SafeTEE Process Analysis Form Step 1 of 5 - Main Information 0% MAIN INFORMATIONDate Performed*Date on which the assessment was performed MM slash DD slash YYYY Person Performing Assessment*Name of the person performing the assessment First Last Email*Email address of the person performing the assessment Facility Name*Name of the hospital or medical facility Facility Location*Relative location of the facility City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Departments Visited*Select the departments visited Select All Central Processing Cardiology Surgical Suite Other Other DepartmentIf Other, enter the name of the department visited STORAGE AND TRANSPORTFor all sections, select all conditions that applyLONG-TERM STORAGEHow are TEE probes stored? (Select all that apply) Probe is stored within a bin, suitcase, drawer, or placed on a shelf Probe is hung vertically Probe is stored in a rack Probe is stored in an open cabinet Probe is stored in a closed cabinet Tip protection is in-place Unknown Other Other storage solutionIf Other, describe the other storage solution Photos of storage practicesProvide photos of how TEE probes are stored Drop files here or Select files Max. file size: 128 MB, Max. files: 2. TRANSPORT TO EXAMWhat are the practices when transporting the probe to the exam location? (Select all that apply) Probe is visually inspected when removed from storage Probe is hand carried Probe is rested on the scanner Probe is placed in a pillowcase or bag Probe is placed in a transport bin or other carrier Nothing is placed in the bin or bag with probe Other item(s) may be placed in bin or bag with probe Tip protection is in-place Unknown Other Other transport practiceIf Other, describe the other transport practices Photos of transport practicesProvide photos of transport practices Drop files here or Select files Max. file size: 128 MB. PRE-USE, DURING-USE, AND POST-EXAMFor all sections, select all conditions that applyTEMPORARY STORAGE AND SETUPHow is the probe staged prior to use? (Select all that apply) Probe remains in the transport bin, bag, case, or other item until insertion Probe is rested across the scanner or alternative device Probe is placed within the probe holders on the scanner Probe is suspended from an IV pole Tip protection is in-place Unknown Other Other setup practiceIf Other, describe the other staging or setup practices Photos of temporary storage, staging, or pre-useProvide photos of how the probe is staged prior to insertion Drop files here or Select files Max. file size: 128 MB. INSERTIONWhat practices are in-place during insertion? (Select all that apply) Bite guards in-use 100% of time on 100% of patients Inconsistent use of bite guards Bite guard placed in mouth PRIOR TO probe insertion Bite guard placed in mouth AFTER probe insertion Unknown Other Other insertion practiceIf Other, describe the other practices observed during insertion EXTRACTIONWhat practices are in-place when the probe is extracted? (Select all that apply) Probe is handed-off to a team member Probe is placed on a table or alternative object/surface Probe is rested on the scanner Probe is set on the floor Probe is placed in a pillowcase or bag Probe is placed in a transport bin or other carrier Tip protection is in-place Unknown Other Other extraction practiceIf Other, describe the other practices observed during/after extraction Photos of extraction and post-use practicesProvide photos of practices after the probe is extracted Drop files here or Select files Max. file size: 128 MB. GROSS CLEANINGGross cleaning is typically performed at the point of care to remove mucous, body fluids, and other materials. It may or may not be performed, or users may wait to perform it as part of general cleaning. When does gross cleaning occur and what practices are in-place? (Select all that apply) Gross cleaning does not occur Gross cleaning is performed at point-of-care Gross cleaning is performed in disinfection area within 1-hour Gross cleaning is performed in disinfection area at some some point Gross cleaning occurs at inconsistent times Unknown Other Other notes for gross cleaningIf Other, describe any other details for gross cleaning GENERAL CLEANING PROCESSGeneral cleaning may incorporate gross cleaning, but also may be a separate task performed by a separate team. General cleaning is designed to remove debris and other materials prior to high-level disinfection. In each section, select all conditions that applyGENERAL CLEANINGWhen does general cleaning occur and what practices are in-place? (Select all that apply) General cleaning does not occur General cleaning is performed at point-of-care General cleaning is performed in disinfection area within 1-hour General cleaning is performed in disinfection area at some point General cleaning occurs at inconsistent times Unknown Other Other notes for general cleaningIf Other, describe any other details for general cleaning PROBE PLACEMENT DURING CLEANINGWhere are the control housing and connector placed during general cleaning?(Select the answer most consistent with the observed practices) Random placement: Laid on a surface, such as a table or countertop Thoughtful placement: Connector and control housing protected from accidental trauma or accidental splashes. Inconsistent placement of control housing and connector Control housing is suspended from a hook or IV pole to protect against accidental trauma Unknown Other Other placement practices during cleaningIf Other, describe the other placement details observed during cleaning Photos of probe placement during cleaningProvide photos of the placement practices during gross cleaning Drop files here or Select files Max. file size: 128 MB. CLEANING PRACTICESWhat practices are occurring during cleaning?(Select all that apply) Control housing may be submerged, at times, to remove debris Control housing may be held under running water, at times, to remove debris Control housing is wiped with a saturated cloth to remove debris Connector is wrapped in a towel to protect against accidental splashing Connector is placed far-away and protected from sink/basin Entire probe is cleaned (tip-to-connector) Only select locations on the probe are cleaned Unknown Other Other practices during cleaningIf Other, describe the other practices observed during cleaning Photos of cleaning practicesProvide photos of the cleaning process Drop files here or Select files Max. file size: 128 MB. CHEMICALS USED DURING CLEANINGExcluding enzymatic cleaners, what liquids or chemicals are used during cleaning? (Select all that apply) Only tap water Tap water and a mild detergent Disinfectant wipe Disinfectant spray Unknown Other Other liquids used during cleaningIf Other, describe the other liquids used to clean the probe Chemical detailsProvide the names of the chemicals, wipes, sprays, or liquids used and the locations on the probe on which the chemical or wipe is used.Photos of chemicals used during cleaning and disinfectionProvide photos of the chemicals in-use Drop files here or Select files Max. file size: 128 MB. ENZYMATIC CLEANERSIs an enzymatic cleaner used as part of the cleaning process to aid in the removal of bio-burden? (Select all that apply) No Yes: Exposure time is not closely monitored, and adequate rinsing may not be occurring Yes: Inconsistent exposure time and inconsistent rinsing occurs Yes: Strict exposure time and adequate rinsing occurs Enzymatic cleaner is applied via a spray, sponge, or wipe A portion of probe is immersed in enzymatic cleaner Unknown Enzymatic Cleaner DetailsEnter the name of the enzymatic cleaner, the exposure time, and the rinsing practiceVISUAL INSPECTIONSWhen do THOROUGH visual inspections of the probe occur? (Select all that apply) Do not occur Occur sporadically Occur during EVERY cleaning cycle Occur as part of or at the beginning of the cleaning process Occur at the end of the cleaning and disinfection process Occur when returned to storage Occur PRIOR-TO a leakage test Occur AFTER a leakage test Unknown Other Other practices for visual inspectionsIf Other, describe the other practices for visual inspections Procces if an issue is found during the visual inspectionDescribe the process that occurs if an issue is found that would permit fluid invasion (hole in bending rubber, cracked tip, missing seals, etc)LEAKAGE/BITE HOLE TESTINGWhen does leakage testing occur? (Select all that apply) Does not occur Occurs sporadically (note interval below) Occurs during EVERY cleaning cycle Occurs AFTER a visual inspection Occurs at the BEGINNING of high-level disinfection Occurs sometime DURING high-level disinfection Occurs AFTER high-level disinfection Unknown Other Other practices for leakage testingIf Other, describe the other practices for leakage testing Leakage/Bite Hole Testing 2If a leakage failure is identified, what occurs next? (Select all that apply) High-level disinfection occurs as normal Probe is immediately removed from the test liquid/disinfectant Probe is wiped with a low or intermediate-level disinfectant Probe is removed from service Unknown Other Other practices for leakage test failuresIf Other, describe the other practices for leakage test failures HIGH-LEVEL DISINFECTIONHigh Level Disinfection may occur in Central Processing or may occur in local departmentsHIGH-LEVEL DISINFECTIONHow are the probes being high-level disinfected Automated system (TD-100, Astra TEE, Medivator, etc.) Manual system (basin, tube, etc.) Photos of disinfection praticesProvide photos of the disinfection practices Drop files here or Select files Max. file size: 128 MB. Immersion LevelIs the probe immersed to the proper level? (Select the answer most consistent with the observed practices) With the probe immersed, the fluid level MAY contact the insertion tube strain relief or control housing With the probe immersed, the fluid level is at least 5cm away from the insertion tube strain relief Inconsistent practices Unknown Immersion TimeIs the probe immersed for the MINIMUM time for disinfection to occur based on the disinfectant's instructions. (Select the answer most consistent with the observed practices) Exposure time is CLOSELY monitored and does not exceed +5 minutes Exposure time is NOT closely monitored Inconsistent practices Unknown Rinsing PracticesIs the probe rinsed appropriately based on the disinfectant's instructions for use (Select the answer most consistent with the observed practices) Rinse time is CONSISTENT with the disinfectant's instructions for use Rinse time is NOT consistent with the disinfectant's instructions for use Inconsistent practices Unkown Drying PracticesIs the probe dried after rinsing? (Select the answer most consistent with the observed practices) Probe is not dried Probe is dried with a lint-free cloth Probe is dried with a towel or washcloth Inconsistent practices Unknown Disinfection Process DetailsEnter the name of the disinfectant, the exposure time, rinsing practices, and any other details RETURN TO STORAGETRANSPORT TO STORAGEWhat occurs when the probe is returned to storage? (Select all that apply) Probe is hand-carried Probe is rested on the an alternative device Probe is placed in a pillowcase or bag Probe is placed in a transport bin or alternative carrier Nothing is placed in bin or bag with probe Additional item(s) placed in bin or bag with probe Tip protection is in-place Unknown Other Other practices for transport to storageIf Other, describe the other practices for transport to storage RETURN TO STORAGEWhat practices are in-place when returning to storage? (Select all that apply) No additional practices are in-place Visual inspection of the connector occurs Functional check of articulation occurs Tip protection is in-place Unknown Other Other practices for return to storageIf Other, describe the other practices for return to storage Additional NotesAdd any additional information that you feel would add to the processAdditional photosProvide any additional photos that help document current practices Drop files here or Select files Max. file size: 128 MB. PhoneThis field is for validation purposes and should be left unchanged.
