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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 meterBlood 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. 
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Central line setCentral 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. 
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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.
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Medical device sterilizer machineDevice Reprocessing

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

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Personal Protective Equipment (PPE)Enhanced Standard Precautions

Enhanced Standard Precautions is a resident-centered and activity-based approach for preventing MDRO transmission in SNF.  The use of gowns and gloves by healthcare personnel during specific care activities is based on periodic assessments of a resident's risk for being colonized and transmitting MDRO, whether or not the resident is known to be MDRO-colonized or infected.
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Environmental equipment cartEnvironmental Services

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

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Handwashing under waterHand Hygiene

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

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Dialysis machineHemodialysis

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.  

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Syringe with vialInjection 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.  

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Doctor listening with stethescopeSource Control and Respiratory Hygiene

Surgery in processSurgical 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.

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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).

Ventilator machine
Ventilator-Associated Pneumonia

Use this tool to measure adherence to VAP practices.


 For questions, suggestions, or an accessible version of these tools, please email HAIProgram@cdph.ca.gov.

Find additional resources at CDC Infection Prevention Observation Tools

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