Hand Hygiene Compliance Checklist

• Facility

• Location
  Address

• Department

• Evaluated by

• Date of Evaluation

  Date

Hand Hygiene Compliance

• The World Health Organization guidelines for Hand Hygiene Technique

  

• Name of Healthcare Worker

• Select healthcare worker category.

  Nurse/ Midwife

  Auxiliary

  Medical Doctor

  Other Healthcare Worker

• Please specify.

Hand Hygiene Technique

• Identify the moment.

  Before patient contact

  Before an aseptic procedure

  After body fluid exposure

  After patient contact

  After contact with patient surroundings

• Which hand hygiene technique did the healthcare worker perform?

  Hand rubbing

  Hand washing

• Hand Hygiene Technique with Alcohol-Based Formulation (20-30 seconds)

• Is the healthcare worker not wearing a stoned ring?

  Yes

  No

• Are the nails of the healthcare worker short and clean?

  Yes

  No

• Did the healthcare worker perform correct hand hygiene technique?

  Yes

  No

• Hand Hygiene Technique with Soap and Water (40-60 seconds)

• Is the healthcare worker not wearing a stoned ring?

  Yes

  No

• Are the nails of the healthcare worker short and clean?

  Yes

  No

• Is the healthcare worker not wearing a wristwatch?

  Yes

  No

• Is the clothing of the healthcare worker 'bare below the elbows'?

  Yes

  No

• Did the healthcare worker perform correct hand hygiene technique?

  Yes

  No

Completion

• Overall Recommendations

• Full Name and Signature of Auditor

  Sign