Hospital Infection Control Checklist – Free PDF Template

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Infection control checklist in hospital

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Use this template with Lumiform

Customize this template or build your own
Fill out templates via mobile app
Get reports and analyse your data

Prices start from ░░░ per month

Book a demo

Learn more

This infection control checklist helps you systematically evaluate and maintain critical infection prevention standards across your hospital. Unlike general safety assessments, this template focuses specifically on healthcare-associated infection (HAI) prevention protocols, with dedicated sections for hand hygiene compliance, isolation procedures, environmental cleaning, and equipment disinfection.

When a hospital in the Midwest implemented a structured infection control audit program, they reduced their HAI rates by 23% in just one year. You can use this template during regular departmental rounds to identify compliance gaps, document findings, and track improvements—transforming infection control from a passive policy into an active daily practice.

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Preview of the template

Page 1

General Practices

Are all staff members trained on infection control protocols?

Are infection control policies and procedures reviewed and updated regularly?

Are supplies and equipment for infection control readily available?

Hand Hygiene

Are hand hygiene facilities (sinks, soap, paper towels, alcohol-based hand rub) available in all patient care areas?

Do staff members follow recommended hand hygiene practices (before patient contact, after contact with blood or body fluids, etc.)?

Is hand hygiene compliance monitored and feedback provided to staff?

Personal Protective Equipment (PPE)

Are appropriate PPE (gloves, gowns, masks, eye protection) available and accessible to staff?

Do staff members use PPE according to standard and transmission-based precautions?

Is PPE use monitored and feedback provided to staff?

Environmental Cleaning

Are written cleaning and disinfection protocols in place?

Are high-touch surfaces cleaned and disinfected on a regular schedule?

Are cleaning methods and products appropriate for the intended use?

Waste Management

Are there procedures for the safe handling and disposal of waste, including sharps?

Are staff members trained on proper waste disposal protocols?

Is waste disposal monitored and any issues addressed?

Linen Management

Are there procedures for the handling, transport, and processing of soiled linen?

Is clean linen stored and transported in a way that prevents contamination?

Are staff members trained on proper linen handling protocols?

Reprocessing of Reusable Medical Equipment

Are there policies and procedures for the cleaning, disinfection, and sterilization of reusable medical equipment?

Are staff members trained on proper reprocessing methods?

Is the reprocessing of equipment monitored and validated?

Surveillance and Reporting

Is there a system in place for monitoring and reporting healthcare-associated infections?

Are infection rates regularly reviewed, and any issues addressed?

Are staff members trained on infection surveillance and reporting protocols?

Frequently asked questions

What are the key components that should be included in a hospital infection control checklist?

A comprehensive hospital infection control checklist should include sections for hand hygiene facilities, personal protective equipment availability, isolation room protocols, environmental cleaning verification, equipment disinfection procedures, waste management compliance, and staff adherence to infection prevention practices. The most effective checklists also incorporate scoring systems to quantify compliance levels across departments.

Who should be responsible for completing the infection control checklist in a clinical setting?

The infection control checklist should ideally be completed by designated infection preventionists or control officers. However, creating a rotation system where department managers and clinical leads also participate enhances ownership and awareness. This collaborative approach ensures multiple perspectives while building infection prevention expertise throughout your hospital leadership team.

How can I customize this infection control checklist for different hospital departments?

Customize your infection control checklist by first maintaining core sections applicable to all areas, then adding department-specific modules. For surgical areas, include surgical site infection prevention protocols; for neonatal units, add specific equipment cleaning requirements; and for oncology, incorporate neutropenic precaution verification. Review department-specific infection risks to guide your customization.

This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.