Appendix E Dental Clinic Inspection Form Form # 910.5.3 B Clinic/Location ________________________Date__________ Observer _________________ Category X = Observations Evaluated Comments Critical not met Proper use of Proper hand washing work Proper use of PPE practice/ Availability of appropriate PPE engineering Proper handling of sharps (no bending, breaking, controls recapping of needles, disposal in sharps container) Dental Clinic-use of recapping cuff or single hand scoop technique Appropriate use of approved safety devices Proper Sharps containers stable, accessible and not handling/ overfilled disposal Contaminated waste placed in red biohazardous . of bags and covered/uncontaminated waste placed in biohazardous regular trash waste Single use (disposable) items not reprocessed Appropriate placement of biohazardous labels Adequate staff Can locate Exposure Control Plan knowledge/ Knowledge of blood spill cleanup procedure education Can state procedure to follow in the event of a blood or other potentially infectious material exposure --immediate first aid, persons to notify, have source pt. remain available Can state signs and symptoms of TB Knowledge of N-95 mask and Knowledge of negative pressure Monthly gauge log maintained (Dental clinics NA) Annual BBP/TB training of all staff Other Sterilization Cleaning routine for sterilizer Chemical indicators used in every pack Biological monitors used weekly or with each run if used less than weekly Documentation of monitoring maintained Staff skills validated for processing of instruments
Appendix E Dental Clinic Inspection Form Form # 910.5.3 B Clinic/Location ________________________Date__________ Observer _________________ Category Critical X = not met Observations Evaluated Comments Proper use of work practice/ engineering controls Proper hand washing Proper use of PPE Availability of appropriate PPE Proper handling of sharps (no bending, breaking, recapping of needles, disposal in sharps container) Dental Clinic-use of recapping cuff or single hand scoop technique Appropriate use of approved safety devices Proper handling/ disposal of biohazardous waste Sharps containers stable, accessible and not overfilled Contaminated waste placed in red biohazardous bags and covered/uncontaminated waste placed in regular trash . Single use (disposable) items not reprocessed Appropriate placement of biohazardous labels Adequate staff knowledge/ education Can locate Exposure Control Plan Knowledge of blood spill cleanup procedure Can state procedure to follow in the event of a blood or other potentially infectious material exposure --immediate first aid, persons to notify, have source pt. remain available Can state signs and symptoms of TB Knowledge of N-95 mask and Knowledge of negative pressure Monthly gauge log maintained (Dental clinics NA) Annual BBP/TB training of all staff Other Sterilization Cleaning routine for sterilizer Chemical indicators used in every pack Biological monitors used weekly or with each run if used less than weekly Documentation of monitoring maintained Staff skills validated for processing of instruments
SoDM-Infection-Control-Manual.docx