Infection Control Audit Tool - Triage
Date : Compliance:-10
Partial Compliance:-05
Department : Non Compliance:- 0
Sign of the Employee after
S.No Parameters 0 5 10 Remarks OJT
I. Equipment and resource Sign Employ Code
Bed pans ,urinals,bed pan washer are
1 clean
Date and time on medical devices
(closed suction,younkar suction
2 sets,gravity bag etc)
II. Personal
Staff aware about hand
3 hygiene(steps/moments/opportunity)
Staff aware about all bundles(1
4 Doctor , 2 S/N)
5 Staff aware about NSI protocol
Awareness regarding barrier nursing
6 and reverse barrier isolation protocols
III. Practice
Standard precautions followed for the
7 procedures witnessed
8 Appropriate bio medical waste disposal
9 Appropriate sharp disposal
All solutions dates of
10 preparation/opening
Aseptic practices for the care of lines
11 and tubes as well as documented
IV. Facility
12 Hand rub available outside the Dept
Routine cleaning with appropriate
13 disinfectant
14 Terminal Disinfection of patient unit
15 Store Rooms arranged properly
TOTAL MARKS
Name /sign/Emply Code
Infection control/Audit Tool/Rev1.6/March 14
AUDIT TOOL
Date : Day :
Department : Time :
( Yes)
( No)
S.No Parameters Deptt 1 0 Remarks
1 Hand Hygiene (Staff Nurse)
2 Hand Hygiene (Doctors)
3 Hand Hygiene ( GDA )
4 *Standard precautions followed
5 Terminal Disinfection of beds
BMW Segregation Followed with
6 proper disposal of sharps
7 Store Rooms arranged properly
8 Dressing trolley complete
9 Trays carried during procedures
10 *Invasive device care given
11 Bed Pans/Urinals clean
12 Fridge clean
13 Date & Time of opened medicines
14 Sharp container with Label/Sticker
Disinfection of Biomedical
15 Equipments
TOTAL MARKS
Name of the Auditor
