Checklist for pre-cleaning of instruments

Which department are you completing this survey for?

Name of the employee observed:

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Transport Container obtained from clean supply or procedure area?

Was Transport Container labeled as “clean”?

Instruments sat for less than 30 minutes before pre-clean process began?

Hand hygiene performed and gloves donned?

Hinged instruments are in open position?

Instruments are placed in Biohazard Bag or Humipak?

Biohazard Bag or Humipak placed in Transport Container and labeled as "dirty"?

Gloves removed and hand hygiene performed?

Moved Transport Container with instruments to Soiled/Pre-clean area?

Pre-cleaning process began immediately and instruments did not sit?

Hand hygiene performed, gloves donned, and googles with mask or mask with face shield donned?

Instruments sprayed until soaked with Enzymatic Spray or Gel?

If Humipak used, is 10 mL water added?

Is Biohazard Bag or Humipak sealed?

Gloves are removed and hand hygiene performed?

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