Hand hygiene is critical to protecting both patients and healthcare workers. A hand hygiene observation form can help ensure that all staff are following proper hand hygiene procedures. The form can also be used to track compliance rates, which can help identify areas where improvement is needed. Use of a hand hygiene observation form is an important tool for maintaining adherence to hand hygiene guidelines and preventing the spread of infection. __________________________________________________________________ Are you looking for a way to improve your hospital's hand hygiene compliance? Look no further than the Hand Hygiene Observation Form! This form can help you keep track of how well each member of your staff is following proper hand hygiene procedures.
We've gathered some technical information about the hand hygiene observation form. It's advised that you check out this info before you decide to start fiddling with the form.
| Question | Answer |
|---|---|
| Form Name | Hand Hygiene Observation Form |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | who hand hygiene checklist pdf, hand hygiene observation form, hand hygiene audit checklist, who hand hygiene checklist |
Observation Form
Facility:
Service:
Ward:
Department:
Country**:
Period Number*: |
|
|
|
|
Session |
|
|
|
|
||
|
|
|
|
Number*: |
|
|
|
|
|
|
|
Date: |
|
|
|
|
Observer: |
|
|
|
|
||
|
/ |
/ |
|
||
(dd/mm/yy) |
|
|
(initials) |
||
|
|
|
|
||
Start/End time: |
|
|
|
|
Page N°: |
|
: |
/ |
: |
||
|
|||||
(hh:mm) |
|
||||
|
|
|
|
|
Session duration: |
|
City**: |
|
||
(mm) |
|
|
|
|
Prof.cat |
|
|
|
Prof.cat |
|
|
|
Prof.cat |
|
|
|
Prof.cat |
|
|
|
|||||
Code |
|
|
|
Code |
|
|
|
Code |
|
|
|
Code |
|
|
|
|||||
N° |
|
|
|
N° |
|
|
|
N° |
|
|
|
N° |
|
|
|
|||||
|
Opp. |
Indication |
HH Action |
Opp. |
Indication |
HH Action |
Opp. |
Indication |
HH Action |
Opp. |
Indication |
HH Action |
||||||||
|
|
|
HR |
|
|
HR |
|
|
HR |
|
|
HR |
||||||||
|
1 |
|
1 |
|
1 |
|
1 |
|
||||||||||||
|
|
HW |
|
HW |
|
HW |
|
HW |
||||||||||||
|
|
|
|
|
|
|
|
|
||||||||||||
|
|
|
missed |
|
|
missed |
|
|
missed |
|
|
missed |
||||||||
|
|
|
gloves |
|
|
gloves |
|
|
gloves |
|
|
gloves |
||||||||
|
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
|
|
HR |
|
|
HR |
|
|
HR |
|
|
HR |
||||||||
|
2 |
|
2 |
|
2 |
|
2 |
|
||||||||||||
|
|
HW |
|
HW |
|
HW |
|
HW |
||||||||||||
|
|
|
|
|
|
|
|
|
||||||||||||
|
|
|
missed |
|
|
missed |
|
|
missed |
|
|
missed |
||||||||
|
|
|
gloves |
|
|
gloves |
|
|
gloves |
|
|
gloves |
||||||||
|
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
|
|
HR |
|
|
HR |
|
|
HR |
|
|
HR |
||||||||
|
3 |
|
3 |
|
3 |
|
3 |
|
||||||||||||
|
|
HW |
|
HW |
|
HW |
|
HW |
||||||||||||
|
|
|
|
|
|
|
|
|
||||||||||||
|
|
|
missed |
|
|
missed |
|
|
missed |
|
|
missed |
||||||||
|
|
|
gloves |
|
|
gloves |
|
|
gloves |
|
|
gloves |
||||||||
|
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
|
|
HR |
|
|
HR |
|
|
HR |
|
|
HR |
||||||||
|
4 |
|
4 |
|
4 |
|
4 |
|
||||||||||||
|
|
HW |
|
HW |
|
HW |
|
HW |
||||||||||||
|
|
|
|
|
|
|
|
|
||||||||||||
|
|
|
missed |
|
|
missed |
|
|
missed |
|
|
missed |
||||||||
|
|
|
gloves |
|
|
gloves |
|
|
gloves |
|
|
gloves |
||||||||
|
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
|
|
HR |
|
|
HR |
|
|
HR |
|
|
HR |
||||||||
|
5 |
|
5 |
|
5 |
|
5 |
|
||||||||||||
|
|
HW |
|
HW |
|
HW |
|
HW |
||||||||||||
|
|
|
|
|
|
|
|
|
||||||||||||
|
|
|
missed |
|
|
missed |
|
|
missed |
|
|
missed |
||||||||
|
|
|
gloves |
|
|
gloves |
|
|
gloves |
|
|
gloves |
||||||||
|
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
|
|
HR |
|
|
HR |
|
|
HR |
|
|
HR |
||||||||
|
6 |
|
6 |
|
6 |
|
6 |
|
||||||||||||
|
|
HW |
|
HW |
|
HW |
|
HW |
||||||||||||
|
|
|
|
|
|
|
|
|
||||||||||||
|
|
|
missed |
|
|
missed |
|
|
missed |
|
|
missed |
||||||||
|
|
|
gloves |
|
|
gloves |
|
|
gloves |
|
|
gloves |
||||||||
|
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
|
|
HR |
|
|
HR |
|
|
HR |
|
|
HR |
||||||||
|
7 |
|
7 |
|
7 |
|
7 |
|
||||||||||||
|
|
HW |
|
HW |
|
HW |
|
HW |
||||||||||||
|
|
|
|
|
|
|
|
|
||||||||||||
|
|
|
missed |
|
|
missed |
|
|
missed |
|
|
missed |
||||||||
|
|
|
gloves |
|
|
gloves |
|
|
gloves |
|
|
gloves |
||||||||
|
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
|
|
HR |
|
|
HR |
|
|
HR |
|
|
HR |
||||||||
|
8 |
|
8 |
|
8 |
|
8 |
|
||||||||||||
|
|
HW |
|
HW |
|
HW |
|
HW |
||||||||||||
|
|
|
|
|
|
|
|
|
||||||||||||
|
|
|
missed |
|
|
missed |
|
|
missed |
|
|
missed |
||||||||
|
|
|
gloves |
|
|
gloves |
|
|
gloves |
|
|
gloves |
||||||||
|
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
|
|
aft.p.surr. |
||||||||
* To be completed by the data manager.
** Optional, to be used if appropriate, according to the local needs and regulations.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material.
Revised August 2009
General Recommendations
(refer to the Hand Hygiene Technical Reference Manual)
1.In the context of open and direct observations, the observer introduces him/herself to the
2.The
3.Detected and observed data should be recorded with a pencil in order to be immediately corrected if needed.
4.The top of the form (header) is completed before starting data collection (excepted end time and session duration).
5.The session should last no more than 20 minutes (± 10 minutes according to the observed activity); the end time and the session duration are to be completed at the end of the observation session.
6.The observer may observe up to three
7.Each column of the grid to record hand hygiene practices is intended to be dedicated to a specific professional category. Therefore numerous
8.As soon as you detect an indication for hand hygiene, count an opportunity in the appropriate column and cross the square corresponding to the indication(s) you detected. Then complete all the indications that apply and the related hand hygiene actions observed or missed.
9.Each opportunity refers to one line in each column; each line is independent from one column to another.
10.Cross items in squares (several may apply for one opportunity) or circles (only a single item may apply at one moment).
11.When several indications fall in one opportunity, each one must be recorded by crossing the squares.
12.Performed or missed actions must always be registered within the context of an opportunity.
13.Glove use may be recorded only when the hand hygiene action is missed while the
Short description of items
Facility: |
to complete according to the local nomenclature |
|
|
||
Service: |
to complete according to the local nomenclature |
|
|
||
Ward: |
to complete according to the local nomenclature |
|
|
||
Department: |
to complete according to the following standardized nomenclature: |
||||
|
medical, including dermatology, neurology, |
|
surgery, including neurosurgery, urology, EENT, |
||
|
haematology, oncology, etc. |
|
ophthalmology, etc. |
||
|
mixed (medical & surgical), including gynaecology |
|
obstetrics, including related surgery |
||
|
paediatrics, including related surgery |
|
intensive care & resuscitation |
||
|
emergency unit |
|
|
|
long term care & rehabilitation |
|
ambulatory care, including related surgery |
|
other (to specify) |
||
Period N°: |
1) |
||||
Date: |
day (dd) / month (mm) / year (yy) |
|
|
||
Start/end time: |
hour (hh) / minute (mm). |
|
|
||
Session duration: |
difference between start and end time, resulting in minutes of observation. |
||||
Session N°: |
attributed at the moment of data entry for analysis. |
|
|
||
Observer: |
observer’s initials (the observer is responsible for the data collection and for checking their accuracy |
||||
|
before submitting the form for analysis. |
|
|
||
Page N°: |
to write only when more than one form is used for one session. |
||||
Prof.cat: |
according to the following classification: |
|
|
||
|
1. nurse / midwife |
|
1.1 nurse, 1.2 midwife, 1.3 student. |
||
|
2. auxiliary |
|
|
|
|
|
3. medical doctor |
|
3.1 in internal medicine, 3.2 surgeon, 3.3 anaesthetist / resuscitator / emergency |
||
|
|
|
physician, 3.4 paediatrician, 3.5 gynaecologist, 3.6 consultant, 3.7 medical student. |
||
|
4. other health- |
|
4.1 therapist (physiotherapist, occupational therapist, audiologist, speech |
||
|
care worker |
|
therapist), 4.2 technician (radiologist, cardiology technician, operating room |
||
|
|
|
technician, laboratory technician, etc), 4.3 other (dietician, dentist, social worker |
||
|
|
|
and any other |
||
Number: |
number of observed |
||||
|
they enter the field of observation and you detect opportunities. |
||||
Opp(ortunity): |
defined by one indication at least |
|
|
||
Indication: |
reason(s) that motivate(s) hand hygiene action; all indications that apply at one moment must be recorded |
||||
|
bef.pat: before touching a patient |
|
aft.b.f: after body fluid exposure risk |
||
|
bef.asept: before clean/aseptic procedure |
|
aft.pat: after touching a patient |
||
|
|
|
|
|
aft.p.surr: after touching patient surroundings |
HH action: |
response to the hand hygiene indication(s); it can be either a positive action by performing handrub or |
||||
|
handwash, or a negative action by missing handrub or handwash |
||||
|
HR: hand hygiene action by handrubbing with an |
|
Missed: no hand hygiene action performed |
||
|
|
|
|
|
|
|
|
|
|
|
|
|
HW: hand hygiene action by handwashing with soap and |
|
|
||
|
water |
|
|
|
|
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material.
Observation Form – Basic Compliance Calculation
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Facility: |
|
|
|
|
|
Period: |
|
|
Setting: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Prof.cat. |
|
|
Prof.cat. |
|
|
Prof.cat. |
|
|
Prof.cat. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total per session |
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
Session N° |
Opp |
HW |
HR |
Opp |
HW |
HR |
Opp |
HW |
HR |
Opp |
HW |
HR |
|
Opp |
HW |
HR |
|
|
|
(n) |
(n) |
(n) |
(n) |
(n) |
(n) |
(n) |
(n) |
(n) |
(n) |
(n) |
(n) |
|
(n) |
(n) |
(n) |
1 |
|
|
|
|
|
|
2 |
|
|
|
|
|
|
3 |
|
|
|
|
|
|
4 |
|
|
|
|
|
|
5 |
|
|
|
|
|
|
6 |
|
|
|
|
|
|
7 |
|
|
|
|
|
|
8 |
|
|
|
|
|
|
9 |
|
|
|
|
|
|
10 |
|
|
|
|
|
|
11 |
|
|
|
|
|
|
12 |
|
|
|
|
|
|
13 |
|
|
|
|
|
|
14 |
|
|
|
|
|
|
15 |
|
|
|
|
|
|
16 |
|
|
|
|
|
|
17 |
|
|
|
|
|
|
18 |
|
|
|
|
|
|
19 |
|
|
|
|
|
|
20 |
|
|
|
|
|
|
Total |
|
|
|
|
|
|
Calculation |
Act (n) = |
Act (n) = |
Act (n) = |
Act (n) = |
|
Act (n) = |
|
Opp (n) = |
Opp (n) = |
Opp (n) = |
Opp (n) = |
Opp (n) = |
|
Compliance |
|
|
|
|
|
|
|
|
|
Compliance (%) = |
Actions |
x 100 |
|
|
|
|
|
Opportunities |
||
Instructions for use
1.Define the setting outlining the scope for analysis and report related data according to the chosen setting.
2.Check data in the observation form. Hand hygiene actions not related to an indication should not be taken into account and vice versa.
3.Report the session number and the related observation data in the same line. This attribution of session number validates the fact that data has been taken into count for compliance calculation.
4.Results per professional category and per session (vertical):
4.1Sum up recorded opportunities (opp) in the case report form per professional category: report the sum in the corresponding cell in the calculation form.
4.2Sum up the positive hand hygiene actions related to the total of opportunities above, making difference between handwash (HW) and handrub (HR): report the sum in the corresponding cell in the calculation form.
4.3Proceed in the same way for each session (data record form).
4.4Add up all sums per each professional category and put the calculation to calculate the compliance rate (given in percent)
5.The addition of results of each line permits to get the global compliance at the end of the last right column.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material.
Observation Form – Optional Calculation Form
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Facility: |
|
|
|
|
|
|
|
Period: |
|
|
|
Setting: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Before touching a |
|
Before clean/ aseptic |
|
After body fluid |
|
|
After touching a |
|
|
After touching |
|
|||||||
|
|
|
|
|
|
|
|
||||||||||||
|
patient |
|
|
|
procedure |
|
|
exposure risk |
|
|
patient |
|
|
|
patient surroundings |
||||
|
|
|
|
|
|
|
|
|
|
|
|||||||||
|
Indic |
HW |
HR |
|
Indic |
HW |
HR |
|
Indic |
HW |
HR |
|
Indic |
HW |
HR |
|
Indic |
HW |
HR |
Session N° |
|
|
|
|
|||||||||||||||
|
(n) |
(n) |
(n) |
|
(n) |
(n) |
(n) |
|
(n) |
(n) |
(n) |
|
(n) |
(n) |
(n) |
|
(n) |
(n) |
(n) |
|
|
|
|
|
|||||||||||||||
1 |
|
|
|
|
|
2 |
|
|
|
|
|
3 |
|
|
|
|
|
4 |
|
|
|
|
|
5 |
|
|
|
|
|
6 |
|
|
|
|
|
7 |
|
|
|
|
|
8 |
|
|
|
|
|
9 |
|
|
|
|
|
10 |
|
|
|
|
|
11 |
|
|
|
|
|
12 |
|
|
|
|
|
13 |
|
|
|
|
|
14 |
|
|
|
|
|
15 |
|
|
|
|
|
16 |
|
|
|
|
|
17 |
|
|
|
|
|
18 |
|
|
|
|
|
19 |
|
|
|
|
|
20 |
|
|
|
|
|
Total |
|
|
|
|
|
Calculation |
Act (n) = |
Act (n) = |
Act (n) = |
Act (n) = |
Act (n) = |
|
Indic1 (n) = |
Indic2 (n) = |
Indic3 (n) = |
Indic4 (n) = |
Indic5 (n) = |
Ratio |
|
|
|
|
|
act / indic |
|
|
|
|
|
Instructions for use
1.Define the setting outlining the scope for analysis and report related data according to the chosen setting.
2.Check data in the observation form. Hand hygiene actions not related to an indication should not be taken into account and vice versa.
3.If several indications occur within the same opportunity, each one should be considered separately as well as the related action.
4.Report the session number and the related observation data in the same line. This attribution of session number validates the fact that data has been taken into count for compliance calculation.
5.Results per indication (indic) and per session (vertical):
4.1Sum up indications per indication in the observation form: report the sum in the corresponding cell in the calculation form.
4.2Sum up positive hand hygiene actions related to the total of indications above, making the difference between handwash (HW) and handrub (HR): report the sum in the corresponding cell in the calculation form.
4.3Proceed in the same way for each session (observation form).
4.4Add up all sums per each indication and put the calculation to calculate the ratio (given in percent)
Note: This calculation is not exactly a compliance result, as the denominator of the calculation is an indication instead of an opportunity. Action is artificially overestimated according to each indication. However, the result gives an overall idea of
of indication.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material.