The Nebraska ICAP team frequently provides assistance to infection preventionists in setting up various infection control measures. During this process, sometimes we develop new tools for them or suggest use of certain tools/forms that are already available. We have compiled the more commonly used tools and forms and divided those into categories. Please click on the categories below to find all the available tools/forms within that category.
Infection Prevention Checklist for Dental Settings: Basic Expectations for Safe Care
Ambulatory Surgical Center Infection Control Surveyor Worksheet
Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program
Precious Drugs & Scary Bugs: Antibiotic Stewardship Toolkit for Dental Providers November 2017
MODULE 1 —Introduction; IC in Dental Settings – Basic Expectations for Safe Care Training Modules
MODULE 2 – Hand Hygiene; IC in Dental Settings – Basic Expectations for Safe Care Training Modules
MODULE 5 – Sharps Safety; IC in Dental Settings – Basic Expectations for Safe Care Training Modules
CIdex OPA Competency Checklist
Essential Elements of a Reprocessing Program for Flexible Endoscopes – Recommendations of the HICPAC
Nebraska ICAP Environmental Cleaning Videos
NE ICAP EVS Audit Planning Worksheet: Acute Care
NE ICAP EVS Audit Planning Worksheet: Long-Term Care
NE ICAP EVS Cleaning Audit Assignment Worksheet: Long-Term Care
NE ICAP EVS Cleaning Audit Assignment Worksheet: Acute Care
NE ICAP Patient Room EVS Audit Tracking Form
NE ICAP Public Area/ Public Restroom EVS Audit Tracking Form
NE ICAP Spa Shower EVS Audit Tracking Form
Annual Blacklight Tracking Workbook (Access fillable file by opening in Google Chrome)
APIC Environmental Rounds Worksheet
AORN Sample Cleaning checklist (General)
AORN Sample Enhanced Cleaning checklist
ICAP Hand Hygiene Monitoring in Hospitals
ICAP Hand Hygiene Monitoring in LTC
NCSPICE Hand Hygiene Competency NCSPICE
ICAP Blood Glucose Monitoring Audit Tool
Virginia Dept. of Health Administrator’s Checklist for Safe BGM
If you are unable to find a resource on our website, please feel free to contact us by emailing subeach@nebraskamed.com . We will try to help you in finding that resource and if possible make it available on our website for others.
Page last reviewed: February 12, 2019