Infection Control Skills Checklist - CrossMed

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Skills Checklist

Infection Control Skills Checklist

Let’s assess your clinical skills and experience. Fill out this checklist to get one step closer to your next opportunity.

1

= No theory and/or experience
2

= Limited Experience
3

= Experienced/minimal support needed to perform
4

= Proficient

Age of Patients Cared For
Newborn/Neonate (birth to 30 days)*
- 1
- 2
- 3
- 4
Infant (1 month to 1 year)*
- 1
- 2
- 3
- 4
Toddler (1 year to 3 years)*
- 1
- 2
- 3
- 4
Preschooler (3 years to 5 years)*
- 1
- 2
- 3
- 4
School Age Child (5 years to 12 years)*
- 1
- 2
- 3
- 4
Adolescents (12 years to 18 years)*
- 1
- 2
- 3
- 4
Young Adults (18 years to 39 years)*
- 1
- 2
- 3
- 4
Middle Adults (39 years to 64 years)*
- 1
- 2
- 3
- 4
Older Adults (64 years to 79 years)*
- 1
- 2
- 3
- 4
Elderly Adults (over 79+ years)*
- 1
- 2
- 3
- 4
Basic Microbiology
Describe microorganism types and their role in HAI*
- 1
- 2
- 3
- 4
Describe antimicrobial resistance and its role in HAI*
- 1
- 2
- 3
- 4
Disease Transmission
Identify links in "chain of transmission"*
- 1
- 2
- 3
- 4
Describe transmission routes in healthcare setting (airborne, droplet, contact, vector, fomite)*
- 1
- 2
- 3
- 4
Apply principles of asepsis (e.g., clean vs. dirty tasks, sterile vs. non-sterile procedures)*
- 1
- 2
- 3
- 4
Distinguish between clean, disinfected, and sterile patient care items. Spaulding scale*
- 1
- 2
- 3
- 4
Describe difference in product selection for cleaning vs. disinfection*
- 1
- 2
- 3
- 4
Describe role of environment in HAI transmission*
- 1
- 2
- 3
- 4
Standard/Transmission Based Precautions
Demonstrate education of proper hand hygiene, and conducting HH rounds*
- 1
- 2
- 3
- 4
Describe the categories of transmission-based precautions, when to initiate the preventative activities of each category, requirements for each type of isolation, and facility signage*
- 1
- 2
- 3
- 4
Demonstrate how to verify negative pressure function of a patient environment*
- 1
- 2
- 3
- 4
Describe appropriate patient placement (e.g., room type, cohorting) relative to the category of transmission-based precautions*
- 1
- 2
- 3
- 4
Describe appropriate interventions required during patient transport relative to the category of transmission-based precautions.*
- 1
- 2
- 3
- 4
Demonstrate proper PPE donning / removal, and fit check (user seal check) of NIOSH-approved respirator.*
- 1
- 2
- 3
- 4
Describe the signs, symptoms and diagnoses that would alert a health care worker to initiate transmission-based precautions (e.g., fever with cough, fever with skin rash/lesion, fever with other respiratory symptoms, gastrointestinal symptoms).*
- 1
- 2
- 3
- 4
Occupational Health
Demonstrate safe handling and disposal of sharps, including appropriate use of safety devices*
- 1
- 2
- 3
- 4
Explain methods to safely handle blood and body fluids to prevent exposure.*
- 1
- 2
- 3
- 4
Describe the first aid for cut/puncture exposures, or fluid exposures to the eyes, nose or mouth.*
- 1
- 2
- 3
- 4
Articulate the process for reporting blood/body fluid exposure in the workplace.*
- 1
- 2
- 3
- 4
Describe regulated waste vs. general trash and the appropriate disposal of each.*
- 1
- 2
- 3
- 4
Explain the importance of health care worker participation in immunization programs.*
- 1
- 2
- 3
- 4
Describe signs, symptoms and diagnoses that require absence from work or work restrictions (e.g., fever with cough, fever with skin rash/lesion, fever with other respiratory symptoms, gastrointestinal symptoms).*
- 1
- 2
- 3
- 4
Emergency Prepardness
Explain own role in the facility disaster plan.*
- 1
- 2
- 3
- 4
Demonstrate participation in facility drills and exercises.*
- 1
- 2
- 3
- 4
Describe practice changes (e.g., altered standard of care) in the event of limited resources.*
- 1
- 2
- 3
- 4
Survelliance
Describe targeting vs. comprehensive surveillance and develop surveillance plan for facility / areas of coverage*
- 1
- 2
- 3
- 4
Notifiable conditions reporting*
- 1
- 2
- 3
- 4
Demonstrate abstraction of surveillance data from electronic and paper health records*
- 1
- 2
- 3
- 4
VAE / VAC surveillance accuracy*
- 1
- 2
- 3
- 4
CLABSI surveillance accuracy*
- 1
- 2
- 3
- 4
CAUTI surveillance accuracy*
- 1
- 2
- 3
- 4
C. diff surveillance accuracy*
- 1
- 2
- 3
- 4
MRSA BSI surveillance accuracy*
- 1
- 2
- 3
- 4
MDRO surveillance accuracy*
- 1
- 2
- 3
- 4
SSI Coding accuracy validation*
- 1
- 2
- 3
- 4
SSI Post-discharge letters*
- 1
- 2
- 3
- 4
Theradoc - data & reports*
- 1
- 2
- 3
- 4
Meditech - abstracting data from PCI*
- 1
- 2
- 3
- 4
Meditech - Common IP Reports*
- 1
- 2
- 3
- 4
NHSN - data entry and upload*
- 1
- 2
- 3
- 4
NHSN - analysis tools*
- 1
- 2
- 3
- 4
MHS Clinical Excellence Data Reports Available*
- 1
- 2
- 3
- 4
MHS HAC Reports/SPAE*
- 1
- 2
- 3
- 4
Process Survelliance
Hands-On Bundle Rounds*
- 1
- 2
- 3
- 4
Abstracting documented bundle compliance*
- 1
- 2
- 3
- 4
IP Environmental rounds - Patient Care Areas*
- 1
- 2
- 3
- 4
IP Environmental rounds - Sterile and Invasive areas*
- 1
- 2
- 3
- 4
IP Environmental rounds - Kitchen and dietary*
- 1
- 2
- 3
- 4
Hand Hygiene - Targeted Solutions Tool*
- 1
- 2
- 3
- 4
Product evaluation*
- 1
- 2
- 3
- 4
MDRO screening / isolation*
- 1
- 2
- 3
- 4
MRSA Decolonization*
- 1
- 2
- 3
- 4
Infection Control Program Annual Reports
Complete Annual IC Program Evaluation*
- 1
- 2
- 3
- 4
Complete cost savings assessment*
- 1
- 2
- 3
- 4
Complete facility program plan*
- 1
- 2
- 3
- 4
Complete Annual Facility Risk Assessment*
- 1
- 2
- 3
- 4
Statistics & Data Analysis
MHS data sources, storage locations*
- 1
- 2
- 3
- 4
Running IP data reports from Theradoc, NHSN*
- 1
- 2
- 3
- 4
Data analysis and communication*
- 1
- 2
- 3
- 4
IP / Epidemiologic study design*
- 1
- 2
- 3
- 4
Proficiency with data presentation*
- 1
- 2
- 3
- 4
Policies & Procedures
MHS Policy Tech - review IC policies*
- 1
- 2
- 3
- 4
Exposures / Outbreak procedures*
- 1
- 2
- 3
- 4
Complies with HIPAA and information security requirements*
- 1
- 2
- 3
- 4
Facilities Management
Construction & Renovation*
- 1
- 2
- 3
- 4
Environmental Services*
- 1
- 2
- 3
- 4
Cleaning Agents*
- 1
- 2
- 3
- 4
Linen Service*
- 1
- 2
- 3
- 4
Regulated Waste*
- 1
- 2
- 3
- 4
Ventilation*
- 1
- 2
- 3
- 4
Water issues*
- 1
- 2
- 3
- 4
Leadership
Discuss own role in infection prevention and control (e.g., recognizing unsafe activities, intervening when breaches in infection control are identified).*
- 1
- 2
- 3
- 4
Describe practice changes (e.g., altered standard of care) in the event of limited resources.*
- 1
- 2
- 3
- 4
Demonstrate ability to problem-solve and apply knowledge to recognize, contain, and prevent infection transmission.*
- 1
- 2
- 3
- 4
Builds rapport and cooperative relationships with colleagues in facility and IP team*
- 1
- 2
- 3
- 4
Collaborates with medical staff and facility quality team to monitor quality and initiate improvement strategies*
- 1
- 2
- 3
- 4
Maintains constructive interpersonal relationships when under stress*
- 1
- 2
- 3
- 4
Evaluates and reinforces understanding of previously taught / discussed information*
- 1
- 2
- 3
- 4
Lead a performance improvement team*
- 1
- 2
- 3
- 4
Presentation, in-servicing and public speaking*
- 1
- 2
- 3
- 4
Special Populations (as applicable for facility or interest)
Women's Health*
- 1
- 2
- 3
- 4
IVF*
- 1
- 2
- 3
- 4
Labor & Delivery*
- 1
- 2
- 3
- 4
Report Perinatal Hep B*
- 1
- 2
- 3
- 4
Neonatal / NICU*
- 1
- 2
- 3
- 4
Geriatrics*
- 1
- 2
- 3
- 4
Implants*
- 1
- 2
- 3
- 4
Intensive Care*
- 1
- 2
- 3
- 4
Immunocompromised*
- 1
- 2
- 3
- 4
Burns*
- 1
- 2
- 3
- 4
Long-term care*
- 1
- 2
- 3
- 4
Behavioral health*
- 1
- 2
- 3
- 4
Post-mortem care*
- 1
- 2
- 3
- 4
Support Services
Cleaning, Disinfection & Sterilization*
- 1
- 2
- 3
- 4
Single-use devices*
- 1
- 2
- 3
- 4
Volunteers*
- 1
- 2
- 3
- 4
Nutrition*
- 1
- 2
- 3
- 4
Animals*
- 1
- 2
- 3
- 4
Diagnostic & Therapeutic Services*
- 1
- 2
- 3
- 4
Surgery*
- 1
- 2
- 3
- 4
Cardiac Catheterization*
- 1
- 2
- 3
- 4
IC & endoscopy*
- 1
- 2
- 3
- 4
Dialysis*
- 1
- 2
- 3
- 4
IC & laboratories*
- 1
- 2
- 3
- 4
Respiratory Therapy*
- 1
- 2
- 3
- 4
Pharmacy*
- 1
- 2
- 3
- 4
Imaging*
- 1
- 2
- 3
- 4
Rehab*
- 1
- 2
- 3
- 4
Please list the EMR systems you have used*
*
I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form.*
*
I hereby consent to allow CrossMed Healthcare Staffing Solutions to release these skills checklist to the client facilities.*
Your Recruiter*
Name*
First Last
Email*
Phone*
TODAY'S DATE*
MM slash DD slash YYYY

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