Checklist template

Surgical suite and sterilization for veterinary hospitals

A ready-to-use checklist with 117 items in 6 sections, covering Suite cleanliness, Instrument processing, Autoclave, Anesthesia equipment, Monitoring, Logs. Use it as-is in Bindy, or adapt it to your own standards in minutes.

  • 6 Sections
  • 117 Items
  • 100 Yes / No checks
  • 6 Scored ratings
  • 130 Points

Use this template How audits work

1. Suite cleanliness 20 items

  1. The surgery room is used only for sterile procedures (no dental cleanings, no abscess or wound treatment) Yes / No 1 pt
  2. The surgery room door is kept closed Yes / No 1 pt
  3. Clipping and the first skin scrub are done in the prep area, outside the surgery room Yes / No 1 pt
  4. The surgery table, its base and the positioning trough are wiped with disinfectant between patients Yes / No 1 pt
  5. Surgical light heads and arms are free of dust Yes / No 1 pt
  6. The surgery room floor is mopped with a mop used only in that room Yes / No 1 pt
  7. Flat surfaces are damp-dusted before the first case of the day Yes / No 1 pt
  8. No cardboard box or bulk stock is stored in the surgery room Yes / No 1 pt
  9. Ceiling vents in the surgery room are free of dust Yes / No 1 pt
  10. Kick buckets are emptied between cases Yes / No 1 pt
  11. Everyone in the room wears a cap and mask once a sterile pack is open Yes / No 1 pt
  12. The scrub sink is located outside the surgery room Yes / No 1 pt
  13. The scrub sink operates without hand contact (knee, foot or sensor control) Yes / No 1 pt
  14. The timed hand scrub or alcohol rub procedure is posted at the scrub sink Yes / No 1 pt
  15. A sterile gown and sterile gloves are worn for every procedure that enters a body cavity Yes / No 1 pt
  16. Patient warming uses warm air or circulating warm water, with no electric heating pad Yes / No 1 pt
  17. The hose and blanket of the warming unit are intact and clean Yes / No 1 pt
  18. The suction canister is emptied or its liner replaced after each case Yes / No 1 pt
  19. The weekly full clean of the surgery room (walls, lights, cabinets, wheels) is recorded Yes / No 1 pt
  20. Cleanliness of the surgery room Rating
    • Clean, clear and restricted to surgery 5 pts
    • Clean but used for storage or other procedures 3 pts
    • Dust, hair or soiled equipment present 1 pt

2. Instrument processing 22 items

  1. Used instruments are soaked or sprayed with enzymatic cleaner before blood dries on them Yes / No 1 pt
  2. Instruments are washed in a dirty area that is separate from the pack-wrapping counter Yes / No 1 pt
  3. Hinged instruments are opened and scrubbed at the box lock Yes / No 1 pt
  4. The ultrasonic cleaner solution is changed daily or when visibly soiled Yes / No 1 pt
  5. Instruments receive a final rinse in distilled or deionized water Yes / No 1 pt
  6. Hinged instruments are dipped in instrument lubricant before wrapping Yes / No 1 pt
  7. Instruments with rust, pitting or misaligned tips are removed from the packs Yes / No 1 pt
  8. Each pack type (spay, general, orthopedic, dental) is assembled from a written list or photo card Yes / No 1 pt
  9. Instruments are wrapped with ratchets unlocked Yes / No 1 pt
  10. A chemical indicator strip is placed in the center of every pack Yes / No 1 pt
  11. Indicator tape seals the outside of every wrapped pack Yes / No 1 pt
  12. Each pack is labeled with its contents Yes / No 1 pt
  13. Each pack is labeled with the date sterilized and the initials of the person who wrapped it Yes / No 1 pt
  14. Sharp tips in pouches are protected so they cannot puncture the pouch Yes / No 1 pt
  15. Gowns and drapes are folded so they can be opened without touching the sterile side Yes / No 1 pt
  16. Cold sterilization solution is used only for items that do not enter sterile tissue Yes / No 1 pt
  17. The cold sterilization tray is marked with the date the solution was changed Yes / No 1 pt
  18. Employees wear utility gloves and eye protection when washing instruments Yes / No 1 pt
  19. Sterile packs are stored in a closed cabinet away from the sink Yes / No 1 pt
  20. Sterile packs checked for date and wrap integrity Number
  21. Packs found torn, damp or past the shelf life set by hospital policy Number
  22. Instrument cleaning and pack preparation Rating
    • Every step followed 5 pts
    • Packs complete but cleaning steps skipped 3 pts
    • Dirty instruments or unlabeled packs found 1 pt

3. Autoclave 20 items

  1. Packs are loaded so they do not touch the chamber walls Yes / No 1 pt
  2. Pouches are placed on edge, paper side to plastic side Yes / No 1 pt
  3. The load does not exceed the capacity stated by the manufacturer Yes / No 1 pt
  4. A chart at the autoclave shows the cycle to select for wrapped packs, pouches and liquids Yes / No 1 pt
  5. The reservoir is filled with distilled water only Yes / No 1 pt
  6. The reservoir is drained and refilled on the schedule set by the manufacturer Yes / No 1 pt
  7. The chamber is cleaned with autoclave cleaner on the schedule set by the manufacturer Yes / No 1 pt
  8. The door gasket is intact and no steam escapes during a cycle Yes / No 1 pt
  9. The chamber drain filter is free of debris Yes / No 1 pt
  10. Packs are dry when taken out of the autoclave Yes / No 1 pt
  11. A pack that comes out damp is rewrapped and sterilized again Yes / No 1 pt
  12. The indicator tape had changed color on every pack sampled in the cabinet Yes / No 1 pt
  13. The internal indicator result of each opened pack is recorded on the surgery record of the case Yes / No 1 pt
  14. A biological indicator (spore test) is run on the schedule set by hospital policy Yes / No 1 pt
  15. Date of the last spore test Date
  16. The employee who runs the autoclave can explain which packs are recalled after a failed spore test Yes / No 1 pt
  17. Date of the last autoclave service by a technician Date
  18. Each load is given a load number that is written on its packs Yes / No 1 pt
  19. The hospital has a written backup for an autoclave breakdown (second unit or a nearby hospital) Yes / No 1 pt
  20. Autoclave operation Rating
    • Loaded, run and verified correctly 5 pts
    • Runs correctly but verification is incomplete 3 pts
    • Overloaded, wet packs or no spore testing 1 pt

4. Anesthesia equipment 22 items

  1. Oxygen flows from the flowmeter and the oxygen flush valve works on each machine Yes / No 1 pt
  2. A chart at the machine gives the breathing circuit and bag size by patient weight Yes / No 1 pt
  3. A non-rebreathing circuit is assembled and ready for the smallest patients Yes / No 1 pt
  4. The vaporizer is filled above its minimum line Yes / No 1 pt
  5. Date the emergency drug kit was last checked Date
  6. The agent of each vaporizer (isoflurane or sevoflurane) is labeled on the machine and matches the bottle in use Yes / No 1 pt
  7. A capnograph sample line and airway adapter are attached and ready before the first case Yes / No 1 pt
  8. Oxygen cylinder pressure on the machine inspected (psi or kPa) Number
  9. A full backup oxygen cylinder with its wrench is on or beside each machine Yes / No 1 pt
  10. Oxygen cylinders are chained or held in a cart Yes / No 1 pt
  11. The pop-off valve is found open except while a breath is being given by hand Yes / No 1 pt
  12. Endotracheal tubes are stocked in every size on the hospital's list, from kitten to large dog Yes / No 1 pt
  13. The cuff of each endotracheal tube is inflated and checked before use Yes / No 1 pt
  14. Endotracheal tubes are washed, dried and stored in a closed container after use Yes / No 1 pt
  15. The laryngoscope light works on each blade size Yes / No 1 pt
  16. Breathing circuits and reservoir bags are washed and hung to dry at the end of each surgery day Yes / No 1 pt
  17. Reservoir bags from 0.5 L to 5 L are stocked at the machines Yes / No 1 pt
  18. A sealed emergency drug kit is kept in or beside the surgery room Yes / No 1 pt
  19. An emergency drug dose chart by body weight is posted where anesthesia is given Yes / No 1 pt
  20. A manual resuscitation bag is at hand in the surgery room Yes / No 1 pt
  21. The fluid pump and the syringe pump power on and hold a set rate Yes / No 1 pt
  22. Readiness of anesthesia equipment Rating
    • Checked and complete 5 pts
    • Working but checks or spares missing 3 pts
    • Faults found on the machine or circuits 1 pt

5. Monitoring 17 items

  1. A trained employee whose only task is monitoring stays with each anesthetized patient from induction to extubation Yes / No 1 pt
  2. The monitor measures pulse oximetry, end-tidal carbon dioxide, blood pressure, ECG and temperature Yes / No 1 pt
  3. Vital signs are written on the anesthesia record at least every 5 minutes Yes / No 1 pt
  4. Monitor alarms are switched on and audible Yes / No 1 pt
  5. Blood pressure cuffs are available in at least five sizes Yes / No 1 pt
  6. An intravenous catheter is placed in every patient under general anesthesia Yes / No 1 pt
  7. A pre-anesthetic checklist (identity, procedure, fasting, blood work, consent) is completed before induction Yes / No 1 pt
  8. The surgeon confirms the patient, the procedure and the surgical site aloud before the first incision Yes / No 1 pt
  9. Sponges are counted before closing the abdomen or chest and the count is recorded Yes / No 1 pt
  10. Eye lubricant is applied after induction Yes / No 1 pt
  11. Body temperature is recorded during anesthesia and again in recovery Yes / No 1 pt
  12. A patient in recovery is not left alone until the endotracheal tube is removed Yes / No 1 pt
  13. Recovery cages are within sight of an employee Yes / No 1 pt
  14. A pain score is recorded before the patient returns to the ward Yes / No 1 pt
  15. Monitor probes and cuffs are wiped between patients Yes / No 1 pt
  16. A Doppler unit or esophageal stethoscope is available as a backup if the monitor fails Yes / No 1 pt
  17. Anesthetic monitoring on 5 records sampled Rating
    • Complete on all 5 5 pts
    • Gaps on 1 or 2 3 pts
    • Gaps on 3 or more 1 pt

6. Logs 16 items

  1. The surgery log lists the date, patient, procedure, surgeon and anesthetist for every procedure Yes / No 1 pt
  2. Anesthesia records sampled Number
  3. Anesthesia records sampled that were filed in the patient record Number
  4. Anesthetic complications and deaths are recorded in a log that the medical director reviews Yes / No 1 pt
  5. The sterilizer load log has an entry for every load of the last 2 weeks Yes / No 1 pt
  6. Spore test results are kept for the period set by hospital policy or local regulation Yes / No 1 pt
  7. The anesthesia machine pre-use checklist is initialed for each surgery day of the last 2 weeks Yes / No 1 pt
  8. The equipment maintenance log gives the next service date of the monitors, anesthesia machines and surgical lights Yes / No 1 pt
  9. The daily cleaning log of the surgery room is initialed for each surgery day of the last 2 weeks Yes / No 1 pt
  10. Surgical site infections reported at rechecks are recorded in a log Yes / No 1 pt
  11. Surgical site infections recorded in the last 3 months Number
  12. A sample of 10 suture packets and implants found none past its expiry date Yes / No 1 pt
  13. Today's surgery schedule, with each patient's weight and procedure, is posted in the prep area Yes / No 1 pt
  14. Name of the lead surgical technician Short text
  15. Overall surgery preparation and instrument processing Rating
    • Suite, packs, autoclave and anesthesia all ready and recorded 5 pts
    • Ready, with gaps in checks or records 3 pts
    • Unsterile packs, faulty equipment or missing monitoring found 1 pt
  16. Corrective actions required in surgery and sterilization 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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