Hand Hygiene Audit

• Conducted on

  Date

• Prepared by

• Location

  LionsGate

  Gorge

  Britannia

  AspenWoods

  WhiteRock

• Specific location of audit

  Select Hallway Dining Room Entering or exiting suite Screening Washroom Common Space Time clock With resident Other: (Please specify in notes)

  • Hallway
  • Dining Room
  • Entering or exiting suite
  • Screening
  • Washroom
  • Common Space
  • Time clock
  • With resident
  • Other: (Please specify in notes)

Hand Hygiene Observation

• Designation of person completing hand hygiene

  Select MCP RCP LPN Housekeeper Culinary Team Resident Admin Screener Life Enrichment

  • MCP
  • RCP
  • LPN
  • Housekeeper
  • Culinary Team
  • Resident
  • Admin
  • Screener
  • Life Enrichment

• Name of person being audited

• Did they perform hand hygiene? (If no, please provide the reason: hands full, frequent entry/exit, dispenser empty, improper glove use, or other

  Yes

  No

  N/A

• What method?

  Alcohol based hand rub (ABHR)

  Wash

• Did they spend 15-20 seconds washing their hands?<br>For alcohol based hand rub (ABHR) did they rub their hands together vigorously ensuring contact with all surfaces of hands and let dry?

  Yes

  No

  N/A

• Hand Hygiene Moment

  Select Entry of suite Exit of suite Before donning gloves After removing gloves After contact with blood or bodily fluids Before dining After using washroom After resident contact Before putting on mask Screening Other:(Please specify in notes)

  • Entry of suite
  • Exit of suite
  • Before donning gloves
  • After removing gloves
  • After contact with blood or bodily fluids
  • Before dining
  • After using washroom
  • After resident contact
  • Before putting on mask
  • Screening
  • Other:(Please specify in notes)

• Do fingernails meet Hand Hygiene Policy? ( No artificial nails, no overlays, no chipped fingernail polish, nails 1/4 inch or less in length?)

  Yes

  No

  N/A