SUNY Upstate Hospital Downtown Campus Hand Hygiene Monitor Question Title * 1. Please enter your Employee ID Number. Question Title * 2. Unit observed for hand hygiene: 2N 4B 5A 5B 6A 6B 6K 6E 6H 6I 7A 8E 8F 8G 9E 9F 9G 10E 10G 10H 11G 11E 12E 12F 2E (CC) 2N (CC) 3N (CC) 3W (CC) 4E (CC) 4N (CC) 4W (CC) 5E (CC) 5W (CC) 6 (CC) Other (please specify) Question Title * 3. Case Manager 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO (Did Not Intervene) Hand Hygiene- NO (Did Not Intervene) 1 Hand Hygiene- NO (Did Not Intervene) 2 Hand Hygiene- NO (Did Not Intervene) 3 Hand Hygiene- NO (Did Not Intervene) 4 Hand Hygiene- NO (Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 4. Dietition 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 5. Environmental Services (EVS) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO (Did Not Intervene) Hand Hygiene- NO (Did Not Intervene) 1 Hand Hygiene- NO (Did Not Intervene) 2 Hand Hygiene- NO (Did Not Intervene) 3 Hand Hygiene- NO (Did Not Intervene) 4 Hand Hygiene- NO (Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 6. Health Care Technician (HCT/UST/MOA) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 7. Licensed Practical Nurse (LPN) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO (Did Not Intervene) Hand Hygiene- NO (Did Not Intervene) 1 Hand Hygiene- NO (Did Not Intervene) 2 Hand Hygiene- NO (Did Not Intervene) 3 Hand Hygiene- NO (Did Not Intervene) 4 Hand Hygiene- NO (Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 8. Medical Student 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 9. Nurse Practitioner 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 10. Nursing Student 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 11. Occupational Therapist (OT) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 12. Physical Therapist (PT) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 13. Physician 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 14. Physician's Assistant (PA) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 15. PICC Team 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 16. Radiology Tech (RT) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 17. Recreational / Speech Therapist 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 18. Registered Nurse (RN) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 19. Respiratory Therapist (RRT) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 20. Social Worker 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 21. Spiritual Care 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 22. Tray Passer 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 23. Transporter 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 24. Volunteer 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Submit