SUNY Upstate University Hospital Hand Hygiene

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* 1. Please enter your Employee ID Number.

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* 2. Area observed for hand hygiene:

7W-(DT)

4B - (DT)

5W-(CC)

Adult Emergency Dept. (DT)

Bariatric Surgery - (CC)

Cancer Center Adult/ Cancer Center Oswego

Cancer Center Peds

Cardiology - UHCC

Dental Clinic - UHCC

Dialysis - (DT)

Emergency Dept. (CC)

Family Medicine - UHCC

Family Medicine (CC)

Adult Medicine/Subspecialties - UHCC

Geriatrics - 550 Harrison

Inclusive Health Services 725 Irving Ave

Joslin Center

Lab Services

Neurology - UHCC

One Day Surgery/AP 1 - (DT)

Ophthalmology - 550 Harrison

Otolaryngology - 550 Harrison

Outpt Rehab

Outpt Surgery Center - 550 Harrison

PACU - CC

PACU - DT

Patricia Numann Center - 550 Harrison

Pediatrics- 725 Irving Ave

Pediatrics- Baldwinsville

Peds Emergency Dept. (CC)

Perinatal - UHCC

Radiation Oncology

Radiology (CC)

Radiology (DT)

Radiology (550, UHCC)

Surgery Center (CC)

Surgical Specialties (LL, 4835)

TU3

University Internists-550 Harrison

UPAC - UHCC

Urology - CC

Urology - 550 Harrison

Vascular Clinic (CC)

Women's Health Services - UHCC

Inpatient Observations

Other (please specify)

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* 3. Anes/CRNA

	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

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* 4. 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

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* 5. 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

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* 6. Lab Technician

	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

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* 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

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* 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

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* 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

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* 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

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* 11. Physical /Occupational/ 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

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* 12. 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

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* 13. 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

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* 14. 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

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* 15. 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

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* 16. 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

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* 17. 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

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* 18. Transporter/Peri-Op

	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