healthcare-associated infections (hai) program

Monitoring Adherence to Health Care Practices that Prevent Infection

Healthcare facilities have infection control and prevention policies in place and are highly encouraged to develop a plan to regularly monitor staff adherence to evidence-based infection prevention practices. The following tools developed by the California Department of Public Health Healthcare-Associated Infections (HAI) Program may be used to measure healthcare worker adherence to care practices critical in preventing infections. Local public health may also use these tools to assist with healthcare facility infection prevention consultations. Select tool(s) based on type of infection control assessment to be conducted.

Suggestions for tool use:

Make use of “secret shoppers.” Monitoring by a designated staff member, such as the infection preventionist, may result in inflated adherence percentages.
Calculate an ‘adherence percentage’ after each monitoring session. Share performance data with staff and leadership to gain support for infection prevention interventions.
Conduct adherence monitoring and provide feedback to frontline staff on a regular basis to assess improvement over time, increase compliance, and prevent HAI.

Glucose meter Blood Glucose Monitoring

Incorrect use of or failing to properly disinfect blood glucose meters places patients at risk for bloodborne pathogen infections. Use this tool to observe blood glucose monitoring practices and identify gaps and opportunities for improvement. Monitoring may be performed in any type of patient care location where blood glucose is monitored.

Blood Glucose Meter Adherence Monitoring Tool (PDF)
Use this tool to observe blood glucose monitoring practices and identify gaps and opportunities for improvement. Monitoring may be performed in any type of patient care location where blood glucose is monitored.

Additional resources:

Central Line Adherence Monitoring

A central line associated bloodstream infection (CLABSI) may occur due to breaches in technique during line insertion or lapses in infection prevention practices when accessing and maintaining the line.

Central Line Insertion Practices Adherence Monitoring Tool (PDF)
Use this tool to observe the central line insertion process.
Central Line Access and/or Dressing Change Practices Adherence Monitoring Tool (PDF)
Use this tool to observe central line medication administration and dressing changes.
Central Line Maintenance Practices Adherence Monitoring Tool (PDF)
Use this tool to observe the condition of the central line dressing and tubing.

Additional resources:

CDC Guideline for the Prevention of Intravascular Catheter-Related Infections, 2011 (PDF)

Personal Protecttive Equipment (PPE) Contact Precautions
Reduction of C. difficile and other multi-drug resistant organisms (MDRO) requires strict adherence to contact precautions and proper use of personal protective equipment.

Contact Precautions Adherence Monitoring Tool (PDF)
Use this tool to determine if staff members are correctly adhering to contact precautions practices. Feedback of results to staff has been shown to increase adherence to these practices.

Additional resources:

CDC 2007 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (PDF)

Medical device sterilizer machine Device Reprocessing

Many areas of the healthcare facility may be performing device reprocessing.

Device Reprocessing Adherence Monitoring Tool (PDF)
Use this tool in any area where device reprocessing is performed.
High-Level Disinfection of Reusable Devices Adherence Monitoring Tool (PDF)
Use this tool in any area where high-level disinfection of reusable devices is performed
Sterilization of Reusable Devices Adherence Monitoring Tool (PDF)
Use this tool in any area where sterilization of reusable devices is performed.

Additional resources:

Personal Protective Equipment (PPE) Enhanced Standard Precautions

AFL 24-15 announces that the CDPH is retiring its Enhanced Standard Precautions (ESP) guidance document and adopting the Centers for Disease Control and Prevention (CDC’s) EBP guidance and terminology.

CDPH has developed Enhanced Barrier Precautions: Additional Considerations for California SNFs (PDF) for additional guidance on EBP.

Environmental equipment cart Environmental Services

Pathogens are transmitted in healthcare settings when contaminated surfaces and equipment are not adequately cleaned and disinfected between patients.

Environmental Services Adherence Monitoring Tool (PDF)
Use this tool to measure how well staff members are adhering to appropriate environmental cleaning and disinfection practices.
Fluorescent Marker Assessment Adherence Monitoring Tool (PDF)
Use this tool in conjunction with the above Environmental Services Adherence Monitoring Tool to measure how well staff members are adhering to cleaning and disinfecting high-touch surfaces.
Environmental Cleaning and Disinfection Responsibility Assessment Tool (PDF): Use this tool to assess staff knowledge on who is responsible for cleaning and disinfecting specific items in your facility.
Who Cleans What Reminder Template (Word): Use in conjunction with Environmental Cleaning and Disinfection Responsibility Assessment Tool. Customize the template to correspond to your facility policy.

Additional resources:

Handwashing under water Hand Hygiene

Regular monitoring with feedback of results to staff can improve hand hygiene adherence.

Hand Hygiene Adherence Monitoring Tool (PDF)
Use this tool to identify gaps and opportunities for improvement. Monitoring may be performed in any type of patient care location.

Additional resources:

CDC Guideline for Hand Hygiene in Healthcare Settings (PDF)

Dialysis machine Hemodialysis

Use these hemodialysis tools to measure adherence to dialysis care practices that are important for the prevention of bloodstream infections.

Urinary catheter equipment Indwelling Urinary Catheter Maintenance Practices

The best ways to prevent a catheter associated urinary tract infections (CAUTI) are to avoid use of indwelling catheter unless absolutely necessary and to remove catheters as quickly as possible after insertion.

Indwelling Urinary Catheter Maintenance Practices Adherence Monitoring Tool (PDF)
Use this tool to observe the conditions of urinary catheters in use, and to identify gaps and opportunities for improvement.

Additional resource:

CDC Guideline for Prevention of Catheter-associated Urinary Tract Infections, 2009 (PDF)

Syringe with vial Injection Safety

Injection safety is a basic expectation in patient care, and includes safe handling of medications and using each needle and syringe for only one patient one time.

Injection Safety Adherence Monitoring Tool (PDF)
Use this tool to measure adherence to safe injection practices in any type of location where medication is prepared or provided to patients.

Additional resource:

CDC Injection Safety Web Materials

Doctor listening with stethescope Source Control and Respiratory Hygiene

Source Control and Respiratory Hygiene (PDF)
Use this tool to measure how well staff members are adhering to appropriate facemask and respirator practices.

Surgery in process Surgical Site Infections (SSI) - Operating Room Environment

Use these tools to measure adherence to evidence-based practices known to reduce SSI in the operating room. Monitoring may be performed in any operating room setting, including hospitals, ambulatory surgery centers, and outpatient clinics.

Additional resources:

CDC Guideline for the Prevention of Surgical Site Infections (PDF)

NOTE: in addition to the 42 new recommendations, 15 other SSI prevention recommendations were carried forward from the 1999 SSI guideline. They are described in the CDC Guideline for Prevention of SSI, 2017, supplemental eAppendix 1 (page 41).