CHEO Hand Hygiene Audits - IPAC

• Location
  Address

• Conducted on

  Date

• Prepared by

Step 1

• Before entering patient environment?

  Yes

  No

  N/A

• Wash with ABHR 15 seconds?

  Yes

  No

  N/A

• Wash with soap and water and dry (40 sec)?

  Yes

  No

  N/A

• Fingertips?

  Yes

  No

  N/A

• Between fingers and thumbs?

  Yes

  No

  N/A

Step 2

• Wash before touching the patient?

  Yes

  No

  N/A

• Wash before putting on gloves?

  Yes

  No

  N/A

• After removing gloves?

  Yes

  No

  N/A

Step 3

• Wash when leaving patient environment?

  Yes

  No

  N/A

Step 4

• After exposure to body fluids?

  Yes

  No

  N/A

Other

• Hands and wrists free of jewelry with edges

  Yes

  No

  N/A

• Nails clean & natural

  Yes

  No

  N/A

• Skin on hands is intact

  Yes

  No

  N/A