminated after each use?
Isolation Practices
April 2012
 Saving Lives - High Impact Intervention

17 Are hoist slings single person use?

18 Are hoist slings washed daily?
Is clinical equipment decontaminated after
19
each use?
Fans are avoided to control the patients
20
temperature
Decontamination
Separate cleaning equipment is in use for
21
isolation facilities
Are appropriate cleaning products used to
22 disinfect designated equipment between
every use?
Is appropriate PPE available for domestic
23
staff?
Linen
Used linen is treated as infectious and
24 removed from the room in a timely
manner?
Are red alginate bags available for use in
25
resident's room?
Waste Disposal
Is an enclosed, lidded and foot operated
26
clinical waste bin available?
Documentation and Information
27 Are outbreak charts completed daily?
Information leaflets are used to support
staff verbal communication to patients and
28
visitors i.e. Clostridium difficile , MRSA,
Norovirus
Totals 0 Yes
0 No
0 N/A
Score #DIV/0!

Isolation Practices
April 2012