Checklist template

Infection prevention and control for dental practices

A ready-to-use checklist with 118 items in 6 sections, covering Hand hygiene, Protective equipment, Surface disinfection, Waterlines, Sharps, Training. Use it as-is in Bindy, or adapt it to your own standards in minutes.

  • 6 Sections
  • 118 Items
  • 101 Yes / No checks
  • 6 Scored ratings
  • 131 Points

Use this template How audits work

1. Hand hygiene 19 items

  1. A handwashing sink is located in each operatory or directly outside its door Yes / No 1 pt
  2. Sink faucets used by clinical employees work by sensor, foot, knee or elbow Yes / No 1 pt
  3. Soap dispensers take sealed cartridges, or are washed and dried before refilling; none are topped up Yes / No 1 pt
  4. Hands are dried with disposable paper towels, with no cloth towels at staff sinks Yes / No 1 pt
  5. Alcohol-based hand rub containing 60% to 95% alcohol is within reach of the chair in each operatory Yes / No 1 pt
  6. Hand rub is available at the entrance to the sterilization area Yes / No 1 pt
  7. Hand rub containers are within their expiry date Yes / No 1 pt
  8. Hand hygiene moments observed during the visit Number
  9. Hand hygiene moments observed where hand hygiene was performed Number
  10. Providers observed cleaned their hands before putting on gloves Yes / No 1 pt
  11. Providers observed cleaned their hands right after removing gloves Yes / No 1 pt
  12. Providers observed rubbed their hands until dry before gloving, without wiping off the hand rub Yes / No 1 pt
  13. Employees asked said they wash with soap and water, not hand rub, when hands are visibly soiled Yes / No 1 pt
  14. Fingernails of clinical employees are short, with no artificial nails Yes / No 1 pt
  15. Clinical employees wear no rings with stones, bracelets or wristwatches during patient care Yes / No 1 pt
  16. Cuts on the hands of clinical employees are covered with a waterproof dressing Yes / No 1 pt
  17. Hand lotion supplied in clinical areas is stated by its maker to be compatible with gloves Yes / No 1 pt
  18. Sterile gloves are worn after surgical hand antisepsis for implant placement and surgical extractions Yes / No 1 pt
  19. Hand hygiene observed Rating
    • Performed at every moment observed 5 pts
    • Missed at some moments 3 pts
    • Missed at most moments 1 pt

2. Protective equipment 19 items

  1. Latex-free gloves are available for patients and employees with a latex allergy Yes / No 1 pt
  2. Providers observed put on new gloves for each patient Yes / No 1 pt
  3. Providers observed removed their gloves before leaving the operatory during treatment Yes / No 1 pt
  4. Gloves are not washed or disinfected for reuse Yes / No 1 pt
  5. Sterile surgical gloves are stocked in the sizes worn by the providers who perform surgery Yes / No 1 pt
  6. Masks were changed between patients during the visit Yes / No 1 pt
  7. Masks observed covered both nose and mouth, with none worn under the chin Yes / No 1 pt
  8. Employees observed did not touch their mask or eyewear with gloved hands during treatment Yes / No 1 pt
  9. Fitted respirators (N95 or equivalent) are stocked for the situations named in the practice's respiratory protection policy Yes / No 1 pt
  10. A fit test record is on file for each employee who wears a fitted respirator Yes / No 1 pt
  11. Providers observed wore eye protection with side shields or a face shield during procedures Yes / No 1 pt
  12. Providers' face shields and protective eyewear are cleaned and disinfected between patients Yes / No 1 pt
  13. Long-sleeved gowns or clinic jackets are worn for procedures that produce spray or spatter Yes / No 1 pt
  14. Gowns and clinic jackets are changed daily and when visibly soiled Yes / No 1 pt
  15. Gowns and clinic jackets are removed before employees enter the break room or leave the building Yes / No 1 pt
  16. Contaminated clinic attire is laundered on site or by a laundry service, not taken home Yes / No 1 pt
  17. Employees observed removed protective equipment without touching its outer surface with bare hands Yes / No 1 pt
  18. High-volume evacuation was used during the ultrasonic scaling and handpiece procedures observed Yes / No 1 pt
  19. Use of protective equipment observed Rating
    • Correct on every procedure observed 5 pts
    • Occasional lapses 3 pts
    • Frequent lapses 1 pt

3. Surface disinfection 20 items

  1. The disinfectant used on clinical contact surfaces is registered for healthcare use with a tuberculocidal claim Yes / No 1 pt
  2. The infection prevention manual names the approved surface disinfectant, and no other product is in use in the operatories Yes / No 1 pt
  3. Concentrated disinfectant is diluted with a measuring device to the ratio on its label Yes / No 1 pt
  4. Bottles of diluted disinfectant are labeled with the product name and the date mixed Yes / No 1 pt
  5. Disinfectant products are within their expiry date Yes / No 1 pt
  6. Earliest expiry date among the disinfectant products in use Date
  7. The safety data sheet of each disinfectant is available in the clinical area Yes / No 1 pt
  8. Cleaning contractors working in clinical areas follow the written cleaning instructions of the practice Yes / No 1 pt
  9. The written operatory disinfection list names the surfaces touched during treatment that carry no barrier (drawer handles, countertops, chair controls) Yes / No 1 pt
  10. Operatories and the sterilization area have no carpet or fabric-covered furniture Yes / No 1 pt
  11. Floors and sinks in clinical areas are cleaned daily according to a signed schedule Yes / No 1 pt
  12. Walls, blinds and window sills in the operatories are cleaned on the schedule in the infection prevention manual Yes / No 1 pt
  13. Cleaning cloths and mops used in clinical areas are kept separate from those used in restrooms Yes / No 1 pt
  14. A spill kit for blood and body fluids is available in the clinical area Yes / No 1 pt
  15. An employee asked could describe the steps for a blood spill: absorb, clean, then disinfect Yes / No 1 pt
  16. Biohazard waste awaiting pickup is held in closed, labeled containers in a staff-only area Yes / No 1 pt
  17. Regulated medical waste is collected by a licensed hauler and the manifests are kept on file Yes / No 1 pt
  18. Extracted teeth containing amalgam are kept out of waste destined for heat treatment or incineration Yes / No 1 pt
  19. Food and drinks are stored in a refrigerator separate from the one holding clinical materials Yes / No 1 pt
  20. Surface disinfection program Rating
    • Approved product, written list and cleaning schedule all followed 5 pts
    • Product correct, list or schedule not followed 3 pts
    • Wrong product or no schedule 1 pt

4. Waterlines 22 items

  1. Dental units in the practice Number
  2. Dental units sampled at the last waterline test Number
  3. The last waterline test covered every dental unit in the practice, not a rotating sample Yes / No 1 pt
  4. Samples are taken from the lines used on patients (air-water syringe, handpiece line), not from the bottle Yes / No 1 pt
  5. Ultrasonic scalers and other devices with their own water supply are included in the waterline tests Yes / No 1 pt
  6. Samples are collected by an employee trained in the sampling method of the laboratory or test kit Yes / No 1 pt
  7. Waterline test results are logged by operatory and by unit for at least the last 12 months Yes / No 1 pt
  8. Units above 500 CFU/mL at the last waterline test Number
  9. A sign or tag marks any unit awaiting a passing retest as out of patient use Yes / No 1 pt
  10. The cause of each failed test in the last 12 months was looked into and recorded Yes / No 1 pt
  11. The backflow prevention device on the water supply to the dental units was tested within the interval required by local regulation Yes / No 1 pt
  12. The infection control coordinator initials each set of waterline results Yes / No 1 pt
  13. The written waterline protocol names the treatment product, the test schedule and the action level Yes / No 1 pt
  14. The treatment product in use is listed as compatible by the maker of the dental units Yes / No 1 pt
  15. The waterline protocol was reviewed after the last change of treatment product or dental unit model Yes / No 1 pt
  16. Dental unit water heaters are switched off or disconnected Yes / No 1 pt
  17. Anti-retraction valves are checked or replaced on the schedule given by the dental unit's maker Yes / No 1 pt
  18. Patients are not told to close their lips around the saliva ejector Yes / No 1 pt
  19. New units and units that had water line repairs are tested before patient use Yes / No 1 pt
  20. The practice has a written procedure for a boil-water advisory Yes / No 1 pt
  21. An employee asked could describe what to do during a boil-water advisory Yes / No 1 pt
  22. Oversight of dental unit water quality Rating
    • All units tested, logged and acted on 5 pts
    • Tested, with gaps in coverage or follow-up 3 pts
    • No testing program 1 pt

5. Sharps 19 items

  1. A sharps container is within arm's reach of where sharps are used in each operatory Yes / No 1 pt
  2. Sharps containers are puncture-resistant, closable and carry the biohazard label Yes / No 1 pt
  3. Sharps containers are mounted or placed upright, out of the reach of children Yes / No 1 pt
  4. Full sharps containers are closed and held in a locked or staff-only area until pickup Yes / No 1 pt
  5. A recapping device or safety syringe is available in each operatory Yes / No 1 pt
  6. Each needlestick in the log was reviewed to identify the device and the task involved Yes / No 1 pt
  7. Orthodontic wires, used burs and endodontic files are discarded in the sharps container, not in the regular trash Yes / No 1 pt
  8. Scalpel blades are removed with a blade remover or forceps, not with fingers Yes / No 1 pt
  9. Burs are removed from handpieces before the handpieces are returned to the unit holder Yes / No 1 pt
  10. Sharps containers are never shaken or emptied, and items are never pushed in by hand Yes / No 1 pt
  11. Safer sharps devices were evaluated with chairside employees in the last 12 months, with the evaluation on file Yes / No 1 pt
  12. The written exposure control plan was reviewed in the last 12 months Yes / No 1 pt
  13. Date of the last review of the exposure control plan Date
  14. The post-exposure procedure is posted with the name and phone number of the medical provider to contact Yes / No 1 pt
  15. An employee asked could state the first steps after a needlestick Yes / No 1 pt
  16. A sharps injury log is kept at the practice Yes / No 1 pt
  17. Sharps injuries recorded in the last 12 months Number
  18. Each injury in the log has a record of medical follow-up Yes / No 1 pt
  19. Sharps safety Rating
    • Safe handling observed and exposure plan current 5 pts
    • Safe handling, plan or log out of date 3 pts
    • Unsafe handling observed 1 pt

6. Training 19 items

  1. An infection control coordinator is named in writing Yes / No 1 pt
  2. Name of the infection control coordinator Short text
  3. A written infection prevention manual specific to the practice is available to every employee Yes / No 1 pt
  4. New clinical employees completed infection control training before their first patient contact Yes / No 1 pt
  5. Every clinical employee attended infection control training in the last 12 months Yes / No 1 pt
  6. Date of the last infection control training Date
  7. Bloodborne pathogens training is given at the interval required by local regulation Yes / No 1 pt
  8. Infection control training records show the date, the content, the trainer and each attendee's signature Yes / No 1 pt
  9. Each clinical employee has a hepatitis B vaccination record or a signed declination on file Yes / No 1 pt
  10. Temporary and agency hygienists receive a site orientation on infection control before treating patients Yes / No 1 pt
  11. The competency of each assistant in hand hygiene and protective equipment was observed and recorded in the last 12 months Yes / No 1 pt
  12. Hand hygiene observations are carried out on the schedule set by company policy Yes / No 1 pt
  13. The written policy states when an ill employee must stay away from patient care Yes / No 1 pt
  14. Signs at the entrance ask patients with a cough or fever to tell the front desk Yes / No 1 pt
  15. Masks and tissues are available in reception for patients with respiratory symptoms Yes / No 1 pt
  16. An infection control self-assessment of the practice was completed in the last 12 months Yes / No 1 pt
  17. Corrective actions from the previous infection control inspection have been completed Yes / No 1 pt
  18. Overall infection prevention and control Rating
    • Meets standards 5 pts
    • Meets most standards 3 pts
    • Below standards 1 pt
  19. Findings and corrective actions Comments

About this template

This checklist is part of the Bindy template library. Yes / No checks score 1 point when met; ratings score the points shown for each option. The overall score is the percentage of points earned, with N/A answers excluded. In Bindy you can add photos, assign corrective actions, require sign-off and compare results across sites.

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