The Oregon Ambulatory Surgery Center Infection Prevention and Control Toolkit is specifically designed to provide guidance on the development and implementation of infection prevention programs that meet infection control standards outlined in Medicare’s Conditions of Coverage and State of Oregon administrative rules. The toolkit was developed by the Oregon Patient Safety Commission to help Oregon’s ambulatory surgery centers (ASCs) implement infection prevention quality improvement projects, reduce infection risks, and better protect patients.

Infection Prevention Program (IPP) Development

1.00 Training Presentation Materials
1.01 ASC Environmental Rounds Survey Tool
1.02 Operating/Procedure Room Observation Tool
1.03 Sterile Processing and High Level Disinfection Rounds Tool
1.04 IPP Risk Assessment Hazard Scoring Tool
1.05 IPP Risk Assessment Surveillance Data Collection Tool
1.06 IPP Annual Goals Evaluation Tool
1.07 IPP Plan

General Infection Prevention Practice

2.00 Training Presentation Materials
2.01a Hand Hygiene Policy and Procedure
2.01b Hand Hygiene Compliance Audit Tool
2.01c Surgical Hand Rub or Hand Scrub Policy and Procedure
2.02 Respiratory Hygiene/Cough Etiquette Policy
2.04 Standard Precautions Policy
2.05 Medical Waste Disposal Grid
2.06 Management of Patients with Transmissible Diseases (Isolation) Policy
2.07 Outbreak Identification and Management Policy
2.08 Reportable Infections Policy and Procedure

Sterilization and Disinfection Practice

3.00 Training Presentation Materials
3.01 Cleaning, Disinfection, and Sterilization Policy and Procedure
3.02 Sterilizer Load Documentation Form
3.03 Instrument Cleaning, Wrapping/Packaging & Sterilization Competency Checklist
3.04 Endoscope Cleaning and Reprocessing Policy
3.05 Endoscope Reprocessing Competency Checklist
3.06 Immediate Use Steam Sterilization Policy
3.07 Immediate Use Documentation Form
3.08 Management of Positive Biological Indicator in a Steam Sterilizer
3.09 Single-use Devices Policy
3.10 Loaner Instrument Policy & Procedure
3.11 Loaner Instrument Documentation Form

Environmental Hygiene

4.00 Training Presentation Materials
4.01 Ambulatory Surgery Center Environmental Cleaning Policy and Procedure
4.02 Operating/Procedure Room Cleaning Checklist Audit Tool
4.03 General Environmental Cleaning Checklist Audit Tool

Safe Injection Practices

5.00 Training Presentation Materials
5.01 Use, Handling, and Storage of Medication, Eye Drops, and Solutions Policy
5.02 Point of Care Device Safe Handling and Disinfection Policy and Procedure

Employee Health Program

6.00 Training Presentation Materials
6.01 Screening and Immunization for Vaccine-preventable Diseases and Tuberculosis Policy
6.02a Declination of Hepatitis B Vaccination Form
6.02b Declination of Influenza (Flu) Vaccination Form
6.03 Tuberculosis Screening Documentation Form
6.04 Healthcare Worker Communicable Disease Illness Policy
6.05 Occupational Exposure to Communicable Disease Policy and Procedure
6.06 Blood & Body Fluid Exposure Policy
6.07 Blood & Body Fluid Exposure Documentation Form

Quality Improvement

7.00 Training Presentation Materials
7.01 Oregon Safe Surgery Checklist