THE IPC FORMS TOOLKIT
Welcome to the IPC Forms Toolkit!
Check below for templates, observation tools, risk assessments, and more that you can use to develop or enhance your own program!
PROGRAM & RISK ASSESSMENT
CDC
ACUTE CARE
"This tool is intended to assist in the assessment of infection control programs and practices in acute care hospitals. If feasible, direct observations of infection control practices are encouraged. To facilitate the assessment, health departments are encouraged to share this tool with hospitals in advance of their visit."
CDC
LONG-TERM CARE
"This tool is intended to assist in the assessment of infection control programs and practices in nursing homes and other long-term care facilities. If feasible, direct observations of infection control practices are encouraged. To facilitate the assessment, health departments are encouraged to share this tool with facilities in advance of their visit."
CDC
OUTPATIENT
"This tool is intended to assist in the assessment of infection control programs and practices in outpatient settings. In order to complete the assessment, direct observation of infection control practices will be necessary. To facilitate the assessment, health departments are encouraged to share this tool with facilities in advance of their visit."
CDC
HEMODIALYSIS FACILITY
"This tool is intended to assist in the assessment of infection control programs and practices in dialysis facilities. In order to complete the assessment, direct observation of infection control practices will be necessary. To facilitate the assessment, health departments are encouraged to share this tool with facilities in advance of their visit."
APIC
AMBULATORY FACILITY RISK ASSESSMENT TOOL
"This Risk Assessment tool, beginning on page 6, can be used to conduct a facility risk assessment for acquiring and transmitting infections in a variety of ambulatory healthcare settings.
CDC
CORRECTIONS FACILITY (COVID)
"This tool can help state and local health departments provide technical assistance to correctional and detention facilities during the COVID-19 pandemic. Each question in this document is intended to initiate discussion between the health department interviewer and facility representative(s) about a specific part of CDC’s guidance for correctional and detention facilities. Some questions have discrete response options while other are open-ended.
APIC'S IMPLEMENTATION GUIDES
"APIC Implementation Guides provide practical, evidence-based strategies for surveillance and the elimination of infection. Each guide includes online tools and resources."
Guides Include topics on:
Operating Room/Peri-op
CLABSI and CAUTI Prevention
CDiff Prevention
MRSA Prevention (Acute and Long-term Care)
SSI Prevention (Ortho and CABG)
Hemodialysis
Hand Hygiene
And more!
MDRO ASSESSMENT AND PREVENTION
CDC
MDRO ACTIVITY ASSESSMENT TOOL
"This form can be used to assess the program in place in acute care hospitals to control transmission of multidrug-resistant organisms (MDROs)."
ENVIRONMENT OF CARE
Cleaning, Disinfection, Sterilization, Injection Safety, Standard and Transmission-based Precaution, etc.
CONSTRUCTION
ASHE
INFECTION CONTROL RISK ASSESSMENT (ICRA) DURING CONSTRUCTION AND RENOVATION
Example of ICRA form provided by the American Society for Healthcare Engineering (ASHE)
DATA COLLECTION
APIC
DATA TABULATION EXCEL SPREADSHEET
"The Microsoft Excel™ spreadsheet available for download includes 12 tabs (labeled T1-T12) for data entry of summary observations for 12 time periods (e.g., one per month) covering all 123 questions found on all 22 observation tools (see example here)"