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Data Collection Tool Sponsored by the Hand Hygiene Targeted Solutions Tool™
The products, technology and/or processes described and/or used on TST may be the subject of intellectual property rights reserved by the Center, The Joint Commission or other third parties. Nothing contained herein shall be construed as conferring to you in any manner, whether by implication, estoppel or otherwise, any license, title, or ownership of or to any intellectual property right of the Center, The Joint Commission or any third party.
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Data Collection Tool Sponsored by the Hand Hygiene Targeted Solutions Tool™
The products, technology and/or processes described and/or used on TST may be the subject of intellectual property rights reserved by the Center, The Joint Commission or other third parties. Nothing contained herein shall be construed as conferring to you in any manner, whether by implication, estoppel or otherwise, any license, title, or ownership of or to any intellectual property right of the Center, The Joint Commission or any third party.
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Instructions: • Step 1: Watch “Improving Care with TST” video (6 minutes) at
http://www.centerfortransforminghealthcare.org/multimedia/improving-‐care-‐with-‐the-‐tst/ • Step 2: Review the data collection tool provided by Joint Commission for Center for Transforming
Healthcare (see Page 3 to 5) • Step 3: Go out to your patient care area and “test it” on 3 to 5 observations before Session 2. • Come back next webinar and tell us your experience
Data Collection Tool Sponsored by the Hand Hygiene Targeted Solutions Tool™
The products, technology and/or processes described and/or used on TST may be the subject of intellectual property rights reserved by the Center, The Joint Commission or other third parties. Nothing contained herein shall be construed as conferring to you in any manner, whether by implication, estoppel or otherwise, any license, title, or ownership of or to any intellectual property right of the Center, The Joint Commission or any third party.
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Definitions of Contributing Factors
Observable contributing factors (11): Column #
Contributing Factor Definition
6 Dispenser location The alcohol based hand-‐rub dispenser(s) is not optimally located in the path of the health care provider’s workflow, and/or the access to the dispensers are either obstructed or hidden.
7 Dispenser empty The alcohol based hand-‐rub dispenser(s) accessible to the observed health care provider is empty.
8 Dispenser broken The alcohol based hand-‐rub dispenser(s) accessible to the observed health care provider is broken or not functional.
9 Equipment shared The health care provider did not wash hands due to the use of shared equipment between patients (e.g., vital sign machine, portable x-‐ray, etc.).
10 Hands full supplies Health care provider’s hands are full of supplies or equipment (e.g., food trays, lab supplies).
11 Hands full meds Health care provider’s hands are full of medications. 12 Improper use of gloves Health care provider did not wash hands before putting on gloves or
after taking gloves off. 13 Follow person entry or exit Health care providers entering or exiting the patient care area followed
someone who did not wash hands. 14 Frequent entry and exit Frequent entry and exit of patient care area. 15 Admissions or discharge process Lack of streamlined admission or discharge process led to unnecessary,
frequent entry or exit o the patient care area by the health care provider.
16 Isolation area (gown + gloves) Prior to entering or exiting the isolation patient care area, the health care provider did not wash hands before or after putting on personal protective equipment (e.g., gloves or gowns, when required).
Non-observable contributing factors (4):
Column #
Contributing Factor Definition
17 Lack of immediate feedback Lack of feedback to the health care provider for hand hygiene compliance coaching.
18 Distracted or forgot Distracted/ forgot/ lack of knowledge/ chose not to wash 19 Perception HH not required Perception that hand hygiene is not necessary if nothing is touched in
the patient care area.
Data Collection Tool Sponsored by the Hand Hygiene Targeted Solutions Tool™
The products, technology and/or processes described and/or used on TST may be the subject of intellectual property rights reserved by the Center, The Joint Commission or other third parties. Nothing contained herein shall be construed as conferring to you in any manner, whether by implication, estoppel or otherwise, any license, title, or ownership of or to any intellectual property right of the Center, The Joint Commission or any third party.
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Column #
Contributing Factor Definition
20 Perception of skin irritation Health care provider perceive that the following will cause skin irritation:
• Alcohol based hand rub is more drying that soap and water • Frequent hand hygiene at work causes skin irritation • The use of gloves eliminates the need for hand hygiene and avoids
skin irritation
Other contributing factors: Column #
Contributing Factor Definition
21 Other contributing factor Please specify other observable or non-‐observable contributing factors that are not listed above.
1. Use a separate row for each entry or exit.2. When there is a defect (wash in/out=no), check any applicable observed contributing factor.3. The “observed by asking” section is for JIT coaches only.4. Emergency situations are EXCLUDED from the data collection process.
Collected by: Role (circle one): Observer Coach Unit:
Non Observable
Date of observations:Hand Hygiene Observation and Contributing Factor FormPossible Contributing Factors to Washing
Observable
1
2
3
4
5
6
7
8
9
10
Instructions:
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22Disp
ense
r loca
tion
Did pe
rson w
ash?
Entry o
r exit
?
Observ
ation
Num
ber
Check
box i
f obs
erved
durin
g rou
nds
RN = Nurs
e
NA = Nurs
ing Assi
stant
MD = Doct
or
RT = Repi
ratory T
herapy
PT = Phys
ical Ther
apy
Diet = D
ietary T
echnic
ian
Lab = L
ab Tec
hnicia
n
HSK = Hous
ekeepi
ng
all oth
ers ple
ase ide
ntify in
comment
s
Enter h
our o
f obs
ervati
on
in
24-ho
ur (m
ilitary
) time
Dispen
ser e
mpty
Dispen
ser b
roken
Equipm
ent s
hared
Hands
full s
uppli
es
Hands
full m
eds
Impro
per u
se of
glov
es
Follow
perso
n entr
y or e
xit
Freque
nt en
try or
exit
Admiss
ions o
r disc
harge
s proc
ess
Isolat
ion ar
ea (g
own +
glov
es)
Lack
of im
mediat
e fee
dbac
k
Distrac
ted or
forgo
t
Percep
tion H
H not re
quire
d
Percep
tion o
f skin
irrita
tion
Other c
ontrib
uting
facto
r
Comments
EN EX
EN EX
EN EX
EN EX
EN EX
EN EX
EN EX
EN EX
EN EX
EN EX
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
6. Dispenser location is not in path of person or is obstructed or hidden7. Dispenser is empty8. Dispenser is broken9. Equipment shared or disposal area (use of equipment shared between patients i.e. vital sign machine, portable x-ray, etc)10. Hands full: supplies or equipment (e.g., food trays, lab supplies)11. Hands full meds12. Gloves (e.g., improper use of or not washing before or after putting gloves on or off)13. Person entering or exiting followed someone who did not wash14. Frequent entry and exit of patient area
15. Admissions or discharge process16. Isolation area (gown + gloves when required)17. Lack of immediate feedback to person for hand hygiene compliance18. Distractions/forgets/lack of knowledge/chose not to wash19. Perception that if nothing is touched in the patient care area hand hygiene is not necessary20. Perception of skin irritation or dislike of alcohol-based hand rub21. Other
Contributing Factors
Circle role of health careprofessional observed
RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other
CM / SW = C
ase Mgm
t / Soci
al Work
er
Pharm = P
harmaci
st
Rad = R
adiolo
gy Tec
h
RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other
RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other
RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other
RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other
RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other
RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other
RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other
RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other
RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other