Infection Control Checklist

Regulatory Questions	Yes	No	Comments
1. Does the facility have in place a system to monitor and investigate causes of infection and manner of spread?
2. Does the facility maintain a separate record on infection that identifies each resident with an infection, states the date of infections, the causative agent, the origin or site of infection, and describes what precautionary measures were taken to prevent the spread of infection within facility?
3. Does the system being used enables the facility to analyze clusters, changes in prevalent organisms, or increases in the rate of infection in a timely manner?
4. Does the facility routinely review the surveillance data and are recommendations made for the prevention and control of additional cases?
5. Is the written infection control policy periodically reviewed by the infection control committee or designated personnel with qualifications and revised as indicated?
6. Does the facility have the definitions of infections in writing?
7. Does the facility have a written protocol on the risk assessment of communicable diseases for both residents and staff and review annually or more frequently as needed?
8. Does the facility have methods in place for identifying, documenting, and investigating facility-acquired infections and communicable diseases?
9. Does the infection control program enable the facility to identify new infections quickly?
10. Does the infection control program pay particular attention to residents of high risks of infections such as immobility, invasive devices, pressures sores, recently discharged from hospitals, mentally retarded or ill, decreased mental status, compromised nutritionally or immunologically?
11. Does the facility have written protocols for early detection of residents who have signs or symptoms of tuberculosis and a referral protocol to a facility where tuberculosis can be evaluated and managed appropriately?
12. Does the facility have written measures for prevention of infections especially those associated with IV therapy, indwelling catheters, tracheotomy care, stoma care , respiratory care, immunosuppression, pressure sores, bladder and bowel incontinence and other factors which compromise a resident’s resistance to infection?
13. Does the facility have written measures for tuberculosis, influenza, hepatitis A, B and C, scabies, MRSA, and VRE?
14. Does the facility have written procedures to inform and involve a local of State Epidemiologist for non-sporadic, facility-wide infections that are difficult to control?
15. Does the facility have isolation procedures and requirements for infected and at risk immunosuppressed nursing home residents?
16. Does the facility have written measures for the use of Standard Precautions and documented in-service education for this standard?
17. Does the facility have written protocols for handwashing, respiratory protection, linen handling, housekeeping practices, needle and hazardous waste disposal?
18. Does the facility have in place needlestick prevention technologies to help comply with applicable regulations for making wise decisions on purchasing?
19. Does the facility have in writing authority and indications for obtaining and acting upon microbiological cultures from residents and for isolating residents?
20. Does the facility have in writing the proper use of disinfectants and antiseptics accordance with manufacturer’s instructions and EPA and FDA label specifications to avoid harm to staff, residents and visitors in order to ensure their effectiveness?
21. Does the facility have written documentation of orientation of all new facility personnel and periodic updates to the infection control program?
22. Does the facility have written measures for the screening of the health care workers for communicable diseases and for the evaluation of workers exposed to residents with communicable diseases including tuberculosis and blood borne pathogens?
23. Does the facility have written guidelines for work restrictions for an employee that is infected or ill with a communicable disease?
24. Does the facility have written measures which address the prevention of infections common to a nursing home such as vaccination for influenza, vaccination for pneumococcal pneumonia, TB screening, TB testing?
25. Does the facility have written measures for the sanitation of tubs, whirlpools and common use equipment performed according to manufacturer’s direction?
26. Does the facility isolate residents appropriately to prevent the spread of infections?
27. Does the facility have written protocols for handwashing? Does it follow CDC’s recommendation?
28. Are handwashing facilities accessible to the health care workers?
29. Are gloves accessible to the health care workers?
30. Are proper glove sizes available to the health care worker?
31. Are hypoallerogenic gloves available to health care workers who need them?
32. Does the facility isolate infected residents to the degree necessary to isolate the organism?
33. Does the facility have written protocols on what type of diseases require droplet precautions?
34. Does the facility prohibit employees with communicable diseases having direct contact with residents?
35. Are employees aware of the facility’s work restriction protocol?
36. Does the facility have written protocols that require staff to wash their hands after each direct resident contact when indicated?
37. Is soiled linen handled to contain and minimize aerosolization and exposure to any waste products?
38. Is the soiled linen storage areas well ventilated and maintained under negative air pressure?
39. Is the laundry designed to eliminate crossing of soiled and clean linen?