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Contact Precautions
Contact Precautions
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Created by Qualaris Staff
Infection Prevention
Table of Contents
Audit Form
Audit Form
Contact Precautions
Description
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Required
Observed Date
Unit
ED
ICU
Med-Surg
PACU
Rehab
Occupation
Facilities
MD-NP-PA
NA
RN
Other
Shift
AM
PM
Night
Contact Precautions Checklist
Mark all as...
Dedicated linen hamper
Yes
No
N/A
Infectious waste can
Yes
No
N/A
PPE available
Yes
No
N/A
Dedicated stethoscope
Yes
No
N/A
Dedicated BP cuff
Yes
No
N/A
Dedicated thermometer
Yes
No
N/A
Proper signage present
Yes
No
N/A
HH prior to PPE
Yes
No
N/A
Gloves worn
Yes
No
N/A
Gown worn
Yes
No
N/A
Mask worn
Yes
No
N/A
HH after PPE
Yes
No
N/A
