Free Nursing Home Infection Control Protocol Checklist Template
Nursing Home Infection Control
Protocol Checklist
Complete this checklist daily to ensure all infection control protocols are being followed correctly. Submit the completed form to the designated infection control officer at the end of each shift.
Hand Hygiene
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Yes |
No |
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|---|---|---|
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Are hand sanitizing stations adequately stocked and functional? |
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Are handwashing signs clearly displayed at all sinks? |
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Is hand hygiene compliance monitored and documented? |
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Personal Protective Equipment (PPE)
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Yes |
No |
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|---|---|---|
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Is PPE readily available to all staff in sufficient quantity? |
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Are there clear instructions for the proper use and disposal of PPE? |
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Is the proper use of PPE being monitored and documented? |
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Resident Care
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Yes |
No |
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|---|---|---|
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Are isolation protocols in place for residents with infectious diseases? |
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Are residents educated about infection prevention practices? |
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Are all staff trained in infection control practices specific to their duties? |
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Cleaning and Disinfection
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Yes |
No |
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|---|---|---|
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Are high-touch surfaces (e.g., door handles, light switches) cleaned and disinfected regularly? |
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Are cleaning protocols for spills of bodily fluids followed promptly and correctly? |
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Is the effectiveness of cleaning agents monitored and evaluated? |
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Equipment and Facility
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Yes |
No |
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|---|---|---|
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Is all medical equipment cleaned and disinfected after each use? |
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Are air filtration systems regularly checked and maintained? |
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Is the overall cleanliness of the facility maintained to high standards? |
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Staff Health Monitoring
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Yes |
No |
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|---|---|---|
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Is there a system in place for monitoring staff health, including symptom checks? |
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Are staff members required to report illness and exposure to infectious diseases? |
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Is there a policy for staff exclusion from work due to infectious illness? |
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Training and Awareness
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Yes |
No |
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|---|---|---|
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Are regular training sessions on infection control conducted for all staff? |
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Are updates on infection control practices communicated effectively? |
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Is there a feedback mechanism for staff to report issues or suggest improvements in infection control? |
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Documentation and Compliance
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Yes |
No |
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|---|---|---|
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Is all documentation related to infection control audits and incidents maintained and up-to-date? |
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Are corrective actions taken in response to audit findings? |
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