healthcare-associated infections (hai) program

Monitoring Adherence to Health Care Practices that Prevent Infection

Healthcare facilities should implement processes to regularly monitor healthcare personnel (HCP) adherence to evidence-based infection prevention and control (IPC) practices and provide performance feedback to HCP and leadership. The following tools may be used to observe and measure HCP adherence to IPC practices while performing specific types of care. Local public health may also use these tools as part of healthcare facility IPC consultations. Select topics below to find associated adherence monitoring tool(s) and resources.

Blood Glucose Monitoring	Central Line	Contact Precautions
Device Reprocessing	Enhanced Barrier Precautions	Environmental Cleaning and Disinfection
Hand Hygiene	Hemodialysis	Indwelling Urinary Catheter
Injection Safety	Source Control and Respiratory Hygiene	Surgical Site Infections
Ventilator-Associated Pneumonia	Wound Care

How to use the adherence monitoring tools:

Follow the instructions for use provided for each adherence monitoring tool. For example, you may be prompted to conduct a minimum number of observations to yield meaningful results.
Calculate an adherence percentage after each monitoring session using the total number of correct observations divided by the total number of observations.
Provide feedback to frontline HCP on a regular basis to assess improvement over time, increase compliance, and prevent HAIs. Share performance data with leadership to gain support for IPC interventions.

Best practices:

Adapt tools to meet your facility’s needs. If you are a facility that has more elements than those identified in your IPC risk assessment, you are welcome to use these elements along with your facility elements in your own tool. Note: We ask that you remove the CDPH logo before distributing any modified tools.
Consider using secret shoppers, staff members or volunteers that HCP do not expect to be monitoring them. HCP might modify their usual behavior when they know they are being observed, which can affect the accuracy of adherence monitoring.
Contact the CDPH HAI Program for additional support or information on how to use the tools at HAIProgram@cdph.ca.gov.

Blood Glucose Monitoring

Incorrect use of lancet devices or failing to properly disinfect blood glucose meters can result in transmission of bloodborne pathogens.

Adherence Monitoring Tool

Blood Glucose Meter (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

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

Adherence Monitoring Tools

Central Line Insertion Practices (PDF)
Use this tool to observe the central line insertion process.
Central Line Access or Dressing Change Practices (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

Guideline for the Prevention of Intravascular Catheter-Related Infections, 2011 (PDF) | CDC
Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update (PDF) | Infection Control & Hospital Epidemiology

Contact Precautions

Preventing the spread of C. difficile and other multidrug-resistant organisms (MDRO) requires strict adherence to Contact Precautions and proper use of personal protective equipment.

Adherence Monitoring Tool

Contact Precautions (PDF)
Use this tool to assess HPC adherence to IPC practices while caring for patients on Contact Precautions.

Additional Resource

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

Device Reprocessing

Proper device reprocessing is essential for preventing transmissions of infections via reusable devices.

Adherence Monitoring Tools

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

Additional Resources

Disinfection and Sterilization Guidance (PDF) | CDC
Essential Elements of a Reprocessing Program for Flexible Endoscopes – Recommendations of the Healthcare Infection Control Practices Advisory Committee (PDF) | CDC
Reprocessing Single-Use Medical Devices: Information for Health Care Facilities | U.S. Food & Drug Administration (FDA)
Reprocessing of Reusable Medical Devices: Information for Manufacturers | FDA

Enhanced Barrier Precautions

Enhanced Barrier Precautions (EBP) are used to prevent the spread of multidrug-resistant organisms (MDROs) in skilled nursing facilities (SNFs).

Adherence Monitoring Tool

Enhanced Barrier Precautions (PDF)
Use this tool in any area of the SNF where residents are on EBP.

Additional Resources

AFL 24-15
QSO-24-08-NH (PDF) | Centers for Medicare & Medicaid Services
Frequently Asked Questions (FAQs) about Enhanced Barrier Precautions in Nursing Homes | CDC
Enhanced Barrier Precautions: Additional Considerations for California Skilled Nursing Facilities (PDF)

Environmental Cleaning and Disinfection

Pathogens can be transmitted when contaminated surfaces and equipment are not adequately cleaned and disinfected between patients.

Adherence Monitoring Tool

Environmental Cleaning and Disinfection (PDF)
Use this tool to measure how well staff members are adhering to appropriate environmental cleaning and disinfection practices.
Fluorescent Marker Assessment (PDF)
Use this tool in conjunction with the Environmental Cleaning and Disinfection Adherence Monitoring Tool to measure how thoroughly staff members are cleaning and disinfecting high-touch surfaces.
Environmental Cleaning and Disinfection Responsibility Assessment (PDF)
Use this tool to assess staff knowledge on who is responsible for cleaning and disinfecting specific items in your facility.
Hand Hygiene for Environmental Services (EVS) Staff (PDF)
Use this tool to identify opportunities for improvement. Monitoring may be performed in any type of patient care location.
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

Hand Hygiene

Hand hygiene is an essential component of all IPC care practices.

Adherence Monitoring Tools

Hand Hygiene (PDF)
Monitoring may be performed in any type of patient care location.
Hand Hygiene for EVS Staff (PDF)

Use this tool to monitor hand hygiene among EVS staff.
Hand Hygiene for Hemodialysis (PDF)
Use this tool to monitor hand hygiene in hemodialysis units.

Additional Resource

Guideline for Hand Hygiene in Health-Care Settings (PDF) | CDC

Hemodialysis

IPC care practices are necessary for the prevention of bloodstream infections in patients receiving hemodialysis.

Adherence Monitoring Tools

Indwelling Urinary Catheter Maintenance Practices

The best ways to prevent a catheter associated urinary tract infections (CAUTIs) are to avoid use of indwelling catheter unless absolutely necessary and to remove catheters as quickly as possible once they’re no longer necessary.

Adherence Monitoring Tool

Indwelling Urinary Catheter Maintenance Practices (PDF)
Use this tool to observe the conditions of urinary catheters in use.

Additional Resource

Catheter-Associated Urinary Tract Infections (CAUTI) Prevention Guideline (PDF) |CDC

Injection Safety

Injection safety includes safe handling of medications and using each needle and syringe for only one patient one time.

Adherence Monitoring Tool

Safe Injection Practices (PDF)
Use this tool to measure adherence to safe injection practices in any location where injectable medication is prepared or provided to patients.

Additional Resource

Safe Injection Practices and Your Health | CDC

Source Control and Respiratory Hygiene

Respiratory hygiene including use of well-fitting facemasks or respirators that cover a person's mouth and nose can reduce respiratory virus transmission.

Adherence Monitoring Tool

Source Control and Respiratory Hygiene (PDF)
Use this tool anywhere HCP are using facemasks or respirators for source control.

Surgical Site Infections (SSI) - Operating Room Environment

Evidence-based operating room practices reduce the risk of SSIs.

Adherence Monitoring Tools

Monitoring may be performed in any operating room setting, including hospitals, ambulatory surgery centers, and outpatient clinics.

Additional Resources

Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017 (PDF) | The Journal of the American Medical Association (JAMA) Surgery
Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals | Society for Healthcare Epidemiology of America (SHEA)

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).