Isolation Room Cleaning & Decontamination Checklist
Ensure patient and staff safety with our comprehensive Isolation Room Cleaning & Decontamination Checklist. A vital Facility Management tool for hospitals and healthcare settings, this checklist guarantees meticulous cleaning and disinfection protocols, minimizing infection risk and maintaining a secure environment. Download now for peace of mind and regulatory compliance.
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Pre-Cleaning Assessment & Preparation
Verifies room status, patient clearance, and gathers necessary supplies.
Date of Cleaning/Decontamination
Start Time of Cleaning/Decontamination
Patient Status (Prior to Cleaning)
Reason for Cleaning/Decontamination (e.g., Routine, Discharge, Known Exposure)
Isolation Type (e.g., Airborne, Contact, Droplet, PUI)
Notes on Patient Condition or Potential Hazards
Room Number
Supporting Documentation (e.g., Patient Isolation Order)
Personal Protective Equipment (PPE)
Ensures appropriate PPE is donned correctly.
Gown Type
PPE Donned (Check all that apply)
Respirator Fit Check Performed?
Time of PPE Donning
Notes regarding PPE condition/fit (if any)
Initial Room Assessment & Waste Removal
Identifies potential hazards and removes all waste materials.
Date of Isolation Room Use End
Time of Isolation Room Use End
Patient Status (e.g., Discharged, Deceased)
Reason for Room Decontamination (Brief description)
Observed Hazards (Check all that apply)
Description of Observed Hazards (if any)
Quantity of Infectious Waste Bags
Waste Types Removed (Check all that apply)
Surface Cleaning - Low Touch Areas
Cleaning of areas less likely to be directly touched by patients or healthcare staff.
Ceiling Cleanliness (Visual Inspection)
Window Frame Cleanliness (Visual Inspection)
Baseboard Cleanliness (Visual Inspection)
Notes on Low-Touch Area Cleaning (e.g., unusual stains, damage)
Door Frame Cleanliness (excluding handle)
Surface Cleaning - High Touch Areas
Cleaning of areas frequently touched by patients or healthcare staff.
Door Handles (Interior & Exterior)
Light Switches
Call Buttons/Nurse Call System
Bedside Table/Surface
IV Pole
Overbed Table
Number of IV pump handles cleaned
Decontamination Procedures
Application of appropriate decontaminating agents and processes.
Disinfectant Type Used
If 'Other' Disinfectant Selected, Specify
Disinfectant Contact Time (Minutes)
Areas Decontaminated (Detailed)
Decontamination Method
Photo Documentation (Optional)
Decontamination Start Time
Decontamination End Time
Equipment Cleaning & Disinfection
Cleaning and disinfection of equipment within the isolation room.
Type of Equipment Being Cleaned:
Specify Monitoring Equipment (If selected above):
Cleaning Agent Used:
Specify Disinfectant (If 'Other' selected above):
Contact Time (in minutes):
Photo Documentation (Optional):
Equipment Surfaces Cleaned:
Cleaner Signature
Time of Cleaning
Post-Cleaning Verification & Residual Disinfectant Removal
Ensuring surfaces are dry and safe, and removing residual disinfectant.
Room Airflow Verification (if applicable)
Visual Inspection - Dampness
Residual Disinfectant Odor
Ventilation Time (minutes)
Surface Dryness Verification
Notes/Comments (e.g., any issues encountered or corrective actions taken)
Verification Date
Verification Time
Verifying Personnel Signature
Waste Disposal
Proper disposal of contaminated waste materials.
Waste Stream Segregation - Identify and segregate waste streams:
Number of Red Bags Used
Number of Sharps Containers Used/Filled
Waste Container Condition - Describe condition of waste containers prior to use:
Comments/Observations Regarding Waste Disposal
Waste Transport - How was waste transported from the room?
If 'Other' for Transport - Specify Transport Method:
PPE Removal & Hand Hygiene
Safe removal of PPE and thorough hand hygiene.
Describe PPE Removal Procedure (e.g., donning/doffing sequence)
PPE Removed Correctly (Observe for contamination)?
Hand Hygiene Duration (seconds)
Hand Hygiene Type Performed?
Hand Hygiene Completion – Observe for any skin irritation or issues?
Cleaner Signature
Date of Hand Hygiene Observation
Documentation & Sign-Off
Recording cleaning and decontamination procedures and obtaining necessary signatures.
Date of Cleaning/Decontamination
Start Time of Cleaning/Decontamination
End Time of Cleaning/Decontamination
Reason for Isolation (Patient Type)
Patient Name (if applicable)
Any Unusual Observations or Issues Encountered During Cleaning/Decontamination
Cleaning Staff Signature
Reviewing Supervisor Signature
Room Status After Cleaning
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