Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
| Surveillance | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Performs targeted surveillance |
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| Outbreak investigations |
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| Collaboration with Infection Control Committee |
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| Collaboration with Hospital Epidemiologist |
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| Performance improvement projects related in communicable diseases |
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| Collects, monitors, and maintains data using facility HER |
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| Utilize Center for Disease Control (CDC) |
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| Infection criteria |
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| TB, AIDS |
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| Documentation and investigation techniques |
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| Rounds of hospital units |
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| Case definition, and other related patient care issues |
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| Monitor infection control practices |
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| Nosocomial infections or AHIs, MRSAs |
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| Health care workers exposures |
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| Tracing the possible sources of infection or transmission of microorganisms |
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| Identification of Problems | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Regularly meet with the hospital Epidemiologist |
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| Risk reduction among patients, facility staff, volunteers, students, and visitors |
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| Understand the transmission and break of infections |
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| Identification of epidemiologically important issues for Infection Control Committee |
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| Hospital Epidemiologist, and Administration | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Design COA including Surveillance, Outbreak Investigations, and Performance Improvement Projects |
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| Communicable diseases reporting as required by the state and the local health authority |
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| Compliance with federal and state laws regarding medical wastes, chemicals in the workplace, infectious disease exposures |
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| OSHA NIOSH standards |
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| Blood borne pathogens and respiratory pathogens |
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| Chart review |
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| Policies and Procedures | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Infection Control policies associated with infection |
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| Staff practices associated with infection contol |
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| Professional guidelines (CDC, APIC, etc.) |
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| The Joint Commission guidelines on infection Control |
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| Infection Control Plan to reflect and meet any required changes |
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| Coordination | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Acts as department liaison for Infection Control Department |
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| Act as consultant for the facility Infection Control activities |
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| Interdepartment and personnel coordination on risk reduction, transmission and improved infection control practices |
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| Provide coordinated services to patients for the improvement of overall |
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| Patient care |
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| Education | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| In-services of all and current employees on Infection Control |
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| Orientation programs of new employees on Infection Control |
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| Infection Control techniques and Policies and Procedures |
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| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Infant (Birth - 1 year) |
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| Preschooler (ages 2-5 years) |
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| Childhood (ages 6-12 years) |
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| Adolescents (ages 13-21 years) |
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| Young Adults (ages 22-39 years) |
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| Adults (ages 40-64 years) |
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| Older Adults (ages 65-79 years) |
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| Elderly (ages 80+ years) |
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