This tool is used to document care provider hand hygiene (waterless or soap and water) before and after patient contact and after removal of gloves. The data collection may be completed by someone trained in the use of the tool (Standard Operating Procedure [SOP] included) and who understands how to document the observation.

The tool provides the ability to document and monitor length of time observing, name and position of person observed, comments (e.g., washed hands for less than 15 seconds), and whether feedback was provided. This form is faxed weekly to the unit managers so coaching may be done as needed and to provide feedback to the specific nursing departments.

Download the tool for complete instructions.