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 |
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Discipline (see below) |
No attempt |
Attempted without success |
Attempted with success |
Comments |
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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 |
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DIRECT PATIENT CONTACT |
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MODERATE RISK FOR TRANSMISSION * Perform hand hygiene between patients |
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INDIRECT PATIENT CONTACT |
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LOW RISK FOR TRANSMISSION * Perform hand hygiene periodically |
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ENVIRONMENTAL CONTACT |
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*These contacts/activities are not priority activities to monitor during your audits
Please make note of the following during this session.
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Yes |
No |
Not applicable |
Comments |
Posters promoting hand hygiene are visible |
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Clinical staff nails are short and clean |
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Hand washing areas are clean, operational, and free from clutter |
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There is visible and easy access to hand washing sinks or hand sanitizer |
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Soap dispensers are available at all hand washing areas |
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Paper towels are available at all hand washing stations |
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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)
File Type | application/msword |
File Title | HIGH RISK FOR TRANSMISSION |
Author | fwu4 |
Last Modified By | KMB6 |
File Modified | 2014-09-23 |
File Created | 2014-09-23 |