Infection Control Audit Checklist: The Observation Walk
An infection control audit checks that the practices that stop infections spreading are actually happening: hand hygiene, the right protective equipment, clean environments and equipment, safe sharps and waste, and proper isolation. In hospitals, clinics, care homes and dental practices, these audits are routine. The best ones aren't done from a chair with a policy in hand. They're done by walking and watching.
This is the observation walk: what to look at, how to watch without changing what you see, and how to turn what you find into better practice.
Why observation beats a questionnaire
Ask staff whether they clean their hands before touching a patient and nearly everyone says yes. Watch them, and the number is different. An infection control audit is useful because it measures what people actually do, which is why most audits combine a short environmental walk with direct observation of practice.
The catch: people behave differently when they know they're being watched. Good observation audits are unobtrusive, repeated, and done often enough that being observed becomes normal.
1. Hand hygiene
Hand hygiene audits usually follow the World Health Organization's "My 5 Moments for Hand Hygiene":
- Before touching a patient
- Before a clean or aseptic procedure
- After body fluid exposure risk
- After touching a patient
- After touching a patient's surroundings
For each opportunity you observe, record whether hand hygiene happened (hand rub or washing) and the staff group. Count opportunities, not people. The result is compliance as a share of opportunities.
Also check:
- Hand rub available at the point of care, and dispensers working and full
- Sinks: soap, paper towels, not used for anything else, clear access
- Bare below the elbows where that's the policy: no wrist watches, long sleeves, false nails
2. Personal protective equipment
- Gloves worn for the right tasks and changed between patients, not worn in corridors
- Aprons and gowns used as required and removed before leaving the bay or room
- Masks and eye protection where indicated
- Removal order: PPE taken off in a way that doesn't contaminate hands, followed by hand hygiene
- Stock: the right sizes available where they're needed
3. The environment and equipment
- Clean and uncluttered: surfaces, floors, bed frames, call bells, high-touch points
- Patient equipment (commodes, stands, monitors, mattresses) clean, with a system that shows it's been cleaned
- Storage: clean items stored off the floor, separate from dirty
- Damage to surfaces, mattresses or chairs that can't be cleaned properly
- Cleaning records and schedules up to date
4. Sharps, waste and linen
- Sharps containers at the point of use, assembled and labeled correctly, not overfilled past the line, temporary closure used between uses
- No re-sheathing of used needles
- Waste segregation: clinical and offensive waste in the right streams and bags, bins foot-operated and lidded
- Linen: used linen bagged at the bedside, infected linen in the right bag, clean linen stored covered
5. Isolation and patient placement
- Signage on isolation rooms that tells staff what's needed without breaching privacy
- Doors kept closed where required
- PPE available at the entrance
- Dedicated equipment for isolated patients where possible
How to observe
- Observe for a set period, often 15 to 20 minutes, in a busy area
- Stay unobtrusive: stand where you can see, but out of the way
- Count opportunities, not individuals, and record the staff group, not names
- Don't intervene unless there's an immediate risk to a patient, and then do it quietly
- Repeat often, at different times and on different days
Feeding back
An audit that ends in a spreadsheet changes nothing.
- Feed back on the day, to the person in charge, with the good as well as what needs work
- Show the numbers: compliance by moment, by staff group, over time
- Agree actions: dispenser moved closer to the bed, more aprons stocked on the trolley, a teaching session on PPE removal
- Re-audit to see whether it changed
Doing it on the walk
Observation audits need your eyes on the ward, not on a form. Ticking a paper sheet while trying to watch three staff at once means missing opportunities.
Speak while you walk, and the document writes itself. Quietly noting "Bay four, nurse, before touching patient, hand rub, yes. Physio, after touching surroundings, no. Sharps bin in the treatment room above the fill line, photo." records each observation with a timestamp, while you keep watching.
Key Takeaway
The free hospital safety checklist covers the wider safety round of a ward or department, including infection control items, and fills in on a phone. In the ReportWalk app you can build an observation audit of your own, with your moments, staff groups and areas, and fill it in by voice. First walks free.
Related
- Hospital safety checklist: the free template
- Cleaning inspection: how clean the environment really is
- Spill kit inspection checklist: for body fluid and chemical spills
- Hazard reporting: getting risks reported before harm
Frequently asked questions
What is an infection control audit? A structured check that infection prevention practices are in place and being followed: hand hygiene, personal protective equipment, environmental and equipment cleaning, sharps, waste and linen handling, and isolation.
What are the 5 moments for hand hygiene? The World Health Organization's five moments are before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching a patient's surroundings.
How do you carry out a hand hygiene audit? Observe care unobtrusively for a set period, record each hand hygiene opportunity, whether hand hygiene was performed, and the staff group, then calculate compliance as a share of opportunities. Repeat regularly at different times.
How often should infection control audits be done? It depends on the setting and local policy. Many hospital wards audit hand hygiene monthly and do wider infection control audits quarterly, with more frequent audits during outbreaks or after poor results.
Who should do infection control audits? Infection prevention teams, ward or unit managers, and trained link staff. Peer audits by staff from other areas can reduce the "being watched" effect.
What should be done with the audit results? Feed them back to the area the same day, agree specific actions with owners, share trends over time, and re-audit to check the actions worked.
