PDF printable version of Self audit / Site visit check list for aged-care facilities (PDF 62 KB)
Date/time:
Public Health Officer:
1. Contact details:
Person notifying outbreak:Position:
Telephone number:
Name of Facility:
Address:
Facility Manager / Director:
Telephone number:
Fax number:
Email address:
2. Laboratory testing
- Are specimens of diarrhoea/vomitus being collected from affected residents / staff? Yes No
3. Isolation / cohorting
- Is a plan of the facility showing location of ill residents obtainable? Yes No
- Have the identified cases been cohorted (grouped) as recommended? Yes No
- In what way have residents been cohorted?
- Have nursing staff been dedicated to the cohorted ill residents? Yes No
- If cohorting is not possible, have dedicated nurses been allocated to only work with ill residents? Yes No
- Are residents being ‘isolated’ until 72 hours after symptoms have ceased? Yes No
- Have residents been advised not to visit the affected ward / area? Yes No
- Is management aware of the need to restrict admissions? Yes No
4. Staff training
- Have all staff been notified of the outbreak? Yes No
- Have all staff been reminded of the importance of effective handwashing? Yes No
- Do staff regularly attend in-service training on infection control? Yes No
- Is this training compulsory? Yes No
- Are infection control training programs part of the orientation program for new employees? Yes No
- Are staff encouraged to accept responsibility for decreasing the transmission of infectious organisms? Yes No
- What strategies are in place to check that staff are compliant with infection control recommendations?
- Do staff on all shifts know to advise Hospital staff of the outbreak prior to transferring a resident to hospital ED or an outpatient appointment (even if the illness is unrelated to the outbreak)? Yes No
5. Exclusion of affected staff
- Is the staff exclusion period of 48 hours being strictly adhered to? Yes No
6. Hand washing:
Are the following available:
- Facilities for handwashing in all areas? Yes No
- If not, what measures have been taken to address this?
- Liquid soap dispensers? Yes No
- Are soap dispensers disposable and not refillable? Yes No
- If refillable, is there a cleaning procedure? Yes No
- Paper towel / air drier? Yes No
- Plastic-lined waste bin with lid in all areas where affected residents are nursed? Yes No
- Is hand disinfection (e.g. 60–80% alcohol solution handrub) available? Yes No
- Are the taps elbow-operated? Yes No
- Are the residents’ hands being washed after each episode of diarrhoea and vomiting? Yes No
- Are gloves readily available to all staff? Yes No
- Are gloves being worn when there is a risk of exposure to staff of contact with blood/body fluids? Yes No
- Are plastic aprons / gowns available to protect the staff member’s clothing during exposures? Yes No
- Are plastic aprons / gowns being worn to protect the staff member’s clothing during exposures? Yes No
- Are masks available when there is a risk to the staff member of airborne exposure to body substances such as after vomiting? Yes No
- Are masks being worn when there is a risk to the staff member of airborne exposure to body substances such as after vomiting?Yes No
- Are the aprons, gloves and masks being changed between residents? Yes No
- Are the bins for the disposal of aprons, gloves and masks near to the residents’ rooms? Yes No
- Are staff washing their hands after removing protective apparel? Yes No
8. Closure of common areas
- Have the use of common areas been appropriately restricted? Yes No
- Are common areas being closed for 1 hour after episodes of vomiting? Yes No
9. Relatives / visitors
- Have visitors been advised of the outbreak, and of the visiting restrictions? Yes No
- Have visitors been advised not to visit if they are unwell? Yes No
- Have non-essential therapists been advised not to visit? Yes No
- Is relevant signage posted in all areas? Yes No
- Have essential visitors been advised to wash their hands when entering and when leaving the ward / unit and after contact with each resident?Yes No
- Are visitors given advice regarding the safe preparation and transportation of food they might bring in to the facility?Yes No
10. Routine cleaning
- Are rooms of well residents cleaned first? Yes No
- Are bathrooms / toilets cleaned twice daily and when visible soiling occurs? Yes No
- Are handrails in corridors and common areas and door handles in residents room cleaned and then disinfected twice daily with the recommended bleach solution?Yes No
- Are commode / shower chairs cleaned after individual resident use? Yes No
- Is a general clean followed by disinfection with the recommended bleach solution, being carried out for all hard surfaces?Yes No
- Is the bleach solution being discarded within 24 hours of constitution? Yes No
11. Care of cleaning materials
- Is all cleaning equipment colour coded, common areas (blue), toilets / bathrooms/ dirty utility rooms (red), food service areas (green)? Yes No
- Are disposable gloves worn during cleaning? Yes No
- Are mops heads detachable and washed and left to air dry after use? Yes No
- Are buckets washed and dried after use? Yes No
- Is equipment stored in cleaning cupboard / room? Yes No
- Are all remaining diluted cleaning products disposed of after use? Yes No
12. Cleaning up vomit and faeces
- Is there a policy / procedure for cleaning spills? Yes No
- Are staff aware of the policy / procedure for cleaning spills? Yes No
- Is bleach being used after spills / vomit / diarrhoea have been cleaned up? Yes No
- Are utility rubber gloves used for cleaning? Yes No
- Are spare mop heads available? Yes No
- Are plastic bags available for contaminated waste? Yes No
- Are disposable cloths / old rags / paper towel available to wipe up bulk spills? Yes No
13. Linen
- Is used linen bagged at the point of generation? Yes No
- Is wet / visibly soiled linen placed in plastic lined linen bags? Yes No
- Is the plastic bag dissolvable? Yes No
- Are linen bags being overfilled? Yes No
- Is linen / clothing being rinsed or sorted in resident care areas? Yes No
- Is soiled linen removed from resident care areas promptly? Yes No
- Is all soiled linen / clothing being put through hot wash / hot dry cycles? Yes No