Low Level Disinfection

Low Level Disinfection Survey Pilot for imaging group

Which department are you completing this survey for?

Name of the employee observed:

What role was the person you observed performing?
Observation Type:
Did the individual disinfect the equipment?
What were the reasons?
Was the low level disinfection performed correctly?

Hospital approved cleaners Oxivir Tb (1-minute wet time): most frequently used. If there is no sticker on the piece of equipment Oxivir is the preferred cleaner. If Oxivir cannot be used, then there will be a sticker that shows which cleaner to use for disinfection. Clorox Healthcare Bleach Germicidal Wipes (3-minute wet time): used for items that cannot use Oxivir Tb, and for post-contact C. Diff and Norovirus. Alcohol (1-minute wet time): used when Oxivir Tb and bleach cannot be used.
Employee confirmed the correct amount of dry time required for the agent in the situation it was being used?

Hospital approved cleaners Oxivir Tb (1-minute wet time): most frequently used. If there is no sticker on the piece of equipment Oxivir is the preferred cleaner. If Oxivir cannot be used, then there will be a sticker that shows which cleaner to use for disinfection. Clorox Healthcare Bleach Germicidal Wipes (3-minute wet time): used for items that cannot use Oxivir Tb, and for post-contact C. Diff and Norovirus. Alcohol (1-minute wet time): used when Oxivir Tb and bleach cannot be used.
What equipment was cleaned?
Was the patient in contact plus isolation?
Was the equipment cleaned with Bleach with a wet time of 3 minutes?
Which shift is this observation?