Infection Control Skills Checklist

Infection Control Skills Checklist

First Name*

Last Name*

Years of Experience*

E-mail*

example@example.com

ANSWER KEY
 
PROFICIENCY
1=Not Applicable 2=No Experience 3=Some Experience
4=Experienced 5=Very Experienced
 
FREQUENCY
1=Never Performed 2=Assisted Only 3=Rarely Performed
4=Occasionally Performed 5=Regularly Performed

General*

	Proficiency	Frequency
Make written and oral reports/recommendations concerning the infection control program of the facility
Plan, develop, organize, implement, evaluate, coordinate, and direct infection control program in accordance with current rules, regulations, and guidelines
Working knowledge of OSHA Blood-Borne Pathogen Standards, OSHA Tuberculosis Protection, Title 22, state and federal laws related to communicable diseases, and JCAHO Standards
Possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies, procedures, etc., that are necessary for preventing and controlling infections, to include the establishing of universal precautions
Basic understanding and use of microbiology and epidemiology principles, statistical presentation, outbreak investigation techniques, and computer use
Knowledge of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to infection control
Serve on, participate in, and attend Infection Control Committee
Knowledge of MDROs
Seek out new methods and principles and incorporate them into existing nursing practices
Understanding of nosocomial infection definitions, chart review, functional understanding of sterilization, disinfections, and sanitation
Adult teaching techniques, clear oral and written communication skills, project management, and policy management

Surveillance*

	Proficiency	Frequency
Conduct rounds to nursing units and hospital departments for the purpose of monitoring isolation precautions/practices
Monitor for compliance with federal and state laws regarding Infection Control issues such as medical wastes, chemicals in the workplace, and infectious disease exposures, and OSHA, CalOsh, and NIOSH standards related to blood-borne pathogens and respiratory pathogens
Collect, monitor, and maintain records and data pertinent to surveillance utilizing Center for Disease Control (CDC) infection criteria, documentation, and investigation techniques
Make rounds of hospital units for the purpose of case definition, monitoring of infection control practices, and other related patient care issues
Perform/Assist with investigation of clusters or outbreaks of infections or colonization
Identify and monitor specified nosocomial infections
Ensure that all personnel follow established procedures for the disposal and removal of infective and contaminated materials from the facility
Perform targeted surveillance and outbreak investigations
Perform/Assist with investigations of possible communicable disease exposures among health care workers, patients, and/or visitors
Monitor infection control practices and procedures to ensure that all personnel are implementing standard operating procedures for tasks involving exposure to blood/body fluids
Perform/Assist with tracing the possible sources of infection or transmission of microorganisms
Develop and implement a practical system of detecting, evaluating, recording, and reporting infections which originate with facility personnel
Participate in performance improvement projects related to communicable diseases and emerging pathogens within the facility

Problem Identification*

	Proficiency	Frequency
Assist in identifying epidemiologically important issues so that appropriate plans for action can be designed, including Surveillance, Outbreak Investigations, and Performance Improvement Projects
Provide information relative to TB assessment and make recommendations concerning the protocols to follow in isolating TB cases
Prepare monthly summaries of all infections, corrective action taken, and the results of the corrective action
Prepare summaries of special investigations of the occurrence of nosocomial and community-acquired infections
Understand the transmission of infections and assist in the reduction of risk among patients, facility staff, volunteers, students, and visitors
Provide a report of pertinent findings and recommendations pertaining to nosocomial infections
Identify and report communicable diseases as required by the state and the local health authority, for example, TB, AIDS, and other current public health issues
Report occupational exposures to blood, body fluids, infectious materials, and hazardous chemicals in accordance with the facility's policies and procedures governing accidents and incidents

Policies and Procedures*

	Proficiency	Frequency
Draft, review, and evaluate Infection Control policies/practices associated with infection control
Develop, maintain, and periodically update infection control precautions and aseptic techniques that successfully correct problem areas
Interpret infection control policies and procedures as necessary
Make recommendations utilizing professional guidelines (CDC, APIC, etc.) to comply with regulatory and accrediting agencies, such as federal, state, and local health agencies, and the Joint Commission of Accreditation of Health Care Organizations. Update policies, practices, and the Infection Control Plan to reflect and meet any required changes
Draft the hospital’s Infection Control Plan and annually review, evaluate, and update plan based upon surveillance data findings
Participate in development of antibiotic protocols
Ensure the facility is in compliance with current CDC, OSHA, and local regulations concerning infection control and universal precautions

Education*

	Proficiency	Frequency
Assist in developing OSHA and CDC in- service training programs for hazard communication, TB management, and blood-borne pathogens standards
Provide personnel with information concerning the facility's policies governing hepatitis B vaccinations
Develop, implement, and conduct in-service training programs relative to infection control
Develop a training program for all personnel required to perform tasks involving exposure to blood/body fluids
Orient new employees to the importance of infection control policies and procedures, personal hygiene, and handwashing techniques, as well as the employee's responsibility to follow established procedures for tasks involving exposure to blood/body fluids
Assist the personnel director in developing and implementing an employee health services program, including individual counseling as outlined in infection control and the employee health program

Coordination*

	Proficiency	Frequency
Assist Laundry Services in developing infection control procedures for the handling of clean and soiled laundry/linen and equipment cleaning
Assist Housekeeping Services in developing infection control procedures for the routine and terminal cleaning of isolation rooms and areas and equipment cleaning
Assist in planning with other departments and personnel to reduce the risk of disease transmission and improve infection control practices
Assist in developing and implementing guidelines for decontamination and sterilization activities
Assist the Infection Control Committee in evaluating and revising infection control practices and aseptic techniques to ensure continued sanitation practices are maintained
Assist in evaluating and implementing recommendations from the Infection Control Committee
Act as department liaison for Infection Control and as consultant for the facility to integrate Infection Control activities
Assist the Discharge Planning Coordinator in developing and implementing discharge plans for patients/clients in isolation or on infection control precautions

Patient Care*

	Proficiency	Frequency
Ensure that patients/clients with known communicable or infectious diseases are placed in isolation or on infection control precautions to include universal precautions
Review and analyze infectious disease laboratory reports and consult with Nursing Services in developing a care plan, ensuring that aseptic techniques are implemented
Review nurses' notes of patients/clients in/on isolation precautions to ensure that they are informative and descriptive of the nursing care being provided and that they reflect the patient/client's response to the care
Assist in the development, implementation, and maintenance of a plan of care for patients/clients in isolation or on infection control precautions that identifies the problems/needs of the patients/clients
Visit isolated patients/clients as necessary to ensure that established isolation precautions and aseptic techniques are followed
Interview patients/clients or family members and explain isolation and universal precautions as necessary

Age Groups*

	Proficiency	Frequency
0-30 days
30 days - 1 year
1 - 3 years
3 - 5 years
5 - 12 years
12 - 18 years
18 - 39 years
39 - 64 years
64+ years

Practice Settings*

	Proficiency	Frequency
Long-Term Care
Acute Care
Health Department/ Other Agency

Perform*

	Proficiency	Frequency
Collect data
Write policies
Statistical Collation
Conduct Continuous Surveillance
Isolation
Develop protocols
Develop and Make Presentations
Doffing PPE
Educate staff
Donning PPE

Specimen Collection*

	Proficiency	Frequency
Butterfly Stick
Urine Dipstick
Sterile Urine
Clean Catch Urine
Sputum
Central Line Draw
Stool
Finger Stick
Cultures-Blood

Medications Administration*

	Proficiency	Frequency
Administer PO
Administer IM and SQ
Needleless Systems
Administer IV

Therapeutic Interventions*

	Proficiency	Frequency
Central Line Bundles
Antimicrobial Protocols
Antibiotic Usage

The information provided is true and to the best of my knowledge. I hereby authorize Summit Medical Staffing to present my Skills Checklist to facilities for the purpose of employment. Please Type Your Name in This Box to Electronically Sign this Form. *

First NameLast Name

Date*

MonthDayYear

Hour MinutesAM/PM Option

Form Reply Email Address

Salesforce Check

Assessment / Patient Care

Age Group Experience

Procedures / Equipment

Medications / Therapeutic Interventions