Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care
The Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care [PDF 538 KB] is a companion to the Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. The checklist should be used:
- To ensure that the facility has appropriate infection prevention policies and procedures in place and supplies to allow healthcare personnel to provide safe care.
- To systematically assess personnel adherence to correct infection prevention practices.
(Assessment of adherence should be conducted by direct observation of healthcare personnel during the performance of their duties.)
Section II. Personnel and Patient-care Observations
1. Hand hygiene performed correctly: |
Practice Performed |
If answer is No, document plan for remediation |
- Before contact with the patient or their immediate care environment (even if gloves are worn)
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Yes No |
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- Before exiting the patient’s care area after touching the patient or the patient’s immediate environment (even if gloves are worn)
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Yes No |
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- Before performing an aseptic task (e.g., insertion of IV or preparing an injection) (even if gloves are worn)
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Yes No |
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- After contact with blood, body fluids or contaminated surfaces (even if gloves are worn)
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Yes No |
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- When hands move from a contaminated-body site to a clean-body site during patient care (even if gloves are worn)
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Yes No |
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2. PPE is correctly used: |
Practice Performed |
If answer is No, document plan for remediation |
- PPE is removed and discarded prior to leaving the patient’s room or care area
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Yes No |
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- Hand hygiene is performed immediately after removal of PPE
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Yes No |
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Gloves: |
- HCP wear gloves for potential contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated equipment
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Yes No |
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- HCP do not wear the same pair of gloves for the care of more than one patient
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Yes No |
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- HCP do not wash gloves for the purpose of reuse
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Yes No |
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Gowns: |
- HCP wear gowns to protect skin and clothing during procedures or activities where contact with blood or body fluids is anticipated
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Yes No |
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- HCP do not wear the same gown for the care of more than one patient
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Yes No |
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Facial protection: |
- HCP wear mouth, nose, and eye protection during procedures that are likely to generate splashes or sprays of blood or other body fluids
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Yes No |
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- HCP wear a facemask (e.g., surgical mask) when placing a catheter or injecting material into the epidural or subdural space (e.g., during myelogram, epidural or spinal anesthesia)
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Yes No |
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3. Injection safety |
Practice Performed |
If answer is No, document plan for remediation |
- Needles and syringes are used for only one patient (this includes manufactured prefilled syringes and cartridge devices such as insulin pens)
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Yes No |
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- The rubber septum on a medication vial is disinfected with alcohol prior to piercing
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Yes No |
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- Medication vials are entered with a new needle and a new syringe, even when obtaining additional doses for the same patient
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Yes No |
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- Single dose (single-use) medication vials, ampules, and bags or bottles of intravenous solution are used for only one patient
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Yes No |
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- Medication administration tubing and connectors are used for only one patient
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Yes No |
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- Multi-dose vials are dated by HCP when they are first opened and discarded within 28 days unless the manufacturer specifies a different (shorter or longer) date for that opened vial
(Note: This is different from the expiration date printed on the vial.)
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Yes No |
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- Multi-dose vials are dedicated to individual patients whenever possible.
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Yes No |
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- Multi-dose vials to be used for more than one patient are kept in a centralized medication area and do not enter the immediate patient treatment area (e.g,. operating room, patient room/cubicle)
(Note: If multi-dose vials enter the immediate patient treatment area they should be dedicated for single-patient use and discarded immediately after use.)
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Yes No |
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- All sharps are disposed of in a puncture-resistant sharps container
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Yes No |
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- Filled sharps containers are disposed of in accordance with state regulated medical waste rules
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Yes No |
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- All controlled substances (e.g., Schedule II, III, IV, V drugs) are kept locked within a secure area
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Yes No |
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4. Point-of-Care Testing (e.g., blood glucose meters, INR monitor) |
Practice Performed |
If answer is No, document plan for remediation |
- New single-use, auto-disabling lancing device is used for each patient
(Note: Lancet holder devices are not suitable for multi-patient use.)
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Yes No |
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- If used for more than one patient, the point-of-care testing meter is cleaned and disinfected after every use according to manufacturer’s instructions
(Note: If the manufacturer does not provide instructions for cleaning and disinfection, then the testing meter should not be used for >1 patient.)
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Yes No |
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For additional guidance on infection prevention during point-of-care testing consult the following resource(s):
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5. Environmental Cleaning |
Practice Performed |
If answer is No, document plan for remediation |
- Environmental surfaces, with an emphasis on surfaces in proximity to the patient and those that are frequently touched, are cleaned and then disinfected with an EPA-registered disinfectant
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Yes No |
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- Cleaners and disinfectants are used in accordance with manufacturer’s instructions (e.g., dilution, storage, shelf-life, contact time)
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Yes No |
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6. Reprocessing of Reusable Instruments and Devices |
Practice Performed |
If answer is No, document plan for remediation |
- Reusable medical devices are cleaned, reprocessed (disinfection or sterilization) and maintained according to the manufacturer instructions.
(Note: If the manufacturer does not provide such instructions, the device may not be suitable for multi-patient use.)
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Yes No |
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- Single-use devices are discarded after use and not used for more than one patient.
(Note: If the facility elects to reuse single-use devices, these devices must be reprocessed prior to reuse by a third-party reprocessor that it is registered with the FDA as a third-party reprocessor and cleared by the FDA to reprocess the specific device in question. The facility should have documentation from the third party reprocessor confirming this is the case.)
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Yes No |
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- Reprocessing area has a workflow pattern such that devices clearly flow from high contamination areas to clean/sterile areas (i.e., there is clear separation between soiled and clean workspaces)
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Yes No |
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- Medical devices are stored in a manner to protect from damage and contamination
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Yes No |
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7. Sterilization of Reusable Instruments and Devices |
Practice Performed |
If answer is No, document plan for remediation |
- Items are thoroughly pre-cleaned according to manufacturer instructions and visually inspected for residual soil prior to sterilization
(Note: For lumened instruments, device channels and lumens must be cleaned using appropriately sized cleaning brushes.)
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Yes No |
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- Enzymatic cleaner or detergent is used for pre-cleaning and discarded according to manufacturer’s instructions (typically after each use)
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Yes No |
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- Cleaning brushes are disposable or cleaned and high-level disinfected or sterilized (per manufacturer’s instructions) after each use
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Yes No |
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- After pre-cleaning, instruments are appropriately wrapped/packaged for sterilization (e.g., package system selected is compatible with the sterilization process being performed, hinged instruments are open, instruments are disassembled if indicated by the manufacturer)
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Yes No |
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- A chemical indicator (process indicator) is placed correctly in the instrument packs in every load
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Yes No |
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- A biological indicator is used at least weekly for each sterilizer and with every load containing implantable items
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Yes No |
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- For dynamic air removal-type sterilizers, a Bowie-Dick test is performed each day the sterilizer is used to verify efficacy of air removal
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Yes No |
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- Sterile packs are labeled with the sterilizer used, the cycle or load number, and the date of sterilization
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Yes No |
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- Logs for each sterilizer cycle are current and include results from each load
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Yes No |
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- After sterilization, medical devices and instruments are stored so that sterility is not compromised
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Yes No |
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- Sterile packages are inspected for integrity and compromised packages are reprocessed prior to use
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Yes No |
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- Immediate-use steam sterilization (flash sterilization), if performed, is only done in circumstances in which routine sterilization procedures cannot be performed
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Yes No |
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- Instruments that are flash-sterilized are used immediately and not stored
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Yes No |
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8. High-Level Disinfection of Reusable Instruments and Devices |
Practice Performed |
If answer is No, document plan for remediation |
- Flexible endoscopes are inspected for damage and leak tested as part of each reprocessing cycle
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Yes No |
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- Items are thoroughly pre-cleaned according to manufacturer instructions and visually inspected for residual soil prior to high-level disinfection
(Note: For lumened instruments, device channels and lumens must be cleaned using appropriately sized cleaning brushes.)
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Yes No |
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- Enzymatic cleaner or detergent is used and discarded according to manufacturer instructions (typically after each use)
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Yes No |
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- Cleaning brushes are disposable or cleaned and high-level disinfected or sterilized (per manufacturer instructions) after each use.
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Yes No |
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- For chemicals used in high-level disinfection, manufacturer instructions are followed for:
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Yes No |
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- preparation
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Yes No |
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- testing for appropriate concentration
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Yes No |
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- replacement (i.e., prior to expiration or loss of efficacy)
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Yes No |
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- If automated reprocessing equipment is used, proper connectors are used to assure that channels and lumens are appropriately disinfected
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Yes No |
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- Devices are disinfected for the appropriate length of time as specified by manufacturer instructions
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Yes No |
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- Devices are disinfected at the appropriate temperature as specified by manufacturer instructions
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Yes No |
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- After high-level disinfection, devices are rinsed with sterile water, filtered water, or tap water followed by a rinse with 70% - 90% ethyl or isopropyl alcohol
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Yes No |
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- Devices are dried thoroughly prior to reuse
(Note: Lumened instruments (e.g., endoscopes) require flushing channels with alcohol and forcing air through channels.)
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Yes No |
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- After high-level disinfection, devices are stored in a
manner to protect from damage or contamination
(Note: Endoscopes should be hung in a vertical position)
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Yes No |
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Additional Resources and Evidence-based Guidelines