Pseudomonas NICU_CA

Appendix 2: Hand Hygiene Observation Tool

Form Approved

OMB No. 0920-1011

Exp. Date 03/31/2017

HAND HYGIENE AUDIT TOOL

HAND HYGIENE ADHERENCE DURING HIGH RISK PATIENT CONTACTS

Monitor each clinical area for approximately 30 MINUTES

Hospital Date Start time AM / PM (circle)

Section of Hospital (e.g. ER, adult inpatient, pediatric)

If Inpatient Ward, Ward ID and number of patients in ward

Observer name Location of observer within ward

Hand Hygiene Opportunities Use tick marks to indicate what behavior was observed for each hand hygiene opportunity
Discipline (see below)	No attempt	Attempted without success	Attempted with success	Comments

Discipline: MD=doctor or resident, RN=registered nurse, T=technician or allied health specialist, S=student (medical or nursing)

Duration of observation period: minutes

Total number of patients observed during audit:

GUIDE TO HAND HYGIENE OPPORTUNITIES

HIGH RISK FOR TRANSMISSION Perform hand hygiene before and after each of the following tasks
DIRECT PATIENT CONTACT	Bathing and mouth care Wound care or dressing changes Repositioning patient Direct patient assessment or care Specimen collection (blood, urine, stool, sputum) Toileting activities Physiotherapy activities Invasive procedures (including, but not limited to, insertion of central or peripheral intravascular devices, lumbar puncture, intubation/ extubation, bladder catheterization, etc)
MODERATE RISK FOR TRANSMISSION * Perform hand hygiene between patients
INDIRECT PATIENT CONTACT	Preparing and administering medications Touching patient equipment at the bedside (eg. Blood pressure cuffs, thermometers) but no patient contact Transporting patient in a wheelchair or stretcher After handling patient soiled linens Before handling food
LOW RISK FOR TRANSMISSION * Perform hand hygiene periodically
ENVIRONMENTAL CONTACT	Charting or log book entry Attendance at rounds Handling stock linens or supplies After personal toileting

*These contacts/activities are not priority activities to monitor during your audits

Please make note of the following during this session.

	Yes	No	Not applicable	Comments
Posters promoting hand hygiene are visible
Clinical staff nails are short and clean
Hand washing areas are clean, operational, and free from clutter
There is visible and easy access to hand washing sinks or hand sanitizer
Soap dispensers are available at all hand washing areas
Paper towels are available at all hand washing stations

ADDITIONAL COMMENTS / OBSERVATIONS

Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74 Atlanta, Georgia 30333; ATTN: PRA (0920-1011)