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.)
Facilities using this checklist should identify all procedures performed in their ambulatory setting and refer to appropriate sections to conduct their evaluation. Certain sections may not apply (e.g., some settings may not perform sterilization or high-level disinfection). If the answer to any of the listed questions is No, efforts should be made to correct the practice, appropriately educate healthcare personnel (if applicable), and determine why the correct practice was not being performed. Consideration should also be made for determining the risk posed to patients by the deficient practice. Certain infection control lapses (e.g., re-use of syringes on more than one patient or to access a medication container that is used for subsequent patients; re-use of lancets) can result in bloodborne pathogen transmission and should be halted immediately. Identification of such lapses warrants immediate consultation with the state or local health department and appropriate notification and testing of potentially affected patients.
Infection Prevention Checklist
Section I. Administrative Policies and Facility Practices
1. Facility Policies |
Practice Performed |
If answer is No, document plan for remediation |
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Yes No |
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Yes No |
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Yes No |
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Yes No |
2. General Infection Prevention Education and Training1. |
Practice Performed |
If answer is No, document plan for remediation |
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Yes No |
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Yes No |
3. Occupational Health |
Practice Performed |
If answer is No, document plan for remediation |
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Yes No |
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Yes No |
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Yes No |
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Yes No |
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Yes No |
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Yes No |
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Yes No |
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Yes No |
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Yes No |
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Yes No |
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For additional guidance on occupational health recommendations consult the following resource(s): |
4. Surveillance and Disease Reporting |
Practice Performed |
If answer is No, document plan for remediation |
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Yes No |
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Yes No |
5. Hand Hygiene |
Practice Performed |
If answer is No, document plan for remediation |
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Yes No |
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Yes No |
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Examples of tools used to record adherence to hand hygiene [PDF - 165 KB] |
Yes No |
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For additional guidance on hand hygiene and resources for training and measurement of adherence, consult the following resource(s). |
6. Personal Protective Equipment (PPE) |
Practice Performed |
If answer is No, document plan for remediation |
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Yes No |
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Yes No |
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For additional guidance on personal protective equipment consult the following resource(s): |
7. Injection Safety |
Practice Performed |
If answer is No, document plan for remediation |
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Yes No |
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Yes No |
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Yes No |
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For additional guidance on injection safety consult the following resource(s): |
8. Respiratory Hygiene/Cough Etiquette |
Practice Performed |
If answer is No, document plan for remediation |
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Yes No |
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Yes No |
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Yes No |
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Yes No |
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Yes No |
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Yes No |
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Yes No |
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For additional guidance on respiratory hygiene/cough etiquette consult the following resource(s): |
9. Environmental Cleaning |
Practice Performed |
If answer is No, document plan for remediation |
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Yes No |
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Yes No |
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Yes No |
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Yes No |
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Yes No |
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For additional guidance on environmental cleaning consult the following resource(s): |
10. Reprocessing of Reusable Instruments and Devices |
Practice Performed |
If answer is No, document plan for remediation |
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Yes No |
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Yes No |
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Yes No |
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Yes No |
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The above basic information allows for a general assessment of policies and procedures related to reprocessing of reusable medical devices. Ambulatory facilities that are providing on-site sterilization or high-level disinfection of reusable medical equipment should refer to the more detailed checklists related to sterilization and high-level disinfection in separate sections of this document devoted to those issues. Critical items (e.g., surgical instruments) are objects that enter sterile tissue or the vascular system and must be sterile prior to use (see Sterilization Section). Semi-critical items (e.g. , endoscopes for upper endoscopy and colonoscopy, vaginal probes) are objects that contact mucous membranes or non-intact skin and require, at a minimum, high-level disinfection prior to reuse (see High-level Disinfection Section). Non-critical items (e.g., blood pressure cuffs) are objects that may come in contact with intact skin but not mucous membranes and should undergo cleaning and low- or intermediate-level disinfection depending on the nature and degree of contamination. Single-use devices (SUDs) are labeled by the manufacturer for a single use and do not have reprocessing instructions. They may not be reprocessed for reuse except by entities which have complied with FDA regulatory requirements and have received FDA clearance to reprocess specific SUDs. Note: Pre-cleaning must always be performed prior to sterilization and/or disinfection For additional guidance on reprocessing of medical devices consult the manufacturer instructions for the device and the following resource(s): |
11. Sterilization of Reusable Instruments and Devices |
Practice Performed |
If answer is No, document plan for remediation |
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Yes No |
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Yes No |
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Yes No |
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For additional guidance on sterilization of medical devices consult the manufacturer instructions for the device and the following resource(s): |
12. High-Level Disinfection of Reusable Instruments and Devices |
Practice Performed |
If answer is No, document plan for remediation |
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Yes No |
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Yes No |
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Yes No |
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For additional guidance on reprocessing of high-level disinfection devices consult the manufacturer’s instructions for the device and the following resource(s): |
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