Infection Prevention and Control Checklist for LTCHs Suggestions for Use

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1 s Suggestions for Use This checklist is designed to assist you to complete an Infection Prevention and Control walkabout in your facility. Some suggestions for use include: Set aside an hour to tour your facility and complete this tool Consider bringing another staff person with you. You may each notice different areas for improvement After completing the tool, type up the results into a report, including plans for addressing not acceptable items Define a timeframe for re-visiting the checklist, both to complete another audit and determine if areas for improvement from the first audit were addressed. Additionally, the following resources may help you complete a gap analysis of your facility and identify areas for improvement: PIDAC Best Practice Guidelines found at under PIDAC Knowledge Products CHICA-Canada Audit Toolkit Environmental Cleaning Toolkit Just Clean Your Hands Program Ministry of Health and Long Term Care Guidelines for Respiratory, Enteric, and Clostridium difficile Infection outbreaks Consult with your local Regional Infection Control Network. We hope you will find this to be a practical resource Spread knowledge, not infection - CHICA-Canada Regards, Public Health Ontario Regional Infection Control Networks

2 s Date Completed: By: Item Acceptable Not Acceptable Front Entrance Sign-in book with pen Hand sanitizer Signage posted encouraging ill visitors to not visit easily visible Lobby furniture cleanable, and cleaned regularly Stairwells Cleaned daily Area around keypads looks clean (no soiling on walls) Stairwell free of visible soil (dust bunnies, waste, mud, etc) Railings easy to clean (no chipping and cracking) Light fixtures clean Ceiling tiles intact and not stained Hand sanitizer at entrances and exits to stairwell Elevators Cleaned daily Area around control panel looks clean (free of fingerprints) Elevator free of visible soil (dust bunnies, waste, etc) Resident s Rooms Signage posted on rooms of residents with communicable organisms Signage if present does not breach confidentiality Signage if present prompts visitors to speak with nurse before entering Process for posting isolation signs Isolation carts if present are appropriately stocked and placed Page 2 of 5

3 Call bell is present and cleanable Privacy curtains are free from visible soil. Privacy curtains are taken down and cleaned on a routine basis Resident Bathrooms Counter top is free from clutter (no personal effects) The countertop, backsplash and wall around sink are intact Floor around the toilet is intact Grout around toilet is intact Toilet cleaned daily A routine exists for changing toilet brushes Urinals and specimen collections containers are not stored on back of toilet Dining Rooms and Lounges Resident s hands are cleansed once they arrive at the table, not before Cleaned after each meal (chairs cleaned and table wiped) Floors swept after each meal Furniture is free from visible soil (including signs of mold on table and chair legs) Furniture is intact and cleanable (no rips or tears in chairs, no fabrics) Lounge areas free from clutter Decorative items if present have a cleaning routine (i.e silk flowers) Tub and Shower Rooms Tubs and showers cleaned between each resident and at the end of every shift Manufacturer s instructions related to tub cleaning being followed Cleaners present and ready to use Tiles and grout intact Walls and ceilings are free from visible stains Activation Programs Resident s hands are cleansed once they arrive at the program, not before Items that are shared between residents (balls, game pieces, etc) are cleaned Page 3 of 5

4 on a routine basis Residents who are soiling the environment are excused from the program for that day Tables and chairs are wiped down on a daily basis Soiled Utility Rooms Soiled items are managed in an organized fashion (waste receptacles, soiled linen, soiled instruments) No clutter Soiled commode chairs properly cleaned Hand sanitizer and gloves readily available Storage Areas Shelving units raised from the floor Storage is well organized with cleanable containers Old (non cleanable) equipment discarded not stored Hallways and Other Areas Ceiling vents from visible soil and dust Ceiling tiles are all present Soiled or stained ceiling tiles are replaced Additional fans if present are free from visible dust and cleaned on a regular basis Outside garden spaces are free from large collections of bird droppings Additional Equipment Glucometers are dedicated to each resident and properly labeled Glucometers are cleaned after each use Fingerprick devices are dedicated to each resident and properly labeled Carts are cleaned on a routine basis Carts are cleanable (good condition) and free from visible soil Page 4 of 5

5 Overall Impressions and Areas for Follow-Up: Page 5 of 5