Table 3. Ice break sessions: Assessment checklist cum training of HCWs on integrated antimicrobial stewardship (ISP/DSP/ASP) practices.

ID, Infectious Diseases; HCW/SNO, Health-Care Worker/ Senior Nursing Officer; PPE, Personal Protective Equipment; BMW, Bio Medical Waste; ICN, Infection Control Nurse; HAI, Hospital Acquired Infections; ISP/DSP/ASP, Infection Prevention Stewardship Practices/Diagnostic Stewardship Practices/Antimicrobial Stewardship Practices; IV, Intravenous; HICC, Hospital Infection Control Committee.

S.No.	ISP/DSP/ASP Questionnaires	Yes (1)	No (0)	Partial (0.5)	Not Applicable/Any comment
I	Assessment of knowledge, practice and audit on integrated antimicrobial stewardship (IAS) Practices of the local admins
1.	Availability of ID practice document released in 2018 & 2022?
2.	Availability of Institute Antibiotic policy 2022?
3.	Availability of Antimicrobial utilization form in patients who are >5days of Antimimcrobials?
4.	Availability of Uses of time dependent antimicrobial policy ?
5.	Availability of Dept specific Reserve list of antimicrobials and its utility policy?
II	Assessment of knowledge, practice and audit on infection prevention stewardship (ISP) Practices
	Knowledge assessment by asking any HCW/SNO
6.	When to use PPE ?
7.	Any random HCW list standard precautions components ?
8.	HCW enlist 5 moments of hand hygiene ?
9.	Any available Protocol on soiled linen items ?
10.	How to prepare various concentration of sodium hypochlorite solution ?
11.	Aware about procedure for bed sore assessment and management in the unit.
	Observation (No need to ask, just see each corner of area, sometimes ask SNO)
12.	General or environment cleaning (Linen, beds, floor, walls, machines, door, BMW bins etc.)
13.	Hand hygiene moments are followed in the right way
14.	Availability of hand hygiene facility and soap solution in the ward
15.	Facility for isolation room in the unit
16.	Availability of signages boards in the unit
17.	Availability of posters on needle stick injury (NSI), Hand hygiene etc.
18.	Do the bundle care protocols are followed in unit (Refer Patient files or see for availability of checklist in the ward)
19.	Hand rubs are available on every bed, nursing station, crash cart etc.
20.	Do the catheter care is performed (Refer patient file)
21.	Availability of infection control material like cleaning items, disinfection, PPE’s, etc. ( Verify from ward store)
22.	Spill management kit is available in the area
23.	Reporting (with in 3 months) of occurrence of HAI rate or surveillance data by HCWs or ICN (Refer from records/ Registers)
24.	Dedicated color-coded BMW containers with lids and proper BMW segregation within the department
25.	Emptying the BMW polythene cover on time when 1/3 is filled
26.	Appropriate reporting and documentation mechanism for NSI in the ward : Check report/registers
27.	Prompt health education for patients and patient family on infection control practices : Cross-verification with documentation
28.	Area ICNs perform root cause analysis for  HAI (Refer from records/ reports)

S.No.	ISP/DSP/ASP Questionnaires	Yes (1)	No (0)	Partial (0.5)	Not Applicable/Any comment
III	Assessment of skills, knowledge, and auditing of Diagnostic Stewardship (DSP) procedures of HCWs
	Knowledge Assessment
29.	HCW understand the meaning of turnaround time (TAT) for an investigation?
30.	HCW practices the administration of antibiotics following the withdrawal of the patient's sample, particularly culture (Refer File/ Records)?
31.	HCW is aware of routine and emergency lab diagnostic testing and their implications in patient management?
32.	Before drawing the sample, HCWs educate and explain the patient and caregivers the purpose and steps involved in a lab diagnostic test (Refer patient file/ Records)?
33.	HCW document  the investigation reports and updates diagnosis in the patient file (Assessment from  patient file)?
	Observations
34.	Is the sample collection area clean? Are there any waiting samples there?
35.	When the correct diagnosis is not being made, the report is not generated promptly, or the results are unclear, do the HCW consults clinical microbiology, biochemistry, pathology, radiology, or other specialists ?
36.	Whether procedure room is organized and clean ?

S.No.	ISP/DSP/ASP Questionnaires	Yes (1)	No (0)	Partial (0.5)	Not Applicable/Any comment
IV	Assessment of HCW's skills, knowledge, and auditing of antimicrobial stewardship (ASP) procedures
37.	HCW comprehends and documents and practice one of the five Ds for a patient: right drug, dosage, duration, delivery, and decision on follow-up choice (Verification form records/ file)?
38.	HCW understand and document the responses or evaluation of antimicrobial therapy  (Verification from records/ file) ?
39.	HCW does/reminds IV to oral switch timely of antimicrobials (Verification from records/ file)?
40.	HCW does/reminds for STOP order after completion the course of antimicrobials (Verification from records/ file)?
41.	HCW is aware of and utilizes the Antimicrobial Authorization Form (>5days on antibiotics) and the AWaRe checklist (Verification from records/file)?
42.	During hospitalization and at the time of discharge, HCW teaches patients and caregivers about all aspects of antibiotics, particularly their side effects, precautions, etc. (Verification from records/ file)?
43.	Do the HCW is aware the policy and how to dispose the expired antimicrobials ?
44.	Do the HCWs is aware and provides regular feedback to the antimicrobial stewardship committee, HICC, and drug and therapeutic committee of the institute?