Hygiene checklist for old people's and nursing homes: Obligations according to IfSG and MedHygV

Section 23 Paragraph 8 IfSG obliges geriatric care facilities to create and adhere to hygiene plans. The specific requirements arise from the state hygiene regulations, such as the MedHygV in Bavaria or North Rhine-Westphalia, and from the recommendations of the Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute. A hygiene checklist is the operational tool with which a hygiene officer checks and documents compliance with these requirements.

In an audit by the home inspector or health authority, the existence of a hygiene plan is less important than its practical implementation. Checklists make care, training and inspections verifiable. This article describes the structure of a hygiene checklist for old people's and nursing homes, the mandatory fields, typical findings and the integration with the hygiene plan according to Section 36 Paragraph 1 IfSG. What is important is the traceability of each test, not the format.

Section 23 Paragraph 8 IfSG explicitly names care facilities and requires that the recommendations of KRINKO and the ART Commission at the Robert Koch Institute be taken into account. Section 36 Paragraph 1 No. 2 IfSG requires the establishment of a hygiene plan that defines internal procedures for infection hygiene. This obligation falls on the provider of the institution. Supervision is the responsibility of the responsible health authority in accordance with Section 36 Paragraph 2 IfSG.

The state hygiene regulations specify the requirements. In Bavaria, the MedHygV regulates the appointment of a hygiene officer in nursing, the training obligations and the hygiene commission. In North Rhine-Westphalia the HygMedVO is the basis, in Baden-Württemberg the MedHygVO is the basis. The content is comparable in substance, but differs in threshold values, ordering obligations and training requirements. A hygiene checklist must therefore be adapted to each country.

The KRINKO recommendations are not a directly binding standard, but in a legal sense they represent the recognised state of knowledge. Anyone who deviates from them must justify and document the deviation. A hygiene officer translates these recommendations into concrete test points for inspections and training.

A testable hygiene checklist contains at least seven fields for each test point. First, the running number. Secondly, the test area, such as the resident's room, nursing bathroom, functional room, kitchen, laundry area. Thirdly, the specific test point in plain text, for example hand disinfectant dispenser is functional and accessible. Fourth, the target state with reference to the KRINKO recommendation or hygiene plan.

Fifth, the test result in the stages fulfilled, partially fulfilled, not fulfilled, not verifiable. Sixth, the date of the examination and name of the person examining it. Seventh, the defects deadline with resubmission. If there are several wards or living areas, the checklist is kept for each area and combined in an overall evaluation. The evaluation shows structural deficiencies and prioritises measures.

A useful extension is a photo or photo documentation field for points that are not met. In the later comparison after the fix, the visual documentation shows the success of the measure. It is important to distinguish between structural and structural deficiencies that require a longer period of time and behavioral deficiencies that can be addressed immediately through training. Audit-proof, documented, Section 36-proof. This means that an inspection results in more than just a list, namely a control document.

According to KRINKO and WHO, hand hygiene is the most effective individual measure for infection prevention. A hygiene checklist therefore checks five aspects. Firstly, the availability of hand disinfectants at the point of care, i.e. directly where care activities take place. Secondly, the suitability of the preparations according to the VAH list with effective range for the respective indication.

Thirdly, the training knowledge of the nursing staff on the five indications for hand disinfection according to WHO: before patient contact, before aseptic work, after contact with potentially infectious material, after patient contact, after contact with the immediate patient environment. Fourthly, compliance with the exposure time, usually 30 seconds. Fifth, the consumption of hand disinfectants per resident day as an objective indicator. The KRINKO benchmark is at least 20 milliliters per resident day in geriatric care.

The testing is carried out in inspections, supplemented by consumption measurements and, if necessary, compliance observations. Consumption measurements are objective and are evaluated quarterly. If the benchmark is not met, training or structural improvements are triggered. The hygiene plan documents the procedures, the checklist documents compliance.

Surface disinfection follows the KRINKO recommendation on hygiene requirements when cleaning and disinfecting surfaces. Four aspects are examined. Firstly, the cleaning and disinfection plans with determination of the areas, the means, the concentrations and the frequencies. Secondly, the suitability of the preparations for the target germs, with proof from the VAH or RKI list.

Thirdly, the correct application, i.e. concentration according to the manufacturer's instructions, exposure time, wiping technique and avoidance of cross-contamination through colour-coded wiping covers. Fourth, the documentation. Cleaning and disinfection records are kept for each area and are part of the inspection. Random ATP measurements complement the visual inspection and objectively show the cleaning effect.

Surfaces close to the patient, such as bed frames, bedside tables, door handles, light switches and sanitary areas, receive special attention. These are cleaned with disinfectant at least daily, and in the case of MRE colonization after each care procedure. The checklist also checks the storage of cleaning and disinfecting agents, their labelling according to hazardous substances law and the availability of safety data sheets. Interfaces to hazardous substance management are often overlooked in practice and are a classic finding of home supervision.

The management of multi-resistant pathogens is particularly relevant for testing in inpatient care facilities. The KRINKO recommendation on MRSA and the recommendation on hygiene in the presence of multi-resistant gram-negative rods provide the framework. A hygiene checklist checks eight points.

Firstly, admission screening for defined risk groups. Secondly, the documentation of the carrier status in the care documentation with data protection compliance in accordance with Art. 9 GDPR. Thirdly, the information of the nursing staff and the further care facilities with the consent of the person concerned. Fourth, the provision of personal protective equipment in the resident's room.

Fifth, the establishment of care processes that minimise cross-contamination, for example through staff allocation. Sixth, the preparation of nursing aids and medical devices according to manufacturer specifications. Seventh, the documentation of the remediation attempts for MRSA with mupirocin nasal application and antiseptic whole body washing, where indicated. Eighthly, the protective measures should only be lifted after three negative control swabs at least 48 hours apart. The checklist links to standardised procedural specifications for risk facilities only if it involves IT-supported documentation systems in nursing homes, otherwise to subject-specific care documentation.

The MedHygV of the federal states requires a written appointment of the hygiene officer in nursing. The appointment certificate specifies tasks, responsibilities, reporting line and scope of exemption. The appointment certificate, signed, filed, verifiable. This form applies analogously to hygiene specialists, if provided, and to members of the hygiene commission.

The training obligation applies to all employees with care contact. Initial training takes place before starting work, repeat training at least annually. The hygiene checklist checks whether training certificates are up to date, thematic coverage and participation. Training content follows the hygiene plan and adapts to current recommendations, for example in the case of new MRE strains or pandemic situations.

The Hygiene Commission usually meets every six months in accordance with state requirements. Topics include evaluation of inspections, incidents, MRE statistics, training planning and measures from supervisory visits. Protocols from the Hygiene Commission are part of the hygiene plan appendix. The checklist checks the existence, completeness and implementation of the decided measures. A hygiene commission without documented decisions and evidence of implementation will be assessed as formal in the audit, which entails requirements.

Food hygiene follows Regulation EC No. 852/2004 and the LMHV. Two areas are relevant in retirement and nursing homes. The central kitchen is fully subject to hygiene law for food establishments, including the HACCP concept. Decentralized eat-in kitchens in living areas are subject to reduced, but still relevant, requirements.

The hygiene checklist checks temperature controls when keeping the temperature above 65 degrees Celsius and when cooling it below 7 degrees Celsius, reserve samples for at least seven days for communal catering, cleaning plans for the kitchen areas and the training of employees in accordance with Section 4 LMHV. Pest monitoring with documented bait stations is standard.

Laundry management follows the KRINKO recommendation on hygiene requirements for cleaning and processing laundry from hospitals and comparable facilities. The separation of clean laundry and dirty laundry during transport and storage, washing processes with thermal or chemothermal disinfection, proof of processing from external laundries with certification according to DIN EN 14065 RABC are tested. Reduced requirements apply to residents' laundry washed in living areas, but a clear procedure is still required. The deadline begins when we become aware of a defect in the laundry process, with immediate action being taken.

Home supervision and the health department carry out regular inspections and event-related inspections. During regular inspections, the hygiene plan is viewed, inspection logs are viewed and practical practice is randomly checked. Occasion-related examinations follow complaints, outbreak reports according to Section 6 IfSG or information from hospitals when residents are transferred.

The most common findings relate to incomplete training records, missing hygiene plan updates over 24 months, incomplete MRE documentation and deficiencies in the preparation of nursing aids. The hygiene checklist is the primary document that auditors view. A complete checklist with verifiable processing of defects regularly leads to short inspections without any requirements. The inspector calls and the proof is ready.

For conditions, deadlines are set, usually between four and twelve weeks, depending on the severity of the defect. Repeated defects can lead to admission or occupancy stops, and in extreme cases, to the withdrawal of the operating licence in accordance with Section 13 WTG or the corresponding state laws. Interlinking the hygiene checklist with quality management according to SGB XI is therefore not a luxury, but an economic necessity. Those responsible for the organisation should receive a quarterly evaluation of the inspections and be informed about the progress of the measures.

Hygiene checklists in paper form work for small facilities. As soon as multiple living areas, multiple shifts and multiple interfaces to home supervision and the health department need to be controlled, a digital solution makes sense. Versioning, defect deadlines, resubmissions and interlinking with proof of training become a permanent task.

CIVAC is a compliance platform and officer-as-a-service. In the workspace, you keep hygiene checklists for each living area, document inspections with photos and control deadlines for due tasks. 490 ready-to-use audit templates cover hand hygiene, surface disinfection, MRE management, food hygiene and laundry management. Evidence of training is linked to checklists so that the auditor sees the personnel file and inspection in one system. The data is stored in the EU data residence, the ISMS is certified according to ISO/IEC 27001:2022. Licence the workspace for your internal representatives or have our representatives order it. In the second model, the appointment certificate is issued within two working days, the external hygiene officer takes over inspections, training and the hygiene commission.

Turn reading into a mandate. Write to info@civac.de or use the contact form on civac.de. You will receive a country-specific hygiene checklist and an assessment of which model suits your facility size.