1
|
Does your facility have an IPC programme?
Choose one answer
Please ask for all the documents that support the answer.
Review the document(s) together with the respondents and answer questions 1A-C.
|
1. No
2. Yes
| |
1A
|
Does the existing IPC programme have clearly defined responsibilities and annual work plan?
SELECT ALL THAT APPLY
|
1. No
2. The existing program has clearly defined responsibilities
3. The existing program has annual work plan
| |
1B
|
Does the existing IPC programme have clearly defined IPC objectives for the facility?
Choose one answer
|
1. No
2. Yes, IPC objectives, but there is no evidence that they are based on local epidemiology and priorities according to risk assessments
3. Yes, IPC objectives based on local epidemiology and priorities according to risk assessments
| |
1C
|
Does the existing IPC programme have clearly defined IPC measurable outcome indicators for the facility?
Choose one answer
|
1. No
2. Yes, IPC measurable outcome indicators (or adequate measures for improvement)
3. Yes, IPC, measurable outcome indicators and future targets
| |
2
|
Does your facility have a budget specifically allocated to the IPC programme (e.g. to address IPC materials, administrative support, staff)?
Choose one answer
|
1. No
2. Yes
3. Don’t know
| |
3
|
Do you consider the budget allocated for IPC as sufficient to cover your needs?
Choose one answer
|
1. No
2. Yes
| |
4
|
Is there an IPC team with one or more IPC staff with dedicated time for IPC activities?
Choose one answer
|
1. No
2. Yes
|
SKIP to 8
|
5
|
How many staff (nurses and/or doctors and/or epidemiologists and/or others) working on the IPC team?
Please ask for a copy of the Terms of Reference for the Team or the IPC Focal point and the document that certifies their appointment.
|
______epidemiologist
______nurses
______physicians
______others
| |
6
|
Does the IPC team have at least one full-time IPC specialist (a nurse and/or a doctor and/or an epidemiologist/other) working 100% on IPC?
Choose one answer
Please verify the answer based on the available documents.
|
1. All IPC staff work part-time on IPC
2. 1 or more full-time IPC specialist for 250 beds and less
3. Less than 1 full-time IPC specialist for 250 beds and less
| |
7
|
Have members of your IPC team received formal IPC course training?
Choose one answer
Please ask for any documents that would verify the answer
|
1. None were trained
2. Some were trained
3. All were trained
| |
8
|
What IPC professional development options for the IPC team are available at your facility?
SELECT ALL THAT APPLY
|
1. No professional development offered
2. IPC members attend IPC-related conferences or workshops
3. IPC members attend IPC-related training courses
| |
9
|
Do you have an IPC Committee or an equivalent actively supporting the IPC team?
Choose one answer
Please ask for a copy of the document appointing members of an Infection Control Committee.
|
1. No
2. Yes
|
SKIP to 12
|
10
|
Which, if any, of the following professional groups are represented or included in the IPC Committee or an equivalent?
SELECT ALL THAT APPLY
Please verify the answer based on the available documents.
|
1. Facility management (e.g. administrative director, chief executive officer (CEO), medical director)
2. Senior clinical staff (e.g. chief physician, chief of nursing)
3. Other facility management [e.g. biosafety, waste, those tasked with addressing water, sanitation and health (WASH)]
| |
11
|
Did the committee meet in the past 12 months?
Choose one answer
|
1. No
2. Yes
|
SKIP to 13
|
12
|
Did you keep notes for the IPC committee meetings conducted in the past 12 months?
Choose one answer
If yes, please ask for a copy of meeting notes from all the meetings conducted during the past 12 months and verify the answer.
|
1. No
2. Yes, for some
3. Yes, for all
| |
13
|
When was the last time someone from the facility management, led or participated in a meeting to discuss IPC-related objectives, targets and challenges?
Choose one answer
Please verify the answer based on the available documents.
|
1. Never
2. More than 3 months ago
3. Within the past 3 months
| |
14
|
Does your facility have microbiological laboratory support for routine day-to-day use?
Choose one answer
|
1. No
2. No, but the facility has access to a clinical laboratory at another site
3. Yes, an on-site laboratory is available
| |
IPC Trainings
Next, I would like to discuss the IPC trainings available to your staff. We will cover trainings that are part of new employee orientation and continuous educational opportunities for existing staff, regardless of level and position, for example trainings for senior administration and housekeeping staff. Trainings can include classroom, e-learning, bedside, and simulation training. We will also discuss periodic evaluations conducted to determine the effectiveness of your facility’s training programmes and assess staff knowledge
|
15
|
Did this facility conduct any IPC trainings for clinical staff and others having contact with patients or wards during the past 12 months?
SELECT ALL THAT APPLY
Please ask for copies of all training materials (agenda and list of participants) from all IPC-related trainings conducted during the past 12 months
|
1. No IPC trainings conducted at this facility
2. Yes, for health care workers (clinical staff)
3. Yes, for non-clinical staff with access to patients or wards at your facility (e.g. cleaners, auxiliary service staff, administrative and managerial staff)
4. Yes, for family members, other care-givers or visitors
|
SKIP to 23
SKIP to 23 if only 4 is marked
|
16
|
Does this facility keep track of which clinical and non-clinical staff have been trained in IPC?
Choose one answer
Please verify the answer based on the available documents. If there is no documented proof that they track training participation, please mark No
|
1. No
2. Yes
| |
17
|
Did IPC trainings for clinical and non-clinical staff conducted during the past 12 months include interactive training sessions (simulations and/or bedside trainings)?
Choose one answer
Please verify the answer based on the available documents. If not verified, then mark a different answer
|
1. No, interactive trainings only included written information and/or oral instructions and/or e-learning
2. Some trainings also included interactive sessions
3. All trainings included interactive sessions
| |
18
|
Who led IPC trainings for clinical and non-clinical staff conducted during the past 12 months?
SELECT ALL THAT APPLY
Please verify the answer based on the available documents.
|
1. External trainers from outside the facility
2. IPC team members
3. Non-IPC personnel
| |
19
|
How did you assess the effectiveness of IPC trainings conducted during the past 12 months?
SELECT ALL THAT APPLY
Please verify the answer based on the available documents.
|
1. No assessment
2. Pre/post test
3. Post-training survey for participants
4. Compliance monitoring of IPC practices
| |
20
|
In general, which statement best describes when IPC training for clinical staff at your facility is delivered?
SELECT ALL THAT APPLY
Please verify the answer based on the available documents (training registers, tracking sheets, prikazes, etc).
|
1. All new HCWs are trained as part of new employee orientation
2. Ongoing regular training at least annually, but not mandatory
3. Ongoing mandatory training at least annually (not confirmed by any documentation)
4. Ongoing mandatory training at least annually (verified by documentation)
5. None of the above
| |
21
|
In general, which statement best describes when IPC training for non-clinical staff in your facility is delivered?
SELECT ALL THAT APPLY
Please verify this answer based on the available documents (training registers, tracking sheets, prikazes, etc).
|
1. All new HCWs are trained as part of new employee orientation
2. Ongoing regular training at least annually, but not mandatory
3. Ongoing mandatory training at least annually (not confirmed by any documents)
4. Ongoing mandatory training at least annually (verified by documentation)
5. None of the above
| |
22
|
Do clinical trainings conducted at your facility for physicians working in specialty areas (for example, surgery or anesthesiology) include IPC?
For example, if there is a line insertion training, would HH and skin prep standards be embedded in it, not just taught separately as IPC training?
Choose one answer
Please verify the answer based on the available documents.
|
1. No clinical trainings for specialists conducted at the facility
2. Clinical trainings for specialists are conducted, but IPC is not included
3. Yes, in some trainings
4. Yes, in all trainings
| |
IPC Monitoring and Audit
One role of the IPC team is to monitor or audit IPC practices, and provide feedback to staff in order to improve the quality of care and practice. An example of this is conducting hand hygiene observations to monitor staff compliance with appropriate hand hygiene practices.
|
23
|
Does this facility have an internal IPC monitoring/audit plan with any of the following?
SELECT ALL THAT APPLY
Please verify the answer based on the available documents. Only select options that were verified by the document review.
|
1. No facility monitoring/audit plan available
2. Yes with clear goals and objectives
3. Yes with tools to collect data in a systematic way (for example checklists)
4. Yes with clearly defined roles and responsibilities
5. Yes with work plan or schedule
| |
24
|
When was the last time there was an internal IPC monitoring/audit to assess compliance of any IPC practices at your facility?
Choose one answer
|
1. Within the past 3 months
2. Within the past 6 months
3. Within the past 12 months
4. More than 12 months ago or never
|
SKIP to 27
|
24A
|
Did IPC staff document in any form implementation of monitoring/audits conducted within the past 12 months documented?
Please ask for a copy of all the available IPC monitoring/audit reports conducted during the past 12 months
|
1. No
2. Yes
|
SKIP to 27
|
25
|
During the past 12 months, how often did you conduct monitoring/auditing of different IPC practices listed below in questions 25A-J?
Choose one answer for each of the following questions 25A-J
Please verify the answers based on the available documents.
| |
25A
|
Hand Hygiene Compliance
(using any observation tools)
If monitoring tools are not available (checklist and schedule), but facility staff claim to conduct monitoring frequently, mark
“
Periodically but no regular schedule”
|
1. Not conducted
2. Periodically but no regular schedule
3. Weekly
4. Monthly
5. Every 6 months
6. Once a year
| |
25B
|
Consumption/usage of alcohol-based hand rub or soap
If monitoring tools are not available (checklist and schedule), but facility staff claim to conduct monitoring frequently, mark
“
Periodically but no regular schedule”
|
1. Not conducted
2. Periodically but no regular schedule
3. Weekly
4. Monthly
5. Every 6 months
6. Once a year
| |
25C
|
Injection safety
If monitoring tools are not available (checklist and schedule), but facility staff claim to conduct monitoring frequently, mark
“
Periodically but no regular schedule”
|
1. Not conducted
2. Periodically but no regular schedule
3. Weekly
4. Monthly
5. Every 6 months
6. Once a year
| |
25D
|
Waste management
If monitoring tools are not available (checklist and schedule), but facility staff claim to conduct monitoring frequently, mark
“
Periodically but no regular schedule”
|
1. Not conducted
2. Periodically but no regular schedule
3. Weekly
4. Monthly
5. Every 6 months
6. Once a year
| |
25E
|
Cleaning of the ward environment
If monitoring tools are not available (checklist and schedule), but facility staff claim to conduct monitoring frequently, mark
“
Periodically but no regular schedule”
|
1. Not conducted
2. Periodically but no regular schedule
3. Weekly
4. Monthly
5. Every 6 months
6. Once a year
| |
25F
|
Disinfection and sterilization of medical equipment/instruments
If monitoring tools are not available (checklist and schedule), but facility staff claim to conduct monitoring frequently, mark
“
Periodically but no regular schedule”
|
1. Not conducted
2. Periodically but no regular schedule
3. Weekly
4. Monthly
5. Every 6 months
6. Once a year
| |
25G
|
Transmission-based precautions, isolation and cohorting (grouping) of patients to prevent the spread of multidrug resistant organisms (MDRO)
If monitoring tools are not available (checklist and schedule), but facility staff claim to conduct monitoring frequently, mark
“
Periodically but no regular schedule”
|
1. Not conducted
2. Periodically but no regular schedule
3. Weekly
4. Monthly
5. Every 6 months
6. Once a year
| |
25H
|
Consumption/usage of antimicrobial agents
If monitoring tools are not available (checklist and schedule), but facility staff claim to conduct monitoring frequently, mark
“
Periodically but no regular schedule”
|
1. Not conducted
2. Periodically but no regular schedule
3. Weekly
4. Monthly
5. Every 6 months
6. Once a year
| |
25I
|
Intravascular catheter insertion and/or care
If monitoring tools are not available (checklist and schedule), but facility staff claim to conduct monitoring frequently, mark
“
Periodically but no regular schedule”
|
1. Not conducted
2. Periodically but no regular schedule
3. Weekly
4. Monthly
5. Every 6 months
6. Once a year
| |
25J
|
Wound dressing change
If monitoring tools are not available (checklist and schedule), but facility staff claim to conduct monitoring frequently, mark
“
Periodically but no regular schedule”
|
1. Not conducted
2. Periodically but no regular schedule
3. Weekly
4. Monthly
5. Every 6 months
6. Once a year
| |
26
|
During the past 12 months, how did you share results of these internal monitoring /auditing of IPC practices with the following facility staff listed in questions 26A-E?
SELECT ALL THAT APPLY
| |
26A
|
Clinical staff?
|
1. Did not share
2. Shared orally during staff meetings
3. Shared in a form of a written report
| |
26B
|
Non-clinical staff that have direct contact with patients?
|
1. Did not share
2. Shared orally during staff meetings
3. Shared in a form of a written report
| |
26C
|
Clinical managers/heads of department?
|
1. Did not share
2. Shared orally during staff meetings
3. Shared in a form of a written report
| |
26D
|
IPC committee?
|
Did not share
Shared orally during staff meetings
Shared in a form of a written report
| |
26E
|
Non-clinical management (CEO, administration, board)?
|
1. Did not share
2. Shared orally during staff meetings
3. Shared in a form of a written report
| |
27
|
During the past 12 months, how often were your monitoring results used to make unit/facility- specific plans for the improvement of IPC practices?
Choose one answer
If yes, please ask to provide examples. Please verify the answers based on the examples provided.
|
1. Always
2. Sometimes
3. Never
| |
28
|
Do you assess IPC safety cultural factors in your facility?
Show example of the surveys (Appendix 9)
Choose one answer
|
1. No
2. Yes
| |
HAI Surveillance
HAI surveillance programmes describe the incidence and prevalence of HAIs in your facility, detect outbreaks in particular wards or patient populations, guide IPC strategies and priorities, and assess the impact and effectiveness of interventions.
|
29
|
Does this facility conduct HAI surveillance?
Choose one answer
Please ask for all the available HAI surveillance guidelines or other documents. Review the documents and answer question 29A.
|
1. No
2. Yes
|
SKIP to 38
|
29A
|
Does HAI surveillance include any of the following?
Please verify the answers based on the available documents.
SELECT ALL THAT APPLY
|
1. List of priority healthcare associated infections which are major causes of morbidity and mortality in the facility
If prioritization process is not described in the document, please ask to describe the process used to identify infections which are major causes of morbidity and mortality in the facility
1. Standardized case-definitions (defined numerator and denominator)
2. Standardized data collection methods
3. Processes to review data quality (for example, assessment of case report forms, review of microbiology results, denominator determination, etc.)
4. Clearly defined roles and responsibilities of staff involved in surveillance
5. Annual work plan and schedule
6. None of the above
|
SKIP to 38
|
30
|
Are you conducting HAI surveillance in your facility for the following infection types listed in questions 30A-G?
Choose one answer
Please ask for all the available HAI surveillance reports.
| |
30A
|
Infections or colonization caused by multidrug-resistant pathogens (non-susceptibility to at least one agent in three or more antimicrobial categories)?
|
1. No
2. Yes
| |
30B
|
Device-associated infections (for example, catheter-associated urinary tract infections, central line-associated bloodstream infections, peripheral-line associated bloodstream infections, ventilator-associated pneumonia)?
|
1. No
2. Yes
| |
30C
|
Surgical site infections?
|
1. No
2. Yes
| |
30D
|
Infections that may affect health care workers (for example, hepatitis B or C, HIV, influenza)?
|
1. No
2. Yes
| |
30E
|
Infections in targeted vulnerable patient populations (for example, neonates, intensive care unit, immunocompromised, burn patients)?
|
1. No
3. Yes
| |
30F
|
Local priority epidemic-prone infections (for example, norovirus, influenza, tuberculosis)?
|
1. No
2. Yes
| |
30G
|
Clinically-defined (based on symptoms) infections?
|
1. No
2. Yes
| |
31
|
What data sources do you use for your HAI surveillance?
SELECT ALL THAT APPLY
Please verify the answers based on the available documents.
|
1. Discharge diagnosis data
2. Voluntary notification from physicians or nurses
3. Ward-based assessments (e.g., chart review, discussion with nurses or physicians, patient exam)
4. Laboratory-based assessment (e.g., review of blood cultures)
5. None of these types of surveillance
| |
32
|
Have staff conducting HAI surveillance been trained in basic epidemiology, surveillance and IPC (i.e. capacity to oversee surveillance methods and manage/analyze/interpret data)?
|
1. No
2. Yes
| |
33
|
During the past 12 months, how were your HAIs surveillance data shared with facility staff?
SELECT ALL THAT APPLY
Please ask for any available reports or staff meetings to verify the answers
|
1. Not shared with facility staff
2. Written reports
3. Oral updates
4. Presentation
| |
34
|
How often, do you provide up-to-date HAIs surveillance information to the following groups listed in questions 34A-E?
Choose one answer for questions 34A-E
Please verify the answers based on the available documents
| |
34A
|
Clinical staff?
|
1. Never
2. Quarterly
3. Half-yearly
4. Annually
5. Periodically but no regular schedule
| |
34B
|
Non-clinical staff that have direct contact with patients
|
1. Never
2. Quarterly
3. Half-yearly
4. Annually
5. Periodically but no regular schedule
| |
34C
|
Clinical managers/heads of department?
|
1. Never
2. Quarterly
3. Half-yearly
4. Annually
5. Periodically but no regular schedule
| |
34D
|
IPC committee?
|
1. Never
2. Quarterly
3. Half-yearly
4. Annually
5. Periodically but no regular schedule
| |
34E
|
Non-clinical management?
|
1. Never
2. Quarterly
3. Half-yearly
4. Annually
5. Periodically but no regular schedule
| |
35
|
Are HAIs surveillance data used to make unit/facility- specific plans for the improvement of IPC practices?
Choose one answer
Please ask to provide examples and verify the answer
|
1. No
2. Yes
| |
36
|
What best describes the microbiology laboratory capacity available to support HAI surveillance in this facility?
Choose one answer
|
1. Laboratory is able to differentiate between gram positive and gram negative strains but cannot identify the pathogen
2. The laboratory can identify pathogens (e.g. isolate identification)
3. The laboratory can identify pathogens and antimicrobial susceptibility patterns
| |
37
|
Do you use any informatics/IT tools to support your HAI surveillance (for example, electronic health records)?
|
1. No
2. Yes
| |
38
|
How often do you analyze and report antimicrobial drug resistance data?
Choose one answer
|
1. Never or rarely
2. Regularly (e.g. quarterly/ half a year /annually)
| |
IPC Guidelines
Facility IPC guidelines provide recommendations for IPC practices in a facility and may be adapted from existing international and national standards. Guidelines are often broad and high-level while standard-operating-procedures are more detailed step-by-step instructions more specific to a certain setting
|
39
|
Does your facility have any IPC Guidelines?
Please ask for all the IPC Guidelines available at the facility. Review the documents to verify the answer.
|
1. No
2. Yes
|
SKIP to 44
|
40
|
Which statement best describes the process you use in this facility to develop or adapt IPC Guidelines?
Choose one answer
|
1. Facility uses international guidelines that have not been adapted to facility context
2. Facility uses national guidelines
3. Facility develops its own guidelines
|
SKIP to 42
SKIP to 42
|
41
|
Who participates in the development and/or adaptation of the facility-level Guidelines?
SELECT ALL THAT APPLY
|
1. IPC personnel
2. Senior facility leadership
Clinical staff
3. Facility management (e.g. Biosafety, Waste, WASH (i.e those tasked with addressing water, sanitation and health)
4. Quality managers
| |
42
|
Do the facility training materials reflect the most updated IPC Guidelines?
Choose one answer
|
1. No training materials available
2. No
3. Yes
4. Don’t know
| |
43
|
Please describe the process you use to train HCW on IPC guidelines when they are issued/updated?
Choose one answer
Please ask to see any training notes and/or list of participants and agenda from the last training.
|
1. Trainings only included written information and/or oral instructions
2. Some trainings included interactive sessions
3. All trainings included interactive sessions
| |
44
|
Does your facility have any IPC SOPs?
Choose one answer
Please ask for a copy of all the SOPs available at the facility. Review the documents to verify the answer.
|
1. No
2. Yes, SOPs not adapted to this facility
3. Yes, adapted to this facility
|
SKIP to 46
SKIP to 46
|
45
|
Who participates in the development and/or adaptation of the facility-level SOPs?
Choose one answer
SELECT ALL THAT APPLY
|
1. IPC personnel
2. Senior facility leadership
3. Clinical staff
4. Facility management (e.g. Biosafety, Waste, WASH (i.e those tasked with addressing water, sanitation and health)
5. Quality managers
| |
Multimodal strategies
The term multimodal strategy refers to the implementation of several elements or components in an integrated way with the aim of improving an outcome and changing behavior. This multimodal strategy includes components such as system change which is the availability of infrastructure and supplies to enable IPC practices; education and training of healthcare workers and other hospital staff; monitoring of infrastructure, practices, processes, outcomes, and providing data feedback; reminders in the workplace; and culture change within the facility. In other words, the strategy involves “building” the right system, “teaching” the right things, “checking” the right things, “selling” the right messages, and ultimately ”living” IPC throughout the entire health system.
|
46
|
For hand hygiene (HH) improvement activities, does your facility have any or all of the following elements listed in questions 46A-E?
SELECT ALL THAT APPLY for questions 46A-E
| |
46A
|
System change
|
1. Element not included in work activities
2. Interventions to ensure the necessary infrastructure and continuous
3. Availability of supplies
4. Interventions to ensure optimal use and accessibility and prevent human error
Please ask to provide examples to verify the answer
| |
46B
|
Education and training on hand hygiene practices
|
1. Element not included in work activities
2. Written information and/or oral instruction and/or e-learning
3. Interactive training sessions (includes simulation and/or bedside training)
| |
46C
|
Monitoring of HH compliance and feedback
|
1. Element not included in work activities
2. Audits of hand hygiene conducted
3. Audit results shared and discussed with health care workers and key players
| |
46D
|
Communications and reminders
|
1. Element not included in work activities
2. Reminders, posters, or other tools used to promote or raise awareness of hand hygiene
3. Additional methods/initiatives to improve team communication across units and specialties (for example, multidisciplinary rounds?)
| |
46E
|
Safety climate and culture change
|
1. Element not included in work activities
2. Managers/leaders (i.e. head of the hospital, chief clinicians, head of nursing) show visible support and act as champions and role models, promoting an adaptive approach and strengthening a culture that supports hand hygiene
3. Facility staff (clinical and non-clinical) are empowered to participate in hand hygiene improvement activities
| |
47
|
How frequently is the WHO Hand Hygiene Self-Assessment Framework Survey conducted?
Choose one answer
Show the Survey to remind people what it is.
Please verify the answers based on the available documents.
|
1. Never
2. Periodically but not annually or on a regular schedule
3. At least annually
| |
48
|
As far as your injection safety improvement activities, does your facility have any or all of the following elements listed in questions 48A-E?
SELECT ALL THAT APPLY for questions 48A-E
| |
48A
|
System change
|
1. Element not included in work activities
2. Interventions to ensure the necessary infrastructure and continuous availability of supplies
3. Interventions to ensure optimize use and accessibility and prevent human error
Please ask to provide examples to verify the answer
| |
48B
|
Education and training on injection safety
|
1. Element not included in work activities
2. Written information and/or oral instruction and/or e-learning only
3. Interactive training sessions (includes simulation and/or bedside training)
| |
48C
|
Monitoring of injection safety compliance and feedback
GIVE THE Injection Safety CHECKLIST as an example (Appendix 8)
|
1. Element not included in work activities
2. Audits of injection safety conducted
3. Results shared and discussed with health care workers and key players
| |
48D
|
Communications and reminders
|
1. Element not included in work activities
2. Reminders, posters, or other tools to promote or raise awareness of injection safety
3. Additional methods/initiatives to improve team communication across units and disciplines (for example, by facilitating multidisciplinary rounds)
| |
48E
|
Safety climate and culture change
|
1. Element not included in work activities
2. Managers/leaders (head of the hospital, chief clinician and head of nursing) show visible support and act as champions and role models, promoting an adaptive approach and strengthening a culture that supports injection safety
3. Facility staff (clinical and non-clinical) are empowered to participate in injection safety improvement activities
| |
49
|
Are your quality improvement staff involved in IPC activities?
Choose one answer
|
1. No quality improvement unit/staff at the facility
2. Quality improvement unit/staff available, but not involved in IPC
3. Quality improvement unit/staff available and involved in IPC
| |
IPC Infrastructure, Staffing, Workload and Supplies
Finally, I would like to ask a few questions about the facility’s infrastructure, and availability of staff and IPC supplies.
|
50
|
Are water services available at all times and of sufficient quantity for all uses (e.g., hand washing, drinking, personal hygiene, medical activities, sterilization, decontamination, cleaning and laundry)?
Choose one answer
|
1. No, available on average < 5 days per week
2. Yes, available on average ≥ 5 days per week or every day but not of sufficient quantity
3. Yes, every day and of sufficient quantity
| |
51
|
Is a reliable safe drinking water station present and accessible for staff, patients and families at all times and in all locations/wards?
Choose one answer
|
1. No, not available
2. Sometimes, or only available in some places or not available for all users
3. Yes, accessible at all times and for all wards/groups
| |
52
|
Is bed occupancy in your facility kept to one patient per bed?
Choose one answer
|
1. No
2. Yes, but not in all departments
3. Yes, for all units including pediatrics/neonatal and emergency
| |
53
|
Do you place patients in beds outside of the room (in the corridor)
Choose one answer
|
1. Never
2. Sometimes, or only in some departments
| |
54
|
Do you ensure adequate spacing of >1 meter between patient beds?
Choose one answer
|
1. No
2. Yes, but not in all departments
3. Yes, for all units including pediatrics and emergency
| |
55
|
Do you have a responsible person/party to assess and respond when adequate bed capacity is exceeded?
Choose one answer
|
1. No
2. Yes the clinical head of department is responsible
3. Yes, the hospital administration/management is responsible
| |
56
|
Are functioning hand hygiene stations (e.g., alcohol-based hand rub solution or soap and water with a basin/pan and clean single-use towels) available at all points of care?
Choose one answer
|
1. No
2. Yes, stations present, but supplies are not always available
3. Yes, always available
| |
57
|
In your facility, are ≥ 4 toilets or improved latrines (clean and functional) available for outpatient settings or ≥ 1 per 20 users for inpatient settings?
Choose one answer
|
1. Less than the required number of latrines available and functioning
2. Sufficient number present but not all functioning or insufficient
3. Sufficient number present and functioning (4 or more (outpatients) and one per 20 users (inpatients))
| |
58
|
In your health care facility, is sufficient energy/power supply available at day and night for all uses
(for example, pumping and boiling water, sterilization and decontamination, incineration or alternative treatment technologies, electronic medical devices, general lighting of areas where health care procedures are performed to ensure safe provision of health care and lighting of toilet hospitals and showers)?
Choose one answer
|
1. No, never available
2. Yes, sometimes or only in some of the mentioned areas
3. Yes, always and in all mentioned areas
| |
59
|
Is functioning environmental ventilation available in-patient care areas, including natural (using natural forces to vent air through windows/doors) or mechanical ventilation?
Choose one answer
|
1. No
2. Yes, in some patient care services
3. Yes, in all patient care areas
| |
60
|
For floors and horizontal work surfaces, is there a visible record of cleaning, signed by the cleaners each day?
Choose one answer
|
1. No record of floors and surfaces being cleaned
2. Record exists, but is not completed daily or is outdated
3. Yes, record completed daily
| |
61
|
Are appropriate and well-maintained materials for cleaning (for example, detergent, mops, buckets, etc.) available?
Choose one answer
|
1. No materials available
2. Yes, available but not well maintained (not labeled, broken, or dirty, etc.)
3. Yes, available and well-maintained
| |
62
|
Do you have single patient rooms or rooms for cohorting (grouping based on common illness) patients with similar pathogens if the number of isolation rooms is insufficient or unavailable (for example, TB, measles, cholera)?
SELECT ALL THAT APPLY
|
1. No single rooms and no rooms for cohorting (grouping) patients
2. Rooms suitable for patient cohorting available
3. Single rooms are available
| |
63
|
Do you have functional waste collection containers for non-infectious (general) waste, infectious waste and, sharps waste at all waste generation points?
Choose one answer
|
1. No bins or separate sharps disposal
2. Separate bins present but lids missing or more than 3/4 full; or two bins (instead of three); or bins at some but not all waste generation points.
3. Yes, all three containers
| |
64
|
Is a functional burial pit/fenced waste dump or municipal pick-up available for disposal of non-infectious (non-hazardous/general waste)?
Choose one answer
|
1. No pit or other disposal method used
2. Pit in facility but insufficient dimensions; pits/dumps overfilled or not fenced/locked; or irregular municipal waste pick up
3. Yes
| |
65
|
Is outsourced waste disposal or an incinerator or alternative treatment for infectious and sharp waste (for example, an autoclave) functional and of a sufficient capacity?
Choose one answer
|
1. No, none present
2. Yes
| |
66
|
Are at least two pairs of household cleaning gloves and one pair of overalls or apron and boots in a good state and available for each cleaning and waste disposal staff member?
Choose one answer
|
1. No, not available
2. Yes, available but in poor condition
3. Yes, in good condition
| |
67
|
Is wastewater safely managed using on-site treatment (for example, septic tank followed by drainage pit) or sent to a functioning sewer system?
Choose one answer
|
1. No, not present
2. Yes, available but in poor condition
3. Yes, in good condition
| |
68
|
Does your health care facility provide a dedicated decontamination area and/or sterile supply department for the decontamination and sterilization of medical devices and other items/equipment?
Choose one answer
|
1. No, not present
2. Yes, present, but not functioning
3. Yes
| |
69
|
Do you reliably have sterile and disinfected equipment ready for use?
Choose one answer
|
1. Available on average < 5 days per week
2. Available on average ≥ 5 days per week or every day, but not of sufficient quantity
3. Available every day and of sufficient quantity
| |
70
|
Are disposable items available when necessary? (for example, injection safety devices (such as sharps injury protection syringes and reuse prevention syringes), examination gloves)
Choose one answer
|
1. Not available
2. Only sometimes available
3. Continuously available
| |