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ASC Infection Control Surveyor Worksheet

MCN Question of the Week

ASC Infection Control Surveyor Worksheet


Where can I find the Ambulatory Surgical Center (ASC) Infection Control Surveyor Worksheet (ICSW) from CMS?


The Centers for Medicare & Medicaid Services (CMS) made minor revisions to the Infection Control Surveyor Worksheet, Exhibit 351 of the State Operations Manual (SOM) for assessing compliance with the Medicare ASC Infection Control Condition for Coverage (CfC) and published the update on June 26, 2015.

The FINAL VERSION of the worksheet was effective as of July 17, 2015.

Revisions were made to bring the worksheet into alignment with current accepted standards of practice; reflect recently released guidance; and improve the clarity of certain questions. Questions regarding the practice of immediate-use steam sterilization (IUSS) were also added.

The worksheet is used by State and Federal surveyors on all survey activity in ASCs when assessing compliance with the infection control CfC.

CMS encourages ASCs to use this worksheet on a voluntary basis for self-assessment of their practices related to infection control.

Related Products from MCN:

Ambulatory Surgical Center Policy and Procedure Manual



Regulatory Compliance Solutions for Healthcare Organizations,
Including Policy Management Software, Policy Library Templates,
StayAlert! – Regulatory Alert System, and Learning Management System










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