Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care

1. Before contact with the patient or their immediate care environment (even if gloves are worn)

2. Before exiting the patient’s care area after touching the patient or the patient’s immediate environment (even if gloves are worn)

3. Before performing an aseptic task (e.g., insertion of IV or preparing an injection) (even if gloves are worn)

4. After contact with blood, body fluids or contaminated surfaces (even if gloves are worn)

5. When hands move from a contaminated-body site to a clean-body site during patient care (even if gloves are worn)

1. PPE is removed and discarded prior to leaving the patient’s room or care area

2. Hand hygiene is performed immediately after removal of PPE

3. HCP wear gloves for potential contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated equipment

4. HCP do not wear the same pair of gloves for the care of more than one patient

5. HCP do not wash gloves for the purpose of reuse

6. HCP wear gowns to protect skin and clothing during procedures or activities where contact with blood or body fluids is anticipated

7. HCP do not wear the same gown for the care of more than one patient

8. HCP wear mouth, nose, and eye protection during procedures that are likely to generate splashes or sprays of blood or other body fluids

9. 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)

1. Needles and syringes are used for only one patient (this includes manufactured prefilled syringes and cartridge devices such as insulin pens)

2. The rubber septum on a medication vial is disinfected with alcohol prior to piercing

3. Medication vials are entered with a new needle and a new syringe, even when obtaining additional doses for the same patient

4. Single dose (single-use) medication vials, ampules, and bags or bottles of intravenous solution are used for only one patient

5. Medication administration tubing and connectors are used for only one patient

6. 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.)

7. Multi-dose vials are dedicated to individual patients whenever possible.

8. 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.)

9. All sharps are disposed of in a puncture-resistant sharps container

10. Filled sharps containers are disposed of in accordance with state regulated medical waste rules

11. All controlled substances (e.g., Schedule II, III, IV, V drugs) are kept locked within a secure area

1. New single-use, auto-disabling lancing device is used for each patient
   (Note: Lancet holder devices are not suitable for multi-patient use.)

2. 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.)

For additional guidance on infection prevention during point-of-care testing consult the following resource(s):

• Infection Prevention during Blood Glucose Monitoring and Insulin Administration
• Frequently Asked Questions (FAQs) regarding Assisted Blood Glucose Monitoring and Insulin Administration

1. 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

2. Cleaners and disinfectants are used in accordance with manufacturer’s instructions (e.g., dilution, storage, shelf-life, contact time)

1. 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.)

2. 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.)

3. 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)

4. Medical devices are stored in a manner to protect from damage and contamination

1. 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.)

2. Enzymatic cleaner or detergent is used for pre-cleaning and discarded according to manufacturer’s instructions (typically after each use)

3. Cleaning brushes are disposable or cleaned and high-level disinfected or sterilized (per manufacturer’s instructions) after each use

4. 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)

5. A chemical indicator (process indicator) is placed correctly in the instrument packs in every load

6. A biological indicator is used at least weekly for each sterilizer and with every load containing implantable items

7. For dynamic air removal-type sterilizers, a Bowie-Dick test is performed each day the sterilizer is used to verify efficacy of air removal

8. Sterile packs are labeled with the sterilizer used, the cycle or load number, and the date of sterilization

9. Logs for each sterilizer cycle are current and include results from each load

10. After sterilization, medical devices and instruments are stored so that sterility is not compromised

11. Sterile packages are inspected for integrity and compromised packages are reprocessed prior to use

12. Immediate-use steam sterilization (flash sterilization), if performed, is only done in circumstances in which routine sterilization procedures cannot be performed

13. Instruments that are flash-sterilized are used immediately and not stored

1. Flexible endoscopes are inspected for damage and leak tested as part of each reprocessing cycle

2. 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.)

3. Enzymatic cleaner or detergent is used and discarded according to manufacturer instructions (typically after each use)

4. Cleaning brushes are disposable or cleaned and high-level disinfected or sterilized (per manufacturer instructions) after each use.

5. For chemicals used in high-level disinfection, manufacturer instructions are followed for:

1. preparation

2. testing for appropriate concentration

3. replacement (i.e., prior to expiration or loss of efficacy)

6. If automated reprocessing equipment is used, proper connectors are used to assure that channels and lumens are appropriately disinfected

7. Devices are disinfected for the appropriate length of time as specified by manufacturer instructions

8. Devices are disinfected at the appropriate temperature as specified by manufacturer instructions

9. 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

10. Devices are dried thoroughly prior to reuse
    (Note: Lumened instruments (e.g., endoscopes) require flushing channels with alcohol and forcing air through channels.)

11. 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)