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Form · SRG-FRM-004 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 2.3
Purpose
Records, for each procedure, whether each part of the bundle was done.
How to complete
- Complete for each procedure.
- Record any missed item and why.
- Count the month’s compliance at the monthly check.
Record fields
| Procedure ID | Antibiotic in window (yes or no) | Skin prepared and dry (yes or no) | Hair removal (if needed) | Sterile technique breaks (count) | Dressing applied (yes or no) | Missed item and reason |
|---|---|---|---|---|---|---|
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WHO Global Guidelines for the Prevention of Surgical Site Infection (2018). |
| E-006 | ASF Policy Framework v1.2. Adapted. |
| E-009 | ASF Expert Committee consensus. |
Change history
| Version | Date | What changed | Approval |
|---|---|---|---|
| 1.0 | the date of approval | First version | set Expert Committee approval |
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References
- Accréditation Sans Frontières (2026). ASF Policy Framework v1.2. (E-006)
- Accréditation Sans Frontières (2026). ASF Expert Committee consensus on Standard 1. (E-009)