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Centers for Disease Control and Prevention (CDC) Patient Hand Hygiene Audit Information and Instructions
You have agreed to help the Network by doing a very important Hand Hygiene Audit. We thank you for your willingness to help improve the quality of care in your dialysis facility. The Network knows that infection prevention is very important to you. It is also important to us, as well as your fellow patients. We appreciate your help in monitoring our hand hygiene practices. With your help, we can reduce infections.
Hand Hygiene for Staff Please note that all staff are required to:
• Wear gloves when caring for you or touching any equipment at the dialysis station. • Remove gloves and complete hand hygiene between each patient or station. • Change gloves often during patient care. • Wash hands with soap and water when hands or gloves are visibly soiled with:
o Blood. o Body fluids (i.e., urine, stool, or vomit). o Greasy substances.
Things to Watch for When Conducting Your Audit Are staff completing hand hygiene before: • Touching you or any patient? • Touching your vascular access? • Moving from a potentially unclean body site to another, e.g., from a wound
to touching a dialysis catheter? • Handling medication? • Preparing food? Are staff completing hand hygiene after: • Touching any patient? • Contact with:
o Body fluids? o Mucous membranes (e.g., inside the mouth/nose)? o Broken skin? o Wound dressings? o Dialysate? o Surfaces and objects, such as medical equipment or the dialysis machine?
• Removal of gloves?
Instructions for Audit Completion (See SAMPLE):
For each audit you conduct, please:
☐ Step 1 Write your facility name and the date of your audit at the top of youraudit sheet.
• You do not need to fill out any of the other information at the topof the page.
☐ Step 2 Use each row on the table as one observation.
☐ Step 3 Enter the letter that corresponds to the staff member’s position (e.g., N=Nurse or T= Technician) for each observation.
☐ Step 4 Enter a check mark for each opportunity observed in the “HandHygiene Opportunity” column:
• If you observed successful hand hygiene, enter a check mark forthat opportunity. (Successful hand hygiene is achieved when youhave observed that the staff meet the requirements as stated in theinstructions on the previous page.)
• If you observed that hand hygiene was not performed/successful,leave the opportunity column blank and make a note in the“Describe Any Missed Attempts” column.
☐ Step 5 Return your audit sheet to the charge nurse or facility manager at theend of your treatment, prior to leaving the dialysis facility.
☐ Step 6 Email or fax all completed audits to the Network by the 5th of thefollowing month.
Important Note: While you are conducting an audit, please do not speak directly to staff about missed opportunities, unless they relate to your own care.
If you have any questions, contact Susan Moretti at Network 15 at 720.697.7914 or [email protected].
This material was prepared by HSAG: ESRD Network 15, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy nor imply endorsement by the U.S. Government. CO-ESRD-15A146-01162017-03
Div
isio
n o
f H
ea
lth
care
Qu
alit
y P
rom
otio
n
H
CD
C D
ialy
sis
Co
llab
ora
tive
F
acili
ty N
am
e: A
BC
Dia
lysis
Date
: 4
/19/1
4
S
tart
tim
e:
AM
/ P
M
Day: M
W
F
Tu T
h S
a
Location w
ithin
unit: ______
Shift: 1
st 2
nd 3
rd 4
th O
bserv
er:
Au
dit
To
ol:
Hem
odia
lysis
hand h
ygie
ne
observ
atio
ns
(U
se
a “√” fo
r ea
ch ‘h
an
d h
ygie
ne
opp
ort
un
ity’ o
bse
rve
d.
Und
er ‘o
ppo
rtunity s
uccessfu
l’, u
se
a “√” if
s
ucces
sfu
l, a
nd
le
ave
bla
nk
if
no
t s
uc
ce
ssfu
l)
Han
d h
yg
ien
e
Descri
be a
ny m
issed
att
em
pts
(e.g
., d
uri
ng
med
icati
on
D
iscip
lin
e
pre
p,
betw
een
pati
en
ts, aft
er
co
nta
min
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on
wit
h
Han
d h
yg
ien
e o
pp
ort
un
ity
Op
po
rtu
nit
y s
uccessfu
l b
loo
d,
etc
.):
N
√
√
T
T
ech
we
nt
fro
m o
ne
pa
tie
nt
sta
tio
n t
o a
no
the
r w
ith
ou
t w
ash
ing
ha
nd
s√
D
√
√
W
S
oci
al
wo
rke
r to
uch
ed
on
e p
ati
en
t th
en
an
oth
er
wit
ho
ut
wa
shin
gfi
rst
√
Dis
cip
line
: P
=p
hysic
ian,
N=
nu
rse,
T=
techn
icia
n,
S=
stu
den
t, D
=d
ieticia
n, W
=so
cia
l w
ork
er,
O=
oth
er
Dura
tion o
f observ
ation p
eriod =
m
inute
s
Num
ber
of successfu
l hem
odia
lysis
hand h
ygie
ne o
bserv
ations =
Tota
l num
ber
of
patients
observ
ed d
uring a
udit =
Tota
l num
ber
of
hand h
ygie
ne o
bserv
ations o
bserv
ed d
uring
audit =
** S
ee h
and h
ygie
ne o
pport
unites o
n b
ackpag
e
Na
tio
na
l C
en
ter
for
Em
erg
ing
an
d Z
oo
no
tic Infe
ctio
us
Dis
ease
s
CS
22
88
27
Div
isio
n o
f H
ea
lth
care
Qu
alit
y P
rom
otio
n
G
Gu
ide t
o H
an
d H
yg
ien
e O
pp
ort
un
itie
s i
n H
em
od
ialy
sis
Han
d h
yg
ien
e o
pp
ort
un
ity c
ate
go
ry
1.
Prior
to touchin
g a
patient
2.
Prior
to a
septic p
rocedure
s
3.
Aft
er
body f
luid
exposure
ris
k
4.
Aft
er
touchin
g a
patient
5.
Aft
er
touchin
g p
atient surr
oundin
gs
Sp
ecif
ic e
xam
ple
s
• P
rior
to e
nte
ring s
tation t
o p
rovid
e c
are
to p
atient
• P
rior
to c
onta
ct w
ith v
ascula
r access s
ite
• P
rior
to a
dju
sting o
r re
movin
g c
annula
tion n
eedle
s
• P
rior
to c
annula
tion o
r accessin
g c
ath
ete
r •
Prior
to p
erf
orm
ing
cath
ete
r site c
are
•
Prior
to p
are
nte
ral m
edic
ation p
repara
tion
• P
rior
to a
dm
inis
tering
IV
medic
ations o
r in
fusio
ns
• A
fter
exposure
to a
ny b
lood o
r body f
luid
s
• A
fter
conta
ct
with o
ther
conta
min
ate
d f
luid
s (
e.g
., s
pent
dia
lysate
) •
Aft
er
handlin
g u
sed d
ialy
zers
, blo
od t
ubin
g,
or
prim
e b
uckets
•
Aft
er
perf
orm
ing
wound c
are
or
dre
ssin
g c
hang
es
• W
hen leavin
g s
tation a
fter
perf
orm
ing
patient care
•
Aft
er
rem
ovin
g g
love
s
• A
fter
touchin
g d
ialy
sis
machin
e
• A
fter
touchin
g o
ther
item
s w
ithin
dia
lysis
sta
tion
• A
fter
usin
g c
hair-s
ide c
om
pute
rs for
chart
ing
• W
hen leavin
g s
tation
• A
fter
rem
ovin
g g
love
s
Ple
ase m
ake n
ote
of
the f
ollo
win
g d
uri
ng
th
is s
essio
n.
Yes
No
C
om
men
ts
There
is a
suff
icie
nt supply
of
alc
ohol-based h
and s
anitiz
er
There
is a
suff
icie
nt supply
of
soap a
t hand-w
ashin
g s
tations
There
is a
suff
icie
nt supply
of
paper
tow
els
at hand-w
ashin
g
sta
tions
There
is v
isib
le a
nd e
asy a
ccess to h
and w
ashin
g s
inks o
r hand
sanitiz
er
Na
tio
na
l C
en
ter
for
Em
erg
ing
an
d Z
oo
no
tic Infe
ctio
us
Dis
ease
s
CS
22
88
27
CDC
Dia
lysi
s Co
llabo
rati
ve
Fa
cilit
y N
ame:
___
____
____
____
____
_ D
ate:
____
____
____
_ S
tart
tim
e:__
____
___A
M /
PM
Day
: M
W F
Tu
Th
Sa
Sh
ift:
1st 2
nd
3rd 4
th
Obs
erve
r: __
____
____
____
____
____
Loc
atio
n w
ithin
uni
t:___
____
____
____
___
Audi
t Too
l: A
rter
iove
nous
fist
ula/
graf
t can
nula
tion
obse
rvat
ions
(Use
a “√
” if a
ctio
n pe
rfor
med
cor
rect
ly, a
“Ф” i
f not
per
form
ed. I
f not
obs
erve
d, le
ave
blan
k)
Dis
cipl
ine
Site
cle
aned
w
ith s
oap
and
wat
er
Han
d hy
gien
e pe
rfor
med
(s
taff
)
New
, cle
an
glov
es
wor
n
Skin
an
tisep
tic
appl
ied
appr
opri
atel
y
Skin
an
tisep
tic
allo
wed
to
dry
No
cont
act
with
fist
ula/
gr
aft s
ite(a
fter
an
tisep
sis)
Cann
ulat
ion
perf
orm
ed
asep
tical
ly
Conn
ect t
o bl
ood
lines
as
eptic
ally
Glo
ves
rem
oved
Han
d hy
gien
e pe
rfor
med
Com
men
ts
Dis
cipl
ine:
P=p
hysi
cian
, N=n
urse
, T=t
echn
icia
n, S
=stu
dent
, O=o
ther
Dur
atio
n of
obs
erva
tion
perio
d =
min
utes
N
umbe
r of p
roce
dure
s pe
rfor
med
cor
rect
ly =
To
tal n
umbe
r of p
roce
dure
s ob
serv
ed d
urin
g au
dit =
AD
DIT
ION
AL C
OM
MEN
TS/O
BSER
VATI
ON
S:
Nat
iona
l Cen
ter f
or E
mer
ging
and
Zoo
notic
Infe
ctio
us D
isea
ses
Div
isio
n of
Hea
lthca
re Q
ualit
y Pr
omot
ion
Audi
t Too
l: A
rter
iove
nous
fist
ula/
graf
t dec
annu
latio
n ob
serv
atio
ns(U
se a
“√” i
f act
ion
perf
orm
ed c
orre
ctly
, a “Ф
” if n
ot p
erfo
rmed
. If n
ot o
bser
ved,
leav
e bl
ank)
CDC
Dia
lysi
s Co
llabo
rati
ve
Faci
lity
Nam
e: _
____
____
____
____
___
Dat
e: __
____
____
___
Sta
rt ti
me:
____
____
_AM
/ PM
D
ay:
M W
F T
u T
h S
a
Shift
: 1st
2nd
3rd
4th
O
bser
ver:
____
____
____
____
____
__ L
ocat
ion
with
in u
nit:_
____
____
____
____
_
Dis
cipl
ine
Han
d hy
gien
e pe
rfor
med
(s
taff
)
New
, cle
an
glov
es w
orn
Dis
conn
ect
from
blo
od
line
asep
tical
ly
Nee
dles
re
mov
ed
asep
tical
ly
Clea
n gl
oves
w
orn
(by
patie
nt/s
taff
) to
com
pres
s si
te
Clea
n ga
uze
/ban
dage
ap
plie
d to
si
te
If ot
her a
ctiv
ities
pe
rfor
med
bet
wee
n ne
edle
rem
oval
s,
hand
hyg
iene
is
perf
orm
ed a
nd
new
, cle
an g
love
s ar
e w
orn
Staff
gl
oves
re
mov
ed
Staff
ha
nd
hygi
ene
perf
orm
ed
Patie
nt g
love
s re
mov
ed a
nd
hand
hyg
iene
pe
rfor
med
(if a
pplic
able
)
Com
men
ts
Dis
cipl
ine:
P=p
hysi
cian
, N=n
urse
, T=t
echn
icia
n, S
=stu
dent
, O=o
ther
Dur
atio
n of
obs
erva
tion
perio
d =
min
utes
N
umbe
r of p
roce
dure
s pe
rfor
med
cor
rect
ly =
To
tal n
umbe
r of p
roce
dure
s ob
serv
ed d
urin
g au
dit =
ADD
ITIO
NAL
CO
MM
ENTS
/OBS
ERVA
TIO
NS:
Nat
iona
l Cen
ter f
or E
mer
ging
and
Zoo
notic
Infe
ctio
us D
isea
ses
Div
isio
n of
Hea
lthca
re Q
ualit
y Pr
omot
ion
CDC
Dia
lysi
s Co
llabo
rati
veD
ay:
M W
F T
u T
h S
a
Shift
: 1st
2nd
3rd
4th
O
bser
ver:
____
____
____
____
____
__ L
ocat
ion
with
in u
nit:_
____
____
____
____
_
Audi
t Too
l: Ca
thet
er c
onne
ctio
n an
d di
scon
nect
ion
obse
rvat
ions
(Use
a “√
” if a
ctio
n pe
rfor
med
cor
rect
ly, a
“Ф” i
f not
per
form
ed. I
f not
obs
erve
d, le
ave
blan
k)
Fa
cilit
y N
ame:
___
____
____
____
____
_ D
ate:
____
____
____
_ S
tart
tim
e:__
____
___A
M /
PM
Proc
edur
e ob
serv
ed,
C=co
nnec
t D
=dis
conn
ectD
isci
plin
e
Mas
k w
orn
prop
erly
(if
re
quire
d)
Han
d hy
gien
epe
rfor
med
New
cle
an
glov
es
wor
n
Cath
eter
re
mov
ed fr
om
bloo
d lin
e as
eptic
ally
(d
isco
nnec
tion
only
)
Cath
eter
hu
b sc
rubb
ed
Hub
an
tisep
tic
allo
wed
to
dry
Cath
eter
co
nnec
ted
to
bloo
d lin
es
asep
tical
ly(c
onne
ctio
n on
ly)
New
cap
s at
tach
ed
asep
tical
ly
(aft
er
disc
onne
ctin
g)
Glo
ves
rem
oved
Han
d hy
gien
e pe
rfor
med
Dis
cipl
ine:
P=p
hysi
cian
, N=n
urse
, T=t
echn
icia
n, S
=stu
dent
, O=o
ther
Dur
atio
n of
obs
erva
tion
perio
d =
min
utes
N
umbe
r of p
roce
dure
s pe
rfor
med
cor
rect
ly =
To
tal n
umbe
r of p
roce
dure
s ob
serv
ed d
urin
g au
dit =
AD
DIT
ION
AL C
OM
MEN
TS/O
BSER
VATI
ON
S:
Nat
iona
l Cen
ter f
or E
mer
ging
and
Zoo
notic
Infe
ctio
us D
isea
ses
Div
isio
n of
Hea
lthca
re Q
ualit
y Pr
omot
ion
Aud
it T
ool:
Hem
odia
lysi
s ha
nd h
ygie
ne o
bse
rvat
ions
(Use
a “√
” for
eac
h ‘h
and
hygi
ene
opp
ortu
nity
’ ob
serv
ed. U
nder
‘op
por
tuni
ty s
ucce
ssfu
l’, us
e a
“√” i
f suc
cess
ful,
and
leav
e b
lank
if n
ot s
ucce
ssfu
l)
Dis
cip
line
Han
d h
ygie
ne
Des
crib
e an
y m
isse
d a
ttem
pts
(e.g
., d
uri
ng
med
icat
ion
pre
p,
bet
wee
n p
atie
nts
, aft
er c
on
tam
inat
ion
wit
h b
loo
d, e
tc.)
:H
and
hyg
ien
e o
pp
ort
un
ity
Op
po
rtu
nit
y su
cces
sfu
l
Dis
cip
line:
P=
phy
sici
an, N
=nu
rse,
T=
tech
nici
an, S
=st
uden
t, D
=di
etiti
an, W
=so
cial
wor
ker,
O=
othe
rD
urat
ion
of o
bse
rvat
ion
per
iod
=
m
inut
es
Num
ber
of s
ucce
ssfu
l han
d hy
gien
e op
por
tuni
ties
obse
rved
=
Tota
l num
ber
of p
atie
nts
obse
rved
dur
ing
audi
t =
To
tal n
umb
er o
f han
d hy
gien
e op
por
tuni
ties
obse
rved
dur
ing
audi
t =
** S
ee h
and
hygi
ene
opp
ortu
nitie
s on
bac
k p
age
CD
C D
ialy
sis
Colla
bor
ativ
e
Fac
ility
Nam
e: _
____
____
____
____
___
Dat
e: _
____
____
____
Sta
rt ti
me:
____
____
_AM
/ PM
D
ay:
M W
F T
u T
h S
a
Shift
: 1st
2nd
3rd
4th
O
bser
ver:
____
____
____
____
____
__ L
ocat
ion
with
in u
nit:_
____
____
____
____
_
Nat
iona
l Cen
ter f
or E
mer
ging
and
Zoo
notic
Infe
ctio
us D
isea
ses
Div
isio
n of
Hea
lthca
re Q
ualit
y Pr
omot
ion
Gu
ide
to H
and
Hyg
ien
e O
pp
ort
un
itie
s in
Hem
od
ialy
sis
Han
d h
ygie
ne
op
po
rtu
nit
y ca
teg
ory
Spec
ific
exa
mp
les
1.Pr
ior t
o to
uchi
ng a
pat
ient
•Prio
r to
ente
ring
stat
ion
to p
rovi
de c
are
to p
atie
nt•P
rior t
o co
ntac
t with
vas
cula
r acc
ess
site
•Prio
r to
adju
stin
g or
rem
ovin
g ca
nnul
atio
n ne
edle
s
2.Pr
ior t
o as
eptic
pro
cedu
res
•Prio
r to
cann
ulat
ion
or a
cces
sing
cat
hete
r•P
rior t
o p
erfo
rmin
g ca
thet
er s
ite c
are
•Prio
r to
par
ente
ral m
edic
atio
n p
rep
arat
ion
•Prio
r to
adm
inis
terin
g IV
med
icat
ions
or i
nfus
ions
3.A
fter
bod
y flu
id e
xpos
ure
risk
•Aft
er e
xpos
ure
to a
ny b
lood
or b
ody
fluid
s•A
fter
con
tact
with
oth
er c
onta
min
ated
flui
ds (e
.g.,
spen
t dia
lysa
te)
•Aft
er h
andl
ing
used
dia
lyze
rs, b
lood
tub
ing,
or p
rime
buc
kets
•Aft
er p
erfo
rmin
g w
ound
car
e or
dre
ssin
g ch
ange
s
4.A
fter
touc
hing
a p
atie
nt• W
hen
leav
ing
stat
ion
afte
r per
form
ing
pat
ient
car
e•A
fter
rem
ovin
g gl
oves
5.A
fter
touc
hing
pat
ient
sur
roun
ding
s•A
fter
touc
hing
dia
lysi
s m
achi
ne•A
fter
touc
hing
oth
er it
ems
with
in d
ialy
sis
stat
ion
•Aft
er u
sing
cha
irsid
e co
mp
uter
s fo
r cha
rtin
g• W
hen
leav
ing
stat
ion
•Aft
er re
mov
ing
glov
es
Ple
ase
mak
e n
ote
of t
he
follo
win
g d
uri
ng
this
ses
sio
n.
Yes
No
Co
mm
ents
Ther
e is
a s
uffici
ent s
upp
ly o
f alc
ohol
-bas
ed h
and
sani
tizer
Ther
e is
a s
uffici
ent s
upp
ly o
f soa
p a
t han
dwas
hing
sta
tions
Ther
e is
a s
uffici
ent s
upp
ly o
f pap
er to
wel
s at
han
dwas
hing
sta
tions
Ther
e is
vis
ible
and
eas
y ac
cess
to h
and
was
hing
sin
ks o
r han
d sa
nitiz
er
Nat
iona
l Cen
ter f
or E
mer
ging
and
Zoo
notic
Infe
ctio
us D
isea
ses
Div
isio
n of
Hea
lthca
re Q
ualit
y Pr
omot
ion
Facility
Name:__________________________________________
Observer:___________________________________________
2
nd 3
rd 4
th
Date:_________________________
Day: M
W
F
Tu
Th
Sa
S
hift:
1
st
Start
time:____________AM
/ PM
Au
dit
To
ol:
He
mo
dia
lysi
s st
ati
on
ro
uti
ne
dis
infe
ctio
n o
bse
rva
tio
ns *
(Use
a “√” if
action
perform
ed correctly,
a “Ф” if
not perform
ed/
pe
rfo
rme
d i
nco
rre
ctly. If not observed, leave
blank.
All applicable
actions within
a row
must
have “√” for the procedure
to
be counted
as successful.”)
*This
audit
tool applies when
there is
no
visible soil on
surfaces
at the dialysis station. If
visible blood
or other
soil is
present,
surfaces
must
be cleaned
prior to
disinfection.
Dis
cip
lin
e
All
su
pp
lie
s re
mo
ve
d f
rom
st
ati
on
an
d
pri
me
bu
cke
t e
mp
tie
d
Glo
ve
s re
mo
ve
d,
ha
nd
h
yg
ien
e
pe
rfo
rme
d
Sta
tio
n i
s e
mp
ty b
efo
re
dis
infe
ctio
n
init
iate
d *
*
Ne
w c
lea
n
glo
ve
s w
orn
Dis
infe
cta
nt
ap
pli
ed
to
all
su
rfa
ces
an
d
pri
me
bu
cke
t
All
su
rfa
ces
are
we
t w
ith
d
isin
fect
an
t
All
su
rfa
ces
all
ow
ed
to
dry
Glo
ve
s re
mo
ve
d,
ha
nd
h
yg
ien
e
pe
rfo
rme
d
No
su
pp
lie
s o
r p
ati
en
t b
rou
gh
t to
sta
tio
n u
nti
l d
isin
fect
ion
co
mp
lete
Discipline:
P=physician, N
=nurse,
T=technician, S=student,
O=other
Duration
of observation
period: ________________
Number
of procedures perform
ed correctly =
Total number
of procedures observed
during
audit
=
AD
DIT
ION
AL
CO
MM
EN
TS
/OB
SE
RV
AT
ION
S:
** Ensure the patient has
left
the dialysis station
before disinfection
is initiated.
CDC Approach to BSI Prevention in Dialysis Facilities
(i.e., the Core Interventions for Dialysis Bloodstream Infection (BSI) Prevention)
Catheter reduction 6.Incorporate efforts (e.g., through patient education, vascular access coordinator) to reduce catheters by identifying and addressing barriers to permanent vascular access placement and catheter removal.
Chlorhexidine for skin antisepsis 7.Use an alcohol-based chlorhexidine (>0.5%) solution as the first line skin antiseptic agent for central line insertion and during dressing changes.*
Catheter hub disinfection 8.Scrub catheter hubs with an appropriate antiseptic after cap is removed and before accessing. Perform every time catheter is accessed or disconnected.**
Antimicrobial ointment 9.Apply antibiotic ointment or povidone-iodine ointment to catheter exit sites during dressing change.*** * Povidone-iodine (preferably with alcohol) or 70% alcohol are alternatives for patients with chlorhexidine intolerance.
** If closed needleless connector device is used, disinfect device per manufacturer’s instructions. *** See information on selecting an antimicrobial ointment for hemodialysis catheter exit sites on CDC’s Dialysis Safety website (http://www.cdc.gov/dialysis/prevention-tools/core-interventions.html#sites). Use of chlorhexidine-impregnated sponge dressing might be an alternative.
Surveillance and feedback using NHSN 1.Conduct monthly surveillance for BSIs and other dialysis events using CDC’s National Healthcare Safety Network (NHSN). Calculate facility rates and compare to rates in other NHSN facilities. Actively share results with front-line clinical staff.
Hand hygiene observations 2.Perform observations of hand hygiene opportunities monthly and share results with clinical staff.
Catheter/vascular access care observations 3.Perform observations of vascular access care and catheter accessing quarterly. Assess staff adherence to aseptic technique when connecting and disconnecting catheters and during dressing changes. Share results with clinical staff.
Staff education and competency 4.Train staff on infection control topics, including access care and aseptic technique. Perform competency evaluation for skills such as catheter care and accessing every 6-12 months and upon hire.
Patient education/engagement 5.Provide standardized education to all patients on infection prevention topics including vascular access care, hand hygiene, risks related to catheter use, recognizing signs of infection, and instructions for access management when away from the dialysis unit.
For more information about the Core Interventions for Dialysis Bloodstream Infection (BSI) Prevention, please visit http://www.cdc.gov/dialysis
National Center for Emerging and Zoonotic Infectious Diseases
Division of Healthcare Quality Promotion
