Template

Prevention of Retained Surgical Items Checklist

by D W, from the Community

20+

Use this CMHS scrub assessment to help perioperative teams prevent retained surgical items. It guides sponge and instrument counts before incision, at wound and skin closure, and during handoffs; supports organized sterile fields, visual and verbal participation by scrub and circulator, reference to the count board, safe sharps handling, discrepancy escalation, and postoperative verification. Ideal for hospitals and surgical centers seeking consistent, auditable practice aligned with patient safety.

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Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

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This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
CMS Surgical Services Requirements Checklist
Use this checklist to assess compliance with CMS hospital surgical services requirements. It covers organization and staffing, circulating and scrub roles, surgical privileges, policies and protocols, informed consent, required equipment, and provisions for immediate postoperative care. Includes guidance on outpatient alignment with inpatient quality, PACU monitoring, and safety practices such as alcohol based skin prep risk reduction and surgical counts.
by Chad Niemeyer, from the Community
Downloads: 20+
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OR Infection Prevention Checklist
This operating room infection prevention checklist helps audit compliance with hospital policies, AORN standards, and CDC guidance. It covers surgical attire, sterile field setup and maintenance, hand scrub and skin prep, traffic control, medication labeling, sharps disposal, environmental cleaning, storage practices, and equipment handling. Use it to document findings, take corrective actions, and support safe, compliant perioperative care across the OR.
by Madeline Burroughs, from the Community
Downloads: 0
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Operating Room Infection Prevention Rounding Tool
This operating room infection prevention rounding tool helps hospitals monitor compliance with AORN and CDC standards across key perioperative practices. It covers surgical attire, sterile field preparation and maintenance, surgical hand scrub, and Universal Protocol time-out. The checklist includes skin prep steps, traffic control, environmental cleaning between cases, temperature and humidity monitoring, and proper storage of linens, equipment, and sterile supplies. It guides safe medication labeling and storage, sharps handling and disposal, fluid warmer checks, and separation of clean and soiled areas. General infection prevention practices include biohazard waste management, disinfectant use and contact times, blood spill protocol, isolation guidelines, MDRO awareness, and hand hygiene requirements.
by Neelie37 User, from the Community
Downloads: 10+
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UWNI Infection Prevention Surgery Observation
Use this UWNI infection prevention surgery observation checklist to audit OR compliance, sterile technique, surgical attire, hand scrub practices, skin prep, time out, traffic control, sharps management, and waste handling. Track adherence to manufacturer directions and aseptic protocols, confirm proper draping and instrument sterilization, and document actions taken. Designed to support safer procedures and reduce surgical site infection risk.
by Infection Prevention Specialist, from the Community
Downloads: 10+
Get

CMS Surgical Services Requirements Checklist

Use this checklist to assess compliance with CMS hospital surgical services requirements. It covers organization and staffing, circulating and scrub roles, surgical privileges, policies and protocols, informed consent, required equipment, and provisions for immediate postoperative care. Includes guidance on outpatient alignment with inpatient quality, PACU monitoring, and safety practices such as alcohol based skin prep risk reduction and surgical counts.

by Chad Niemeyer, from the Community

20+

Get

Template

OR Infection Prevention Checklist

This operating room infection prevention checklist helps audit compliance with hospital policies, AORN standards, and CDC guidance. It covers surgical attire, sterile field setup and maintenance, hand scrub and skin prep, traffic control, medication labeling, sharps disposal, environmental cleaning, storage practices, and equipment handling. Use it to document findings, take corrective actions, and support safe, compliant perioperative care across the OR.

by Madeline Burroughs, from the Community

Get

Template

Operating Room Infection Prevention Rounding Tool

This operating room infection prevention rounding tool helps hospitals monitor compliance with AORN and CDC standards across key perioperative practices. It covers surgical attire, sterile field preparation and maintenance, surgical hand scrub, and Universal Protocol time-out. The checklist includes skin prep steps, traffic control, environmental cleaning between cases, temperature and humidity monitoring, and proper storage of linens, equipment, and sterile supplies. It guides safe medication labeling and storage, sharps handling and disposal, fluid warmer checks, and separation of clean and soiled areas. General infection prevention practices include biohazard waste management, disinfectant use and contact times, blood spill protocol, isolation guidelines, MDRO awareness, and hand hygiene requirements.

by Neelie37 User, from the Community

10+

Get

Template

UWNI Infection Prevention Surgery Observation

Use this UWNI infection prevention surgery observation checklist to audit OR compliance, sterile technique, surgical attire, hand scrub practices, skin prep, time out, traffic control, sharps management, and waste handling. Track adherence to manufacturer directions and aseptic protocols, confirm proper draping and instrument sterilization, and document actions taken. Designed to support safer procedures and reduce surgical site infection risk.

by Infection Prevention Specialist, from the Community

10+

Get

Prevention of Retained Surgical Items Checklist

About author

You might also like

CMS Surgical Services Requirements Checklist

OR Infection Prevention Checklist

Operating Room Infection Prevention Rounding Tool

UWNI Infection Prevention Surgery Observation

You might also like

CMS Surgical Services Requirements Checklist

OR Infection Prevention Checklist

Operating Room Infection Prevention Rounding Tool

UWNI Infection Prevention Surgery Observation