Ambulatory Hand Hygiene Monitoring

1.Please enter your Employee ID Number.(Required.)
2.Area observed for hand hygiene:(Required.)
3.Anes/CRNA
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
4.Environmental Services (EVS)
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
5.Health Care Technician (HCT/UST/MOA)
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
6.Lab Technician
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
7.Licensed Practical Nurse (LPN)
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
8.Medical Student
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
9.Nurse Practitioner
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
10.Nursing Student
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
11.Physical /Occupational/ Recreational / Speech Therapist
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
12.Physician
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
13.Physician's Assistant (PA)
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
14.Radiology Tech (RT)
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
15.Registered Nurse (RN)
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
16.Respiratory Therapist (RRT)
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
17.Social Worker
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
18.Transporter/Peri-Op
1
2
3
4
5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)