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    Hemodialysis Clinic Assessment Tool

    Uploaded by

    An-Nisa Khoirun Ummi
    This document contains an assessment tool for a hemodialysis clinic. It includes sections on policies and procedures, education, cleaning and disinfectant products, the clinic environment, clean supplies, equipment, and linen, waste and sharps. For each element, compliance can be marked as yes, no, or not applicable. A total compliance score is calculated based on the number of yes and no answers.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Hemodialysis Clinic Assessment Tool

    Uploaded by

    An-Nisa Khoirun Ummi
    169 views5 pages
    This document contains an assessment tool for a hemodialysis clinic. It includes sections on policies and procedures, education, cleaning and disinfectant products, the clinic environment, clean supplies, equipment, and linen, waste and sharps. For each element, compliance can be marked as yes, no, or not applicable. A total compliance score is calculated based on the number of yes and no answers.

    Original Description:

    dialysis

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    This document contains an assessment tool for a hemodialysis clinic. It includes sections on policies and procedures, education, cleaning and disinfectant products, the clinic environment, clean supplies, equipment, and linen, waste and sharps. For each element, compliance can be marked as yes, no, or not applicable. A total compliance score is calculated based on the number of yes and no answers.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    169 views5 pages

    Hemodialysis Clinic Assessment Tool

    Uploaded by

    An-Nisa Khoirun Ummi
    This document contains an assessment tool for a hemodialysis clinic. It includes sections on policies and procedures, education, cleaning and disinfectant products, the clinic environment, clean supplies, equipment, and linen, waste and sharps. For each element, compliance can be marked as yes, no, or not applicable. A total compliance score is calculated based on the number of yes and no answers.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 5

    AssessmentTool HemodialysisClinic

    ELEMENT

    COMPLIANCE
    YES NO N/A

    COMMENTS

    POLICIESANDPROCEDURES

    Thefollowingpolicieshavebeendeveloped,
    implementedandstaffareawareoftheirlocation:
    1. InfectionPreventionandControl(IP&C)
    policyormanual
    2. HaemodialysisClinicpolicyormanual
    3. OccupationalHealthandSafetyPolicyor
    Manual
    4. EmployeeTrainingandDevelopmentPolicy
    orManual
    TheHaemodialysisUnitPolicy/Manualincludes
    detailedprocessesforcleaninganddisinfectionof
    haemodialysismachines
    TheHaemodialysisUnitPolicy/Manualincludes
    detailedprocessesforcleaninganddisinfectionof
    reusablemedicaldevices
    TheHaemodialysisUnitPolicy/Manualincludes
    detailedprocessesforcleaninganddisinfectionof
    portablepatientcareequipment
    TheHaemodialysisUnitPolicy/Manualincludes
    detailedprocessesforEnvironmentalcleaningand
    disinfectioninthedialysisunit
    TheHaemodialysisUnitPolicy/Manualincludes
    detailedprocessesfortheuseofpersonalprotective
    equipment(PPE)basedonriskassessmentofthe
    tasktobeperformed
    TheHaemodialysisUnitPolicy/Manualincludes
    detailedprocessesfortesting,cleaningand
    disinfectionofthewatertreatmentanddistribution
    system
    TheHaemodialysisUnitPolicy/Manualincludes
    detailedprocessesforcleaninganddisinfecting
    BloodandBodyFluidSpills
    TheHaemodialysisUnitPolicy/Manualincludes
    detailedprocessesforcollection,handling,storage,
    transportanddisposalofbiomedicalwaste,basedon
    provincialandmunicipalregulationsandlegislation
    TheHaemodialysisUnitPolicy/Manualincludes
    detailedprocessesforHandHygiene
    TheHaemodialysisUnitPolicy/Manualincludes
    detailedprocessesforDonningandDoffingPersonal
    ProtectiveEquipment
    TheHaemodialysisUnitPolicy/Manualincludes
    detailedprocessesforanongoingpreventative
    maintenanceprogramfordialysismachines
    TheHaemodialysisUnitPolicy/Manualincludes
    detailedprocessesforcleaninganddisinfectionof
    icemachinesaccordingtomanufacturersguidelines

    2770CoventryRoad
    Oakville,OntarioL6H6S2
    Tel:18003877578Fax:(905)8130220
    www.infectionpreventionresource.com

    AssessmentTool HemodialysisClinic
    ELEMENT

    EDUCATION

    COMPLIANCE
    YES NO N/A

    HaemodialysisUnitstaffreceiveorientationand
    ongoingeducationin:
    1. Infectionpreventionandcontrolpractices
    includingRoutinePractices(RP)and
    AdditionalPrecautions(AP)and
    transmissionofinfectiousagents
    2. Instructiononthesafeandcorrect
    proceduresforthehaemodialysismachines
    3. Instructiononthesafehandlingand
    disposalofthechemicalsrequiredforthe
    haemodialysismachines
    4. Watertreatmentanddistributionsystems
    5. Thecorrectuseofcleaninganddisinfectant
    chemicalsincludingdilutionrequirements,
    contacttimesandshelflife
    6. Instructionontoappropriateuseofthe
    cleaninganddisinfectingagentstobeused
    includingnodoubledippingofclothsand
    notoppingupofcleaning/disinfecting
    chemicals
    7. WHMIStrainingrelatingtotheuseof
    cleaningagentsanddisinfectants
    8. InstructiononHandHygiene
    9. InstructionregardingInfectionControl
    signageusedtodesignateAdditional
    Precautions(AP)
    10. Instructionontheappropriateuseof
    personalprotectiveequipment(PPE)
    Allstafftrainingandeducationisdocumentedand
    evaluated
    CLEANINGANDDISINFECTANTPRODUCTS
    TheHaemodialysisUnitPolicy/Manualincludes
    proceduresdefininghowcleaninganddisinfecting
    productsareapprovedforuse
    TheHaemodialysisUnitPolicy/Manualincludes
    proceduresdefininghowapprovedcleaningand
    disinfectantproductsaremonitoredforcompliancy
    TheHaemodialysisUnitPolicy/Manualincludes
    proceduresregardingmonitoringtheshelflifeof
    concentratedproductsoncediluted
    TheHaemodialysisUnitPolicy/Manualincludes
    procedurestoroutinelymonitorautomateddilution
    systemstoensureproductsaredilutedcorrectly
    TheHaemodialysisUnitPolicy/Manualincludes
    procedurestoensureapreventativemaintenance
    programforautomateddilutionsystems

    COMMENTS

    2770CoventryRoad
    Oakville,OntarioL6H6S2
    Tel:18003877578Fax:(905)8130220
    www.infectionpreventionresource.com

    AssessmentTool HemodialysisClinic
    ELEMENT

    COMPLIANCE
    YES NO N/A

    COMMENTS

    HAEMODIALYSISCLINICENVIRONMENT

    Alcoholbasedhandrub(ABHR)isavailableforstaff
    atpointofcareandforpatients/visitorsinpublic
    areasofthehaemodialysisunit
    Generalappearanceiscleanandtidy
    Suppliesinprocedureroomarelimitedtowhatis
    needed
    Thereisaclearseparationbetweencleananddirty
    equipment/itemstreams
    Thereisnoevidenceofdustordampnessinthe
    cleanarea
    Thereisadedicatedhandwashingsink
    Alinenbag/containerisreadilyavailableandisnot
    overfilled
    Biomedicalwastecontainersarepresentandarenot
    overfilled
    Apunctureresistantbiohazardcontainerforsharps
    isaccessibleatpointofuse
    Personalprotectiveequipment(PPE)isreadily
    availableinavarietyofsizes
    StaffdonotleaveprocedureroomwearingusedPPE

    CLEANSUPPLIES

    Cleansuppliesandmedicationsarestoredaway
    fromwasteorsoiledequipmentandsupplies
    Cleansuppliesarestoredabovethefloor
    Soileditemsarenotbroughtintothecleanarea
    Cleansuppliesandmedicationsareonlydeliveredto
    aterminallycleanedbedspaceafterthepatienthas
    vacatedthespace
    Unusedsuppliesandmedicationstakentoone
    patientsstationarediscardedorreprocessedbefore
    useonanotherpatient
    Cartsandtrays/binsusedtotransferstartup
    equipmenttodialysisstationsarecleanedand
    disinfectedonaroutinebasis(e.g.,weekly)
    Cartsandtrays/binsarestoredinacleanarea
    Apunctureresistantbiohazardcontainerforsharps
    isaccessibleatpointofuse
    Sterilesuppliesoropenedtraysarekeptawayfrom
    possiblesourcesofcontamination
    Thereisarefrigeratorreservedformedicationonly
    Thereisarefrigeratorreservedforstafffood
    Refrigeratorsarecleanandclearoffrost
    Chemicalsarestoredseparatelyandapartfrom
    food/drugitems

    2770CoventryRoad
    Oakville,OntarioL6H6S2
    Tel:18003877578Fax:(905)8130220
    www.infectionpreventionresource.com

    AssessmentTool HemodialysisClinic
    ELEMENT

    COMPLIANCE
    YES NO N/A

    COMMENTS

    EQUIPMENT

    Equipmentlabelledsingleuseisnotreusedunless
    reprocessedbyanapprovedFDAcleared3rdparty
    reprocessor
    StaffemployPPEduringcleaning/disinfecting
    procedures
    Patientbedspaceandallmachinesurfacesare
    cleanedanddisinfectedbetweenpatients
    Noncriticalpatientequipmentisdisinfected
    betweenpatientswithahospitalgradedisinfectant
    (e.g.,glucometers,pulseoximeters,stethoscopes,
    sphygmamometers,commodes,earphones)
    Criticalreusableequipmentissterilizedbetween
    patients
    Equipmentthatrequiresrepairsorservicing,either
    inhouseorshippingout,iscleanedanddisinfected
    orsterilizedpriortobeingservicedorbeforeleaving
    thefacility
    Serviceandmaintenanceisperformedusinggloves,
    masksandeye/faceprotectionwhencontamination
    islikely
    Alldialysismachinesarenumberedandthemachine
    numberisrecordedforeverydialysistreatment
    Chemicalproductsareclearlylabelledandare
    compliantwithWHMISrequirements
    Inthecaseofabloodleak,thedialysismachineis
    subjecttocleaninganddisinfectionforinternaland
    externalpathwaysbeforeuseonanotherpatient
    LINEN,WASTEANDSHARPS
    Soiledlineniscontainedinleakproofbagsthatare
    notoverfilled
    Wasteisremovedaccordingtofacilitypolicy:
    1. linensaretreatedasregularwaste
    2. linenswithlargeamountsofblood/body
    fluidsaretreatedasbiomedicalwaste
    Wastecontainersarenotoverfilled
    Largewastecontainersarecovered(thisdoesnot
    includebedsidewastereceptacles)
    Thereisnoleakageofbodyfluidsfromwaste
    containers
    Apunctureresistantbiohazardcontainerforsharps
    isaccessibleatpointofuse
    Sharpscontainersarenotoverfilled

    2770CoventryRoad
    Oakville,OntarioL6H6S2
    Tel:18003877578Fax:(905)8130220
    www.infectionpreventionresource.com

    AssessmentTool HemodialysisClinic

    COMPLIANCESCORE
    TotalNumberofYes

    TotalNumberofNo

    TotalNumberofYesandNo,excludeN/A

    COMMENTS:

    COMPLIANCESCORE

    2770CoventryRoad
    Oakville,OntarioL6H6S2
    Tel:18003877578Fax:(905)8130220
    www.infectionpreventionresource.com

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