SPU Secure Order Form
for

"Policies & Procedures"

**Printable Version of this Form**

Please Fill Out All the Information Requested in the Following Form


Conditions:

1. These policies and forms are copyrighted. They cannot be shared with any other individual, hospital, publication, presentation, etc. They may be used within a healthcare facility system.

2. These policies may be modified to meet the specific needs of your facility.

3. All policies written in compliance with the most current federal standards and guidelines in effect at the time of purchase. The facility is required to update policies as recommended by the specific facility.

4. Areas highlighted or in red require specific information from your facility.

NOTE: All policies will be emailed to you to facilitate modifications. Please provide your email address at the bottom of this form.

If you would like the policies on a CD, please indicate at the bottom of this form.


Pricing:

Individual Policies: $25 each
Individual Forms: $10 each
Any Combination of Policies & Forms OVER 25: $20 each
All Policies, Procedures and Forms: $650 (save $570 off the individual prices!)


**PLEASE CHECK THE BOX NEXT TO EACH POLICY OR FORM NEEDED.**

38 Policies are listed in BLUE
27 Forms are listed in BLACK

Accountability for Surgical Instruments/Sets
BI Log Form - 3 Hour Rapid Readout for Pre-Vac 270oF, 275oF and Gravity 250oF
BI Log Form - 1 Hour Rapid Readout for Pre-Vac 270oF and 275oF
Cleaning of Steam Sterilizers
Cidex OPA Competency Summary
Decontamination of Soiled Instruments and Devices
Decontamination Area Temperature and Humidity Log Form
Designation of Time Related or Event Related Dating
Early Release of Implantable Device/Tray Form
Environmental Cleaning Protocols for SPD
High Level Disinfection Log Form
Implantable Devices
Known or Suspected Prion Contaminated Items Processing Log Form
Lap Insulation Testing Log Form
Lending/Borrowing of Instruments
Loaner Instrumentation/Borrowed Instruments/Dr.'s Instruments
Lot Control for Sterilization
Manufacturer’s Instructions for Processing
Monitoring of Sterilization Cycles
Off-Site Processing
PI Form for Infection Control
Prep/Packaging Area Temperature and Humidity Log Form
Preparation, Assembly and Handling of Surgical and Lap Instruments
Process Improvement Plan for Sterile Processing
Process Improvement – Tray Audit Form
Process Improvement – Event Related Dating Audit Form
Process Improvement – Problem Report Form
Process Improvement – Sterilization Record Audit Form
Precautions for Patients with Known or Suspected Creutzfeldt-Jakob Disease (CJD)
Perioperative Screening Form for Patients Who Are at Risk for Creutzfeldt-Jakob Disease (CJD)
Pre-Processing Treatment of Instruments in Ancillary Departments/Units
Processing of Flexible Fiber Optic GI Scopes and Bronchoscopes
Processing Reusable Laryngoscope Handles and Blades
Processing of Ophthalmic Instruments
Processing of Patient Care Equipment
Product Testing
Product Testing Log Form
Quality Assurance Testing of HLD Test Strips Form
Recall of Facility Sterilized Products and Products from Outside Manufacturers
Rigid Container Testing
Rigid Container Testing Documentation Form
Re-sterilization of Opened, Unused Single Use Devices and Return of Explanted Implants to Patients
Single Use Devices
Steam Sterilization Protocols
Sterile Storage Area Temperature and Humidity Log Form
Sterilizer Access Area Temperature Log Form
SPD Annual Competency Testing Form
SPD Dress Code
SPD Orientation Guide Form
SPD Vendor Delivered Trays Form
SPD Implant Log Form
Surgical Instrument Marking
STERRAD 100NX Log and BI Form
STERRAD 100S Log and BI Form
STERRAD NX Form
Use of the STERRAD NX Sterilization System
Use of the STERRAD 100NX Sterilization System
Use of the STERRAD 100S Sterilization System
Storage of Sterile Supplies
Temperature, Humidity and Air Flow Requirements for the Sterile Processing Areas
Testing of Emergency Eyewash Stations
Testing of Emergency Eye Wash Stations Log Form
Training, Continuing Education and Competency Assessments
Transport of Sterile/Clean Items
Use of Cidex OPA High Level Disinfectant

All Policies/Procedures and Forms: $650 (save $570 off the individual prices!)


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