By: Eileen Thompson & Jill Holdsworth
Introduction
Infection prevention (IP) rounds are one of the most powerful tools available to healthcare organizations. They provide an opportunity to move beyond policies and written procedures to understand what is actually happening at the point of care. IPs split their time between many competing priorities, including surveillance, investigations, construction audits, procedure observations, performance improvement projects, and various types of rounds.
Many organizations unintentionally reduce rounding to a compliance exercise: a checklist is completed, a few deficiencies are documented, and the report is filed away until the next scheduled visit. Effective rounding should accomplish much more than this. IPs should round on the physical environment, processes, knowledge, and many other items as appropriate. In addition to this, IPs should round in ALL areas of the facility, not just the areas that impact the facility scorecard or overall metrics. Patient safety matters in all areas where patient care is provided or impacted, whether or not the area is patient-facing.
The best infection prevention rounding programs add value for the rounding area. The focus is not on simply finding deficiencies and checking boxes based on policies, but, instead, is placed on strengthening relationships, identifying system barriers before they become patient safety events, reinforcing positive behaviors, and creating meaningful action plans that lead to measurable improvements over time. Whether evaluating sterile processing departments, ultrasound probe reprocessing, endoscopy, respiratory therapy, or any area involving reusable medical devices, successful rounding means impactful rounding programs, and that requires consistency, curiosity, collaboration, and follow-through.
IP rounding is critical and should be performed with such frequency and across shifts so the IP may observe daily practice and understand the barriers in everyday workflows. This includes observing human factors considerations and other contributing factors such as production pressures, competing priorities, staff turnover, workflow interruptions, and equipment limitations.
Regular rounding allows IP to:
- Identify breakdowns before they contribute to infections.
- Detect trends across departments.
- Reinforce evidence-based practices
- Build trust with frontline staff.
- Improve regulatory readiness
- Promote a culture of continuous improvement.
- Better understand workflow challenges faced by frontline teams.
Misconceptions
Perhaps the biggest misconception surrounding IP rounds is that they exist to "catch people doing something wrong." IPs have long been called the "hand hygiene police" or the "infection cops". As endearing as these nicknames are, the IP rounds are so much more than just audits. Just as our SPD Technicians are so much more than the "dishwashers downstairs". Breaking down this stereotype should be first and foremost on all IPs minds. When team members perceive rounds as inspections, they often become anxious, defensive, or less transparent.
Successful IP rounds should focus beyond the checklist and function as collaborative conversations. Open-ended questions and polite observation frequently reveal barriers that are invisible on paper. Rather than asking: "Why didn't this get done?" The IP should focus on being curious, learning, and asking questions such as: "Can you walk me through your process?" Often, the process, not the employee, is the problem.
Skills for Successful Rounding
The most successful IPs excel in communication and humility. Technical knowledge is only one part of effective rounding and takes years to develop. It is important for IPs to acknowledge that they will not have all the answers, and that they may instead serve as liaisons to solutions: consulting the Manufacturer's Instructions for Use, conducting vendor outreach, or simply spending time researching a topic. Taking on these tasks for an already overburdened SPD team will not only earn an IP great appreciation but will also serve as a great vector for knowledge accumulation.
Additional skills for an IP to master include active listening, emotional intelligence, conflict resolution, coaching, relationship building, positive reinforcement, and inquisitiveness. Listening to the team members will build trust and equity. Sometimes listening can be just as effective as providing timely solutions. Often, the team members will already have a suggestion in mind. Positive reinforcement and inquisitiveness will show the team you are doing more than passively auditing, and will give them a chance to showcase the hard work they do daily. With coaching, the IP is showing their mastery, and showing they have put themselves in the team member's shoe covers. For newer IPs, participating in small tasks around the department can serve the same purpose, such as unloading a cart washer or helping apply load stickers. All of these skills do not develop overnight and will take time for the IP to become proficient.
Preparation
Effective rounding begins before the IP ever enters the department. Walking in cold wastes the limited time available and signals to the team that the visit is routine rather than intentional. Preparation allows the IP to round with purpose and to be already fluent in the department's history.
Prior to rounding, the IP should:
- Review past rounding reports to establish a baseline of expectations, anticipated findings, and open action items still awaiting verification.
- Check for updates to relevant standards, manufacturer IFUs, and facility policies, so observations are measured against current expectations rather than outdated ones.
- Review related audits and data that inform the visit, such as IUSS logs, contamination or bioburden reports, tray-error data, and competency completion
- Coordinate with the department leader on timing, so the visit lands when staff can actually engage rather than during a production crunch.
- Confirm the rounding tool or checklist is current and ready to serve as a conversation starter.
Preparation also means deciding what the visit is for. A general relationship-building round looks different from a targeted follow-up on an active action plan. Knowing the purpose in advance keeps the IP focused and respects the team's time.
What to Observe
While each organization has unique workflows, comprehensive rounding should evaluate the entire reprocessing process. And while rounding itself should not focus on checking boxes, having a checklist can offer a jumping-off point for conversation starters. Standardized checklists improve consistency between infection preventionists and ensure important observations are not overlooked.
Organizations should consider the following when developing rounding tools:
- Regulatory expectations
- Manufacturer Instructions for Use (IFU)
- Organizational policies
- Best practices
- Space for observations
- Action items
- Follow-up documentation
Some examples of sections to include in your rounding tool/checklist are:
Environment
- Clean and dirty workflow separation
- Hand hygiene accessibility
- PPE availability
- Sink configuration
- Water quality considerations
- Storage conditions
- Traffic patterns
Equipment
- Equipment condition
- Preventive maintenance
- IFUs available
- Leak testing equipment (TEE probes)
- Timers
- Cleaning accessories
- Drying equipment
Reprocessing Process
- Point-of-use cleaning
- Transport
- Manual cleaning technique
- Detergent preparation
- High-level disinfection
- Rinsing
- Drying
- Inspection
- Storage
- Documentation
- Traceability
Documentation
- Competencies
- Training records
- Preventive maintenance
- Quality monitoring
- MRC/MEC documentation
- Exposure logs
- Incident reports
Human Factors
- Interruptions
- Staffing levels
- Workload
- Workflow bottlenecks
- Ergonomic concerns
- Process variation
Looking at the entire "system" of a department as a whole often reveals opportunities that individual observations or audits alone may miss. Scheduling enough time to spend with the leader and team in the department will provide the IP a chance to ask questions, learn, and interact with the individual contributors (which is where the best information hides).
"Stop Button" Findings:
In the rare event of an immediate risk to life or patient safety, rounding may need to be halted to triage a high-level concern. The IP must decide right away whether the concern requires stopping the rounding and the line: quarantining trays, pulling instruments, sequestering a load, or notifying the OR about potentially affected sets. Immediate containment comes before a report and subsequent action planning. If there's any chance a device reached a patient, that shifts into recall/notification and possible risk-management/IP escalation. Key stakeholders should be pulled in immediately for escalation. This may include the perioperative team, educators, life safety team members, and others.
Rounding Frequency
There is no set answer for how often IP rounding should occur. The frequency should reflect the organizational and departmental needs as well as align with the facility risk assessment. Additionally, the rounding should be set to a cadence that allows team members to recognize the IP to start building a relationship of mutual trust. Without this recognition, team members may continue to feel uncomfortable talking to the "surveyor." Moreover, the team will then feel more comfortable voicing underlying concerns. Consistency is key. Additionally, past reports should be reviewed to establish a baseline of expectations, anticipated findings, and identify key rounding priorities prior to rounding in the department.
Rounding frequency may be increased or decreased based on consistency of findings and based on additional audits reviewed by IP (IUSS, contamination reports, etc.). If an action plan is developed and implemented, then an increase in rounding frequency should be expected. This additional time in the department will allow the IP to monitor for outcomes of the action(s) put in place and observable roadblocks. Relationship building before this stage is key so that team members will voice their own ideas about what should/can be modified so the action plan is successful.
Many rounding programs fail because observations never become action. Without accountability, even excellent observations rarely lead to lasting improvement.
Announced, Unannounced, and Multidisciplinary Rounding
Two practical questions shape every rounding program: whether visits are announced, and who rounds alongside the IP.
Announced rounds allow the department leader to prepare, ensure the right team members are available, and treat the visit as a partnership. They tend to build relationship equity and reduce the "surveyor" anxiety that undermines transparency. Unannounced rounds, by contrast, capture daily practice as it actually happens, including the production pressures and workflow interruptions that a scheduled visit can mask. Neither approach is correct in isolation. Most mature programs use a blend: announced rounds to build trust and work action plans collaboratively, with periodic unannounced observation to confirm that practice holds when no one is preparing for a visit. The right balance should reflect the department's risk profile and the maturity of the IP's relationship with the team.
Who rounds matters as much as when. Rounding alongside SPD leadership, the department educator, or a perioperative partner reinforces that a finding is a shared responsibility rather than an IP verdict handed down from outside. A multidisciplinary round distributes ownership, surfaces contributing factors the IP cannot see alone, and shortens the path from observation to action because the people who can fix the problem are already in the room. It also reinforces the central premise that rounding is a partnership, not a policing function.
Reporting
Rounding that goes undocumented is as effective as rounding that never occurred. Closing the communication loop builds credibility, and team members will quickly notice when rounding results in no follow-up or follow-through. Depending on the findings, a quick report of high-level issues may suffice, or a more detailed report may be in order. When detailed reports are needed, a standard format used across rounds can be beneficial to help benchmark across visits. No matter the length of the report, the report should remain objective and factual. IPs should avoid overdramatization of issues and excessive use of superfluous adjectives.
Findings should be shared promptly, allowing for open discussion and questions. Pictures are often worth a thousand words when it comes to quickly illustrating findings to leaders included on reports and provide educators with examples to share during team huddles. IPs should confirm that any photography complies with facility policy and patient-privacy expectations, and should avoid capturing identifiable patient or vendor-proprietary information. Communication should be streamlined so that one report can be sent to all stakeholders, from the department leads to others involved, such as the perioperative team, environmental services, and facilities.
Recurring themes should be tracked across rounds, with past reports referenced and trends elevated to senior leadership. This includes celebrating progress, which can build a positive safety culture. Improvements and "wins" should be recognized both in the IP rounding report and during rounds. This also boosts the IP's reputation as someone who recognizes hard work and isn't always "auditing". It is especially important to celebrate wins from the action plans and to recognize team members for their process improvements.
Action Planning
Action planning should begin immediately, often starting during rounds, initial actions covered in the report, and subsequent steps happening once the report is sent. Response at the point of observation may occur in the form of real-time education or in immediate discussion with department leaders. Addressing the immediate issue while rounding will ensure the same defect doesn't proceed downstream while the larger team works on the deeper concern.
Before the IP writes anything, they must decide who actually needs to be at the table. The report's audience must determine its tone. A finding contained within SPD may go to the SPD manager and educator. A cross-departmental one (OR, Supply Chain, Endoscopy) will need those stakeholders plus whoever has authority to actually move resources. Including the wrong people, or too many, may stall the fix or turn the finding political. The best advice is to start with the smallest group that can decide and act.
To maintain efficiency, the IP must characterize and document the finding objectively in their rounding report. Note whether it's a single occurrence or a pattern. The report should capture what was observed, where, when, and against which standard (AAMI ST79, ST91, manufacturer IFUs, facility policy). A finding tied to a specific standard carries far more weight with leadership.
Communications should lead with what was observed and the standard it touches, not with blame. "During rounds on [date], IP observed [X], which conflicts with [ST79 section / IFU]. IP wants to make sure we align on containment and a durable fix; can we meet [timeframe]?" This frames the finding as a shared problem to solve, not an accusation. Avoid solving the problem in the email; the email's job is to get the meeting. The problem-solving and action planning must be collaborative.
In summation, the initial communication should be short and do three jobs:
State the finding neutrally and tie it to the standard. State the risk plainly. Propose a next step (usually a meeting)
During follow-up, IP should work with stakeholders to determine the root cause, not just the symptom. Sometimes this is quickly evident, other times a quick structured method, such as Root Cause Analysis, 5 Whys, or a fishbone diagram across people, process, equipment, environment, and materials, may be required. Distinguish knowledge gap vs. training gap vs. process/design failure vs. staffing/workload. Focusing on the wrong gap or failure point is where most action plans go wrong. You cannot retrain team members to fix an issue that actually lies with a broken workflow or missing tool.
Just as importantly, the IP must assign the owner, action, and date. Every action needs a named owner, a specific corrective action, and a target completion date. Vague ownership, such as "SPD will address," is the most common reason findings resurface. Once the assignments are finalized, define how the team will verify effectiveness. IP must guide the group to decide the metric and re-audit cadence before the planning can be completed. This may be as simple as re-round in two weeks, or may be more intensive, such as auditing every case cart returned to decontamination for bioburden (not an SPD-owned issue, but a problem some SPD departments may encounter), pulling tray-error data from an instrument track system, or checking competency completion for the entire department.
The action plan should only be considered completed when the data confirms the fixes have worked and progress has been maintained. If the issue is ongoing after enough time has passed when progress should have been expected, it may be time for the team to revisit the potential root cause. Once the plan is completed, the IP should close the loop and trend the events in a formal report. This should be revisited for subsequent rounds to ensure that there has been no backward movement and permit recurring themes to show themselves.
Next Steps
To support your rounding needs, CS Medical offers two free Infection Prevention rounding resources designed specifically for ultrasound probe reprocessing:
- TEE Probe Reprocessing Infection Prevention Rounding Checklist
- Endocavity Ultrasound Probe Reprocessing Infection Prevention Rounding Checklist
These tools help infection preventionists evaluate the complete workflow, from point-of-use cleaning through transport, cleaning, high-level disinfection, drying, storage, documentation, and traceability, and can serve as a foundation for collaborative discussions with frontline teams. They are available for download in the Audit Tools section of the CS Medical IP Insights website.
An effective rounding program is not measured by the number of deficiencies identified or even overall percentages. Tracking should include a variety of metrics that are actionable and value-added to the department and the IP team/program. Metrics like repeat findings, compliance trends, staff member engagement, etc., should be considered as overall metrics to indicate the rounding program is overall successful. The ultimate goal is not perfect audit scores. It is creating safer, more reliable systems for patients and healthcare professionals.
The most successful infection prevention rounds do more than identify problems: they create partnerships. By combining standardized tools, thoughtful observation, effective communication, collaborative action planning, and consistent follow-up, infection preventionists can transform rounding from a routine inspection into one of the organization's most valuable quality improvement activities. Every round is an opportunity to strengthen relationships, improve processes, and reduce patient risk. When observations lead to action, and action leads to sustained improvement, rounding becomes far more than a checklist. It becomes a catalyst for safer care.
Guest Author, Eileen R. Thompson, MPH, MS, CIC, CRCST, is an infection prevention specialist focused on high-level disinfection and sterilization within a large multihospital health system. Her work centers on perioperative infection prevention, sterile processing oversight, and endoscope reprocessing, with particular emphasis on the collaboration among sterile processing, operating room, and endoscopy teams. She holds certification as an infection preventionist and as a central service technician and has continued to pursue frontline reprocessing credentials to strengthen her technical practice. She has presented nationally on vendor-related perioperative risk and has led quality improvement efforts spanning instrument integrity, endoscope reprocessing, and sterilization quality. Her academic background includes graduate training in public health and applied research. She frequently partners with perioperative and sterile processing leadership on accreditation readiness, competency development, and the practical translation of reprocessing standards into daily practice.
*Disclaimer: The information shared in this article is that of the author(s) and should be reviewed by the consumer as that written by an independent party to CS Medical or in conjunction with CS Medical staff. The article may or may not directly represent any employer, company, or third party, and are solely that of the individual(s) or contributors themselves.
