BETWEEN-CASE ANESTHESIA WORK AREA CLEANING CHECKLIST (Turnover)
Hospital: ________________________ | Dept of Anesthesia	Form Code: F-26 | Version: ___ | Effective: ___ | PAGE 1 of 1

SECTION 1 — CASE / ROOM IDENTIFICATION
Date: ______/______/_________	Time: __________________	Area: ☐ OR   ☐ NORA ☐ PACU procedure area	Room/Location: __________________
Case # / Patient MRN (optional): __________________________________________		Cleaned by (Name): ______________________ Role: ☐ Anesthesia   ☐ Tech   ☐ Nurse   ☐ EVS Signature: ______________________________

SECTION 2 — DISINFECTANT USED
Disinfectant product name: ________________________________________________ EPA/Facility approved:    ☐ Yes    ☐ No	Required wet contact time: ________ minutes Contact time achieved:    ☐ Yes    ☐ No If No → repeat disinfection. Gloves/PPE used:   ☐ Gloves   ☐ Eye protection   ☐ Gown (if splash risk)

SECTION 3 — HIGH-TOUCH ANESTHESIA ZONE
Instruction: “Clean if soiled → then disinfect. Complete before next patient enters.”
ANESTHESIA MACHINE (external high-touch): ☐ Flow knobs / controls ☐ APL valve / bag area ☐ Ventilator controls/screen ☐ Vaporizer knobs/external surfaces ☐ Drawer handles/handles ☐ Shelf/work ledge MONITORS & ALARMS: ☐ Monitor knobs/buttons ☐ Alarm silence button ☐ Touchscreen/keyboard (if present) ☐ Cables handled during case (wipe external surfaces) SUCTION: ☐ Suction handle/external surfaces ☐ Canister area wiped (external) ☐ Tubing external wipe (if handled)	ANESTHESIA CART / WORK SURFACES: ☐ Cart top surface ☐ Handles ☐ Drawer pulls ☐ Medication prep surface ☐ Computer keyboard/mouse/touchpad (if used) PUMPS / IV POLES: ☐ Syringe pump buttons/knobs ☐ Infusion pump buttons/knobs ☐ IV pole handle/adjusters OTHER HIGH-TOUCH ITEMS (tick if present): ☐ Stethoscope (external wipe) ☐ BP cuff (external) ☐ Temperature probe cable (external) ☐ Ultrasound machine touch points (if used) ☐ Other: ___________________________

SECTION 4 — SOIL / SPILL MANAGEMENT

Visible blood/body fluid contamination present?    ☐ No    ☐ Yes (location): _________________________________ Action taken:    ☐ Cleaned spill    ☐ Disinfected with correct contact time    ☐ Waste disposed correctly

SECTION 5 — COMPLETION & RELEASE
Turnover cleaning completed before next patient:    ☐ Yes    ☐ No
Exceptions/notes: ______________________________________________________________________________________________
Checked by (Charge/Lead optional): Name: ______________________	Signature: ___________________	Time: _________