DHHS: Hand Hygiene Audit Tool

• Site conducted

  Select

• Date Observed

  Date

• Prepared by

• Name of Associate Being Observed

  Sign

• Unit/Site conducted

  Select

• The Associate performed Hand Hygiene

  Select

• The Associate performed Hand Hygiene at the following momement

  Select

Hand Wash

• The Associate performed hand wash for at least 40 -60 seconds

  Yes

  No

  N/A

• The Associate wet their hands first with water

  Yes

  No

  N/A

• Applied enough soap to the palm of the hand

  Yes

  No

  N/A

• Rub hands palm to palm

  Yes

  No

  N/A

• Rubbed right palm over left dorsum with interlaced fingers and then left palm over right dorsum with interlaced fingers.

  Yes

  No

  N/A

• Rubbed palm to palm with fingers interlaced

  Yes

  No

  N/A

• Rubbed back of fingers to opposing palms with fingers interlocked.

  Yes

  No

  N/A

• Rotationally rubbed left thumb clasped in right palm and then right thumb clasped in left palm

  Yes

  No

  N/A

• Rotationally rubbed backward and forward with clasped fingers of right hand in left palm and then left fingers in right palm

  Yes

  No

  N/A

• Rinse both hands with water without touching the sink or faucet

  Yes

  No

  N/A

• Dry both hands thoroughly with a clean hand towels

  Yes

  No

  N/A

• Used a clean hand towel to turn of the faucet

  Yes

  No

  N/A

• Once the hand was completely dry and the faucet was turned off Associate proceeded to apply appropriate PPE to perform the scheduled task if applicable

  Yes

  No

  N/A

Hand Rub

• The Associate performed hand rub for a minimum of 20 seconds

  Yes

  No

  N/A

• Associate Applied hand sanitizer to cupped hand, covering all surfaces

  Yes

  No

  N/A

• Rubbed hands palm to palm

  Yes

  No

  N/A

• Rubbed Right palm over left dorsum with fingers interlaced and left palm over right dorsum (back of the hand) with fingers interlaced

  Yes

  No

  N/A

• Rubbed hands palm to palm with fingers interlaced

  Yes

  No

  N/A

• Rubbed back of fingers to opposing palms with fingers interlocked

  Yes

  No

  N/A

• Rotationally rub left and right thumb

  Yes

  No

  N/A

• Rotationally rub backward and forward clasped fingers of the right and left hand in the opposite palm

  Yes

  No

  N/A

• Once dry, proceed to apply appropriate PPE to perform scheduled task if applicable

  Yes

  No

  N/A

Associate Feed Back

• No Remediation required

  Yes

  No

  N/A

• No re-education and reinforcement required to improve hand hygiene practices

  Yes

  No

  N/A

• Overall Individual rating of Hand Hygiene Assessment

  Select