Internal Infection Control: Checklist

79

Abstract
Internal control is an important and time-saving way of reviewing the depart-
ment’s standard with regard to hygiene and infection control. Internal control is
carried out by the department’s own employees and is an internal matter. Results
of the check often result in a note/report that is then used as a document for
improvement measures. The following chapter is focused on hygienic control
and check routines that may protect against the spread of infections between
patients, personal and environment.

Keywords
Internal control · Hygienic checklist · Patient ward · Infection control

79.1 Purpose

• To ensure good hygienic routines for the department.

• To detect defects, unfortunate routines, procedures and measures that may be of
major importance for infection control and hygiene at the department.

79.2 Comprise

• Patients, visitors and healthcare personnel at the department.

79.3 Responsibility

The hospital’s management should provide a written infection control programme

including a procedure for internal control.

© Springer Nature Switzerland AG 2019 1007

B. M. Andersen, Prevention and Control of Infections in Hospitals,
https://doi.org/10.1007/978-3-319-99921-0_79
1008 79 Internal Infection Control: Checklist

Department management should implement internal controls with regard to

hygiene and infection control, twice per year, and with written report to the Director
and to the infection control personnel.
Hygiene contact is responsible for participating in internal control work.
The safety deputy is responsible for protection issues that must be submitted to
the safety overseer.
The cleaning manager is responsible for the feedback to the workplace and the
head of the service department regarding deviations according to hygiene and infec-
tion protection.
All personnel are responsible for ensuring that current procedures and guidelines
are implemented and followed up.

79.4 Practical Measures

Internal controls regarding hygiene and infection protection are carried out at all
departments at least twice a year. The control should be performed by the depart-
ment’s management (manager), hygiene contact, safety representative and cleaning
manager. Department nurses attend at their wards; the kitchen manager participates
in the ward kitchen. Technical department is contacted concerning technical internal
control, i.e. control of technical equipment.
The department’s responsible physician should, if possible, participate in inter-
nal control, especially during periods of problems with hospital infections.
Prevalence and incidence of all infections and hospital infections at the depart-
ment should be included as documentation.
Inspection reports from the hospital hygiene/infection protection personnel are
used as the basis for internal control.

79.4.1 The Department Management Is Responsible for

• Hand hygiene training for all department employees (including extra duty, night
duty, etc.)
• Adequate washbasins with liquid soap and disinfectant dispensers, paper towels
and waste bin with bag and placement of this.
• Good personal hygiene among the staff, patient hygiene and use of the hospital’s
work uniform.
• The quality and cleaning of patient beds, mattresses, bed linen, toilet chairs,
wheelchairs, other chairs, textiles and other equipment.
• Proper cleaning of patient room, toilet room, washroom, laundry room, storage
for clean/sterile equipment, other storage room, dining room, corridor and living
room.
• Good hygienic conditions for newly operated patients.
• Proper wound care and treatment of wound infections.
• Measures for epidemics or outbreaks of communicable diseases, according to
hospital routines.
79.4 Practical Measures 1009

• Responsibility for proper use of isolation regimes.

• Knowledge of guidelines concerning resistant microbes.
• Good hygienic conditions in nutrition, fluid treatment and care.
• Distribution, storage and handling of drugs.
• Training in correct treatment and separation of clean versus unclean items:
patient clothes, waste, equipment, etc.
• Distribution, storage, inspection and expiry date of disinfectants.
• In case of purchasing new equipment, disposable equipment, etc., contact infec-
tion control personnel/medical technical units for advice and approval.
• Errors and deviations are reported to the hospital’s management, quality selec-
tion and infection control nurse.

79.4.2 Responsibilities in the Ward Kitchen (Kitchen Chef)

• Proper cleaning, preventing microbes from spreading in the environment and

causing infections in patients and personnel. This applies to daily cleaning and
main cleaning.
• To comply with procedures and regulations of the Ministry of Social Affairs—
the country’s Food Safety Authority to ensure that staff have good practices for
personal hygiene and hand hygiene.
• To arrange washbasins with liquid soap, paper and hand disinfection container.
• Make sure the kitchen has trash cans with pedal lock.
• To ensure proper storage of clean equipment.
• That all sorts of foods are kept in a hygienically satisfactory manner.
• That the dishwasher has a satisfactory temperature and that the machine has a
proper flush/cleaning and disinfecting effect.
• Checking the temperature of the dishwasher according to plan.
• To distinguish clear between clean and unclean equipment.
• To clean equipment in a satisfactory way.
• Daily cleaning and order in the kitchen.
• Cleaning of food trays, trolleys and containers.
• Main cleaning of kitchen and storage rooms once a year—or more often if
needed.
• Equipment replacement and maintenance (of the equipment).
• Errors and deviations are reported to the department’s management; the kitchen
chef reports to the hospital’s management.
• Conditions of importance for hygiene and infection control are reported to the
hospital’s management, quality committee and infection control unit.

79.4.3 Responsibilities for Cleaners (Cleaning Management)

• Hand hygiene training (including temporary staff).

• Personal hygiene and uniform.
• Current procedures for cleaning are followed.
1010 79 Internal Infection Control: Checklist

• Proper cleaning of patient room, toilet room, washroom, laundry room, storage for
clean/sterile equipment, other storage rooms, dining room, corridor and living room.
• Proper cleaning of patient beds, mattresses, toilet chairs, wheelchairs, other chairs, etc.
• Proper methods and soaps are used, according to plan. This applies to daily
cleaning of the department and main cleaning once a year or more often.
• Storage, checking and shelf life of disinfectants.
• Training in current infection control procedures and practical review of disinfec-
tion and cleaning of contaminated rooms and furniture.
• Errors and deviations are reported to the department’s management and hospital
management via the hospital’s reporting system for deviations.
• Conditions of importance for hygiene and infection control are reported to the
hospital’s management, quality committee and infection control unit.

79.4.4 The Safety Deputy Is Responsible for Controlling

• That the staff are not exposed to infection.

• That technical equipment and aids work appropriately, to avoid strain injuries.
• Disinfectants/chemicals are stored and used in accordance with the regulations.
• Error and deviations are reported to the safety overseer, the department’s man-
agement, the hospital’s management, the quality committee and the infection
protection unit.

79.4.5 Technical Department Is Responsible for Controlling

• Maintenance of windows, ceilings, walls and floors, as well as all technical

installations.
• That the ventilation filter is checked and replaced by agreement with the supplier
of the hospital ventilation system and that there is no leakage between the filter
and the ventilation duct.
• That in some departments, filter change is advised twice a year.
• Cleaning of valves for air intake and extraction.
• That hot water from the crane has at least 75 °C.
• Temperatures of dishwashers (at least 85  °C) and decontaminators (at least
85 °C).
• That logbook is kept to document temperatures in decontaminators, washing
machines, dishwashers and filters.
• Error and deviations are reported to the department’s management and to the
hospital’s management, quality selection and infection control unit.

79.4.6 Responsible for the Textile Department Must Check

• Hand hygiene training (including temporary staff).

• Textile personnel’s personal hygiene and working suit.
79.4 Practical Measures 1011

• Training of personnel in washing procedures and proper treatment and separa-

tion between clean and unclean textiles.
• Adequate washbasins with liquid soap dispensers, paper towels, hand disinfec-
tants and waste bin with bag and placement of this.
• Purchasing, transportation and use of all fabrics at the institution.
• Internal control in the laundry.
• Washer/dryer and other laundry equipment.
• Storage of clean textiles.
• Laundry of different textile fabrics.
• Laundry of regular hospital textiles.
• Laundry of infected textiles.
• Storage and sorting of used textiles.
• Storage and sorting of infectious textiles.
• Cleaning of laundry trolleys.
• Cleaning of laundry containers.
• Daily cleaning in the laundry unit and dust removal.
• Main cleaning of the laundry unit at least once a year.
• Errors and deviations are reported to the hospital’s management, quality selec-
tion and infection control unit.

79.4.7 Checklist for Internal Control: A Regular Patient Ward

This is a checklist for a regular patient ward. It is recommended that special depart-
ments (laboratory medicine, radiology departments, internal service, surgery and
intensive care unit) should make their own checklists, even contact the infection
control unit.

79.4.7.1 Patient Rooms

• Beds/mattresses/bedding, storage, placement and cover of clean beds.
• Washbasins, liquid soap, paper towels, hand disinfectants.
• Waste bin with bag.
• Cleaning of fixtures and rooms.
• Cleaning of call button, telephone, light switches, door handles.
• Cleaning of wardrobe, curtain and display board.
• Light.
• No storage of clean clothes, bandages, ointments, etc. in the patient room.
• Check the number of patients/m2 area in the patient room (at least 16 m2 per
patient); furthermore the distance between beds (at least 130 cm) and between beds
and washbasin (at least 130 cm) and between bedside and wall (at least 130 cm).
• Check that beds do not stand against the wall with long sides.
• Check cleaning/disinfection of medical devices used by patients.
• Everything up from the floor.
• Hygienically safe toilet/shower.
1012 79 Internal Infection Control: Checklist

79.4.7.2 Isolation Unit (Patient Room, Sluice, Toilet/Shower/

Decontamination)
• Check routines for isolating patients with infection.
• Check that the department’s cleaner can provide decontamination and isolation
routines.
• Check negative air pressure in airborne isolation unit and check logbook for
measurements of pressure.
• See also patient rooms.

79.4.7.3 Toilet-Bathroom Conditions

• Handwash, hand disinfection.
• Liquid soap, paper towels, waste bin with bag.
• Hanging for toilet paper.
• No storage space for equipment.
• Cleaning twice a day.
• Control of toilet, lid, cleaning.
• Check the silicone at the floor around the toilet.
• Cleaning of toilet seats, seat higher (also below).
• Check that the correct cleaning routine is followed (how to clean the toilet).

79.4.7.4 Shower
• Daily cleaning of the sink and shower room.
• Cleaning in showers between each patient.
• If a shower cabinet is used by several patients, an infected patient will shower as
the last person. Disinfect the shower afterwards.
• Check the wall and floor coverings.
• Disposable bag for textile rack.

79.4.7.5 Bathroom
• Check cleaning procedures of bath/handwash, hand disinfection.
• Cleaning and disinfection procedures for patients with and without infection.
• Bubble bath should preferably not be used.
• Waste bin with bag.
• Cleaning of shelves.
• Stand for unclean laundry/towels.
• No storage space for clean textiles, bandages, ointments, etc.

79.4.7.6 Textile Storage

• Order.
• Cleaning.
• Everything up from the floor.
• No unauthorized effects.
79.4 Practical Measures 1013

79.4.7.7 Disinfection Room

• Handwash.
• Liquid soap/paper towels/hand disinfectants.
• Disinfectants and strong detergents in locked cabinets.
• Own stand for waste and laundry.
• Cleaning of shelves and cabinets.
• Cleaning of all surfaces, floors daily.
• Strong distinction between clean/unclean.
• Temperature control and function control of the decontaminator and instrument
washing machine.
• Container with tight fitting lid for disinfectant, if used.
• Collection of waste.
• Collection of laundry.
• Do not wash or dry laundry in the disinfection room.
• Order.
• Everything up from the floor.
• Negative air pressure compared to other rooms and corridor.

79.4.7.8 Clean Storage

• Order.
• Hand hygiene.
• Check daily cleaning and cleaning of cabinets.
• Everything up from the floor.
• Only clean equipment on clean storage.
• No unauthorized effects.
• No office space.

79.4.7.9 Post (Ward) Kitchen

• Handwash.
• Liquid soap, paper towels, hand disinfection.
• Sink, sufficient washbasins.
• Cleaning of cabinets and drawers weekly.
• Cleaning of floors daily.
• Replacement of worn-out equipment.
• Waste container with pedal lock for food residue.
• Waste bin with a waste bag.
• Check that the Foodstuffs Act with regulations is followed.
• Cleaning of cookers, etc., daily.
• Weekly cleaning of ice machine.
• Cleaning of refrigerator once a week.
• Freezer compartment/cupboard twice a year.
• Main cleaning twice a year.
1014 79 Internal Infection Control: Checklist

• Temperature control on the fridge every day.

• Temperature control on dishwasher (measured in the basket) every 14 days.
• Temperature control of hot food.
• Check storage of food.
• Daily cleaning of the food trolley.

79.4.7.10 Ward Office

• Check training in hand hygiene.
• Are written routines for infection control and hygiene easily accessible?
• Is the staff familiar with the routines?
• Washbasin with soap dispenser/paper towels/hand disinfectant/lotion and waste
bin with bag.
• Daily cleaning of all surfaces/phone/floor/data and keyboard.
• Weekly cleaning of chairs and fixtures.
• Make sure that there is no food or drink when working with patient journals,
patient samples or medicines.
• No equipment or wires on the floor.

79.4.7.11 Medicine Room/Medicine Cabinet/Unit

• Daily cleaning of all surfaces.
• Weekly cleaning of all shelves/drawers/cabinets and carts.
• Main cleaning of the room twice a year.
• Check the hood.
• Check opened vials/ampoules/medicines for durability and storage.
• Check the handling of medications.
• Check cleaning of medicine boards, trays, trolleys, etc.

79.4.7.12 Storage Room of Washing Equipment

• Sink.
• Liquid soap, paper towels, hand disinfection.
• Sufficient shelf space.
• Peg for hanging equipment, etc.
• Daily wash of the sink/bucket rack.
• Daily disinfection of the buckets.
• Cleanliness and order.
• Floor space free of equipment and supplies.
• No private laundry.
• Waste bin with bag.

79.4.7.13 Dining Room and Living Room

• Washing tables after each meal.
• Cleaning of floors daily, possibly twice a day and when needed.
• Washing of seats, window frames, lists and fixtures weekly.
79.4 Practical Measures 1015

79.4.7.14 Corridors on Wards

• Cleaning once a day.
• Cleaning of railings twice a week.
• Wash the door handles daily.
• All furniture is vacuum cleaned and cleaned weekly.
• Dirty/broken furniture is sent for cleaning/repair.

79.4.7.15 Elevator
• Daily cleaning of floors, railing and pushbuttons.
• Check cleaning.
• Light conditions.

79.4.7.16 Waste Disposal

• Proper treatment of waste.
• All surfaces easily washable.
• Drain to water in the floor.
• Check routines for removal and transport of waste.
• Cleaning once a week.
• Negative air pressure relative to the corridor.
• Check any shafts for dropping.

79.4.7.17 Physiotherapy
• Handwash, soap dispenser, paper towels, hand disinfection.
• Waste bin with bag.
• Adequate closet space for all equipment.
• Cleaning procedures for equipment are followed.
• Daily cleaning of all tables/benches/floors.
• Hygiene rules for physiotherapists are followed.
• Check cleaning.

79.4.7.18 Ergo-therapy Room

• Handwash, soap dispenser, paper towels, hand disinfection.
• Waste bin with bag.
• Daily cleaning of all tables/benches/floors.
• Regular cleaning and order in the cabinets.
• Check cleaning.

79.4.7.19 Ventilation Valves

• Cleaning/cleaning of all valves every 3 months.
• Note! Fungi are growing in valves, especially in bathroom/shower room/kitchen/
laundry and waste room.

79.4.7.20 Ventilation Filter

• Regular check of filter, eventually shift.
1016 79 Internal Infection Control: Checklist

79.4.7.21 Wardrobe for Employees

• Handwash, soap dispenser, paper towels, hand disinfection.
• Waste bin with bag.
• Clean storage room for clean uniforms/clothes.
• Proper storage of used clothes and good emptying routines.
• No equipment, shoes, clothes on the floor.
• Check cleaning of available wardrobes.
• Check cleaning under and on top of the wardrobe.

79.4.7.22 Shower
• Daily cleaning of washbasin, shower room and toilet.
• Check walls and floor coverings.
• Disposable bag for used clothes and rack.

79.4.7.23 Toilet
• Handwash.
• Liquid soap, paper towels, waste bin with bag.
• Hanging for toilet paper.
• No storage space for equipment.
• Cleaning daily.
• Control of toilet, lid, cleaning.
• Check the silicone at the floor around the toilet bowls.
• Check that the correct cleaning routine is followed (how to clean the toilet).

79.5 Background Information

Internal control: to ensure compliance with requirements stipulated in or in compli-

ance with the law or regulation.

79.5.1 Law/Regulation/Guidelines: Example from Norway

• Regulations on internal control. Determined by kgl res. 22 March 1991 pursuant

to Act 4 February 1977 No. 4 Section 16a on Workers protection and Work
Environment, etc.
• Regulations on infection protection in healthcare institutions—hospital infec-
tions. Established by the Ministry of Social Affairs and Health on 5 July 1996
pursuant to Sections 4–7 and 7–11 of Act No. 5 of 5 August 1994 on protection
against communicable diseases.
• Infection control programme for each hospital, updated locally.
• Hygiene Regulations for production and marketing, etc., of foodstuffs, deter-
mined by kgl, 8 July 1983, No. 1253, changed by kgl. of 29 April 1988 No. 312,
pursuant to paragraphs 1 and 3 of the Act of 19 May 1933 No. 3 on supervision
of foodstuffs, etc. with later changes.
79.5 Background Information 1017

• Internal control in foodstuffs—businesses IK—Food at NMT, INFO G 3 7

October 1997.
• Working Environment Act published by the Directorate for Labour Inspection.

Internal control is an important and relatively little time-consuming way of

reviewing the department’s standard with regard to hygiene and infection control.
Internal control is carried out by the department’s own employees and is an internal
matter. Results of the check often result in a note/report that is then used as a docu-
ment for improvement measures.