DENTAL INFECTION CONTROL CHECKLIST: PPE & SURFACE DISINFECTION

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--- PERSONAL PROTECTIVE EQUIPMENT (PPE) ---
[ ] Quantity of N95 Masks Available
[ ] Quantity of Surgical Masks Available
[ ] Quantity of Gloves (various sizes)
[ ] Number of Gowns Available
[ ] PPE Types Currently in Use: (N95 Masks, Surgical Masks, Gloves, Gowns, Eye Protection (Face Shields/Goggles), Hair Covers)
[ ] Date of Last PPE Inventory Check
[ ] Notes on PPE Supply or Shortages

--- HAND HYGIENE ---
[ ] Handwashing Duration (seconds)
[ ] Soap Type Used (Antibacterial, Non-Antibacterial)
[ ] Handrub Used? (Yes, No)
[ ] Last Hand Hygiene Training Date
[ ] Time of Last Handwashing
[ ] Areas of Hands Washed Thoroughly (Palms, Backs of Hands, Between Fingers, Under Nails)

--- SURFACE DISINFECTION ---
[ ] Disinfectant Contact Time (Minutes)
[ ] Disinfectant Type Used (EPA-Registered Hospital Grade Disinfectant, Quaternary Ammonium Compound, Hydrogen Peroxide, Other (Specify))
[ ] Specific Surfaces Disinfected (Detailed List)
[ ] Date of Last Surface Disinfection
[ ] Time of Last Surface Disinfection
[ ] Frequency of Disinfection (Between Each Patient, Daily, Weekly)
[ ] Photo Documentation (Optional)

--- INSTRUMENT PROCESSING ---
[ ] Autoclave Cycle Time (Minutes)
[ ] Autoclave Temperature (Â°C)
[ ] Autoclave Pressure (PSI)
[ ] Autoclave Load Type (Single, Full)
[ ] Last Autoclave Maintenance Date
[ ] Cycle Start Time
[ ] Indicator Type Used (Chemical, Biological, Both)
[ ] Comments/Observations

--- WASTE MANAGEMENT ---
[ ] Quantity of Red Bag Waste Generated (Approximate)
[ ] Quantity of Sharps Container Waste Generated (Approximate)
[ ] Waste Segregation Practices Followed? (Red Bag Waste, Sharps Waste, Recyclable Materials, General Trash)
[ ] Date of Last Sharps Container Replacement
[ ] Any Unusual Waste Handling Procedures?
[ ] Container Lids Secure? (Yes, No, N/A)
[ ] Waste Storage Area Clean and Organized? (Yes, No, N/A)

--- PPE DONNING & DOFFING ---
[ ] Order of PPE Application (Correct Sequence) (Gloves, Mask, Eye Protection (Face Shield/Goggles), Gown)
[ ] Detailed steps for Glove Donning (Observed)
[ ] Detailed steps for Mask Application (Observed)
[ ] Detailed steps for Eye Protection Application (Observed)
[ ] Detailed steps for Gown Application (Observed)
[ ] Potential Contamination Points (During Doffing) (Gloves, Gown, Mask, Eye Protection)
[ ] Glove Removal Technique (Description - e.g., Over-the-wrist technique)
[ ] Gown Removal Technique (Description)
[ ] Observer Signature (Confirmation of Protocol Adherence)

--- ENVIRONMENTAL SURFACE CLEANING ---
[ ] Dilution Ratio of Disinfectant (e.g., 1:10)
[ ] Contact Time of Disinfectant (Minutes)
[ ] Surfaces Cleaned (Check all that apply) (Dental Operatory Furniture, Light Handles, Computer Keyboards/Mice, Dental Unit Controls, Mobile Carts, Waiting Room Surfaces)
[ ] Date of Last Surface Cleaning
[ ] Disinfectant Used (Specify Brand and Type)
[ ] Notes/Comments Regarding Cleaning Procedure

--- RESPIRATORY PROTECTION ---
[ ] Fit Test Frequency (Months)
[ ] Last Fit Test Date
[ ] Respiratory Protection Program in Place? (Yes, No)
[ ] Type of Respirator Used (if applicable) (N95, KN95, Powered Air-Purifying Respirator (PAPR), None)
[ ] Notes on Respirator Use and Program
[ ] Employee Trained on Respirator Use? (Yes, No)

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