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DATE_____/______/_ _ ___
Hand Hygiene Observation Tool INSTRUCTIONS: 1. The
Department Head or Charge Nurse will be responsible for delegating
this assignment.
2. Observe 15 Hand Hgiene Opportunities wee!l.". #dentif title
of staff observed from list below.
$. Cross out O for ea%h Opportunit observed and H for
ea%h time Hand Hgiene performed for that Opportunit.
NOTE& Hand Hgiene refers to use of al%ohol gel or
washing with soap and water for at least 15 se%onds.
5. 'ubmit %ompleted form(s) to Health%are *esear%h via
interoffi%e mail on +ondas for the previous wee!
('unda,'aturda).
STAFF TITE
! Hand Hygiene O""ort#nities
$ U"on entering "atient roo% O H O H O H O H O H O H O H O H O H
O H
& A'ter (andling ob)e*ts and devi*es ie +soiled
linen, tras(, %edi*al e-#i"%ent.
O H O H O H O H O H O H O H O H O H O H
0e'ore *lean and ase"ti* "ro*ed#res,
in*l#ding %ed "re" 1 sterile "ro*ed#res
O H O H O H O H O H O H O H O H O H O H
2 A'ter *onta*t 3it( blood, body 'l#ids, %#*o#s
%e%branes, non4inta*t s5in
O H O H O H O H O H O H O H O H O H O H
6 A'ter re%oving gloves or ot(er 77E8 O H O H O H O H O H O H O
H O H O H O H
9 U"on eiting roo% O H O H O H O H O H O H O H O H O H O H
TOTAS
Sta'' Titles:
Do%tor +;D/DO.- hsi%ians /0tender +7E.- Nurse ra%titioners +N7.-
Nurse +RN. Nurse +idwives +N;. Nursing Te%h'itter +NT. *espirator
Therap
+RT. 34*a Te%h +
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INSTRU>SI:
$8 >e"ala De"arte%en ata# ;engisi 7era3at a5an
bertangg#ng )a3ab #nt#5 %endelegasi5an t#gas ini8
&8 A%ati $6 Tangan 7el#ang Hygiene %ingg#an8
8 ;engidenti'i5asi )#d#l sta' dia%ati dari da'tar di ba3a( ini8
28 intas 5el#ar O #nt#5 setia" 7el#ang dia%ati dan H #nt#5 setia"
5ali tangan
Hygiene dila5#5an #nt#5 7el#ang it#8
CATATAN: Tangan Ana5 %enga*# "ada "engg#naan gel al5o(ol
ata# %en*#*i dengan sab#n dan air sela%a %ini%al $6 deti58
68 ;enyera(5an 'or%#lir yang tela( dileng5a"i +s. #nt#5
>ese(atan 7enelitian %elal#i antar 5antor "os "ada (ari Senin
#nt#5 %ingg#
sebel#%nya +;ingg#4Sabt#.8
Tangan 7el#ang >ebersi(anSetela( %e%as#5i r#angan "asien O H
O H O H O H O H O H O H O H O H O H
Setela( "enanganan benda dan "erang5at yait# +linen 5otor,
sa%"a(, "eralatan %edis. O H O H O H O H O H O H O H O H O H O
H
Sebel#% bersi( dan ase"ti5 "rosed#r, ter%as#5 %ed "re" 1
"rosed#r steril O H O H O H O H O H O H O H O H O H O H
Setela( 5onta5 dengan dara(, *airan t#b#(, sela"#t lendir, yang
tida5 #t#( 5#lit O H O H O H O H O H O H O H O H O H O H
Setela( %ele"as sar#ng tangan ata# A7D lainnya8 O H O H O H O H
O H O H O H O H O H O H
Setela( 5el#ar 5a%ar O H O H O H O H O H O H O H O H O H O H
TOTA
