Customizable Template Helps Practices Implement Infection Control Plan

As health care services are transitioning more and more to ambulatory care settings, health care providers are mindful of the need, regardless of the level of care provided, to make infection prevention a priority and observe standard precautions. But, how do you know what should be included in an infection control plan?

An Infection Control Plan Template, recently developed by PMSCO Healthcare Consulting, a subsidiary of the Pennsylvania Medical Society, can help practices implement an effective infection control plan. The entire plan is a Microsoft WORD document so that you can review and customize to represent the actual policies and procedures applicable to your practice. It also contains sample forms and logs. It is available for $250 for members and $300 for non-members.

In addition to helpful definitions and an overview of the purpose and principles of the plan, the template includes sections on:

  • Scope and components of the plan
  • Authority and responsibility
  • Reportable diseases, including a list from the Pennsylvania Department of Health
  • Isolation precautions
  • Cleaning of the office, exam room, and general housekeeping guidelines (Sample log form included)
  • Clean-up of blood spills
  • Blood glucose monitoring
  • Regulated and non-regulated medical waste disposal
  • Monitoring of refrigerator temperature (Sample log form included)
  • Storage and handling of vaccines
  • Hand hygiene
  • Safe injection practices
  • Medication and biological management (Sample pharmaceutical inventory checklist included)
  • Care and sterilization of surgical instruments

Additional sample forms and logs in the template include:

  • High level disinfection competency form and disinfectant solution testing log
  • Quality control protocol form for HLD test strips and HLD test strips quality control log
  • Protocol for high level disinfection of instruments form
  • Clinical competency record form for infection control practices competencies

Standard precautions represent the minimum infection prevention expectations for safe care in ambulatory care settings. Ambulatory care infection prevention programs should extend beyond Occupational Safety and Health Administration (OSHA) bloodborne pathogen training to address more comprehensive infection prevention guidelines.

If you need consulting assistance during customization of the manual, please contact PMSCO at (888) 294-4336 or by email at to request a proposal.