_____________________________________________________________ Date (s) of observation: Observer: ________________________________ Any answer that is in a RED box requires an action plan Compliant Compliant STANDARDS N/A DESCRIPTION/COMMENTS YES NO I. ADMINISTRATIVE REQUIREMENTS Manufacturers’ written instructions current, readily available to staff, and followed for: Equipment YES NO Instruments Cleaning solution All sterilization and reprocessing policies and procedures readily available for YES NO staff Orientation and education performed and documented Demonstrated knowledge of and documented competence YES NO Continuing education at regular intervals Training for all new instrumentation, devices, and equipment Equipment maintenance records maintained YES NO Sterilization records storage follows the facilities record retention policy YES NO Management of loaner instrumentation program in place YES NO Consistently adhering to dress code (facial hair covered, facility laundered YES NO scrub attire) Hands are washed after removing PPE YES NO PPE readily accessible, worn and removed as indicated YES NO II. POINT OF USE Disposable sharps are separated from reusable items YES NO Delicate instruments are kept separated YES NO Instruments are kept moist prior to transport and decontamination Note: If used instruments are pre-soaked in enzymatic solution at point of use, they are transported inside a YES NO closeable container in a manner preventing spilling/cross contamination. Instruments are not cleaned in hand sinks or scrub sinks YES NO Contaminated are properly contained during transport YES NO
Date (s) of observation: _____________________________________________________________ Observer: ________________________________ Any answer that is in a RED box requires an action plan STANDARDS Compliant YES Compliant NO N/A DESCRIPTION/COMMENTS I. ADMINISTRATIVE REQUIREMENTS Manufacturers’ written instructions current, readily available to staff, and followed for: Equipment Instruments Cleaning solution YES NO All sterilization and reprocessing policies and procedures readily available for staff YES NO Orientation and education performed and documented Demonstrated knowledge of and documented competence Continuing education at regular intervals Training for all new instrumentation, devices, and equipment YES NO Equipment maintenance records maintained YES NO Sterilization records storage follows the facilities record retention policy YES NO Management of loaner instrumentation program in place YES NO Consistently adhering to dress code (facial hair covered, facility laundered scrub attire) YES NO Hands are washed after removing PPE YES NO PPE readily accessible, worn and removed as indicated YES NO II. POINT OF USE Disposable sharps are separated from reusable items YES NO Delicate instruments are kept separated YES NO Instruments are kept moist prior to transport and decontamination YES NO Note: If used instruments are pre-soaked in enzymatic solution at point of use, they are transported inside a closeable container in a manner preventing spilling/cross contamination. Instruments are not cleaned in hand sinks or scrub sinks YES NO Contaminated are properly contained during transport YES NO
1.03_Sterile_Processing_and_High-Level_Disinfection_Rounds_Tool_1.docx