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  • FORM KEPATUHAN Kebersihan Tangan

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    The document is an observation form for monitoring hand hygiene compliance (KKT) at a healthcare facility. It records details of a KKT observation, including date, time, observer name, unit observed, names and professions of staff observed, and whether they performed correct hand hygiene before and after various patient contact points. The form allows observation data to be collected for up to 3 staff members over multiple opportunities to assess their hand hygiene practices.

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    The document is an observation form for monitoring hand hygiene compliance (KKT) at a healthcare facility. It records details of a KKT observation, including date, time, observer name, unit observed, names and professions of staff observed, and whether they performed correct hand hygiene before and after various patient contact points. The form allows observation data to be collected for up to 3 staff members over multiple opportunities to assess their hand hygiene practices.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    3 views1 page

    FORM KEPATUHAN Kebersihan Tangan

    Uploaded by

    ADIBAH
    The document is an observation form for monitoring hand hygiene compliance (KKT) at a healthcare facility. It records details of a KKT observation, including date, time, observer name, unit observed, names and professions of staff observed, and whether they performed correct hand hygiene before and after various patient contact points. The form allows observation data to be collected for up to 3 staff members over multiple opportunities to assess their hand hygiene practices.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    FORM OBSERVASI KEPATUHAN KEBERSIHAN TANGAN (KKT)

    Tanggal Observasi/Jam mulai/Jam : Tgl. Jam Mulai:


    akhir/Durasi Jam berakhir: Durasi : ……. Menit
    Nama Observer (lengkap dengan gelar) :
    Unit Pelayanan Petugas yang dinilai : 1. Ruang Administrasi 8. Ruang Kesehatan Gigi & Mulut
    (Lingkari yang sesuai) 2. Ruang Pendaftaran & Rekam 9. Ruang KIE
    Medis 10. Ruang Farmasi
    3. Ruang Pemeriksaan Umum 11. Ruang Persalinan
    4. Ruang Tindakan&Gawat Darurat 12. Ruang Rawat Pasca Persalinan Normal
    5. Ruang Kesehatan Ibu dan KB 13. Ruang Rawat Inap
    6. Ruang Kesehatan Anak & 14. Ruang Laboratorium
    Imunisasi
    7. Ruang Pemeriksaan Khusus

    Nama Nama Nama


    Petugas Petugas Petugas
    diobservasi diobservasi diobservasi
    Kategori Kategori Kategori
    Profesi Profesi Profesi
    Jumlah Opp. Jumlah Opp. Jumlah Opp.
    Opp. Indikasi Tindakan Opp. Indikasi Tindakan Opp. Indikasi Tindakan
    HH HH HH
    1 Bef.pat HR 1 Bef.pat HR 1 Bef.pat HR
    Bef.asept, HW Bef.asept, HW Bef.asept, HW
    Aft.b.f Aft.b.f Aft.b.f
    Missed Missed Missed
    Aft.pat Aft.pat Aft.pat
    Aft.p.surr. Aft.p.surr. Aft.p.surr.
    2 Bef.pat HR 2 Bef.pat HR 2 Bef.pat HR
    Bef.asept, HW Bef.asept, HW Bef.asept, HW
    Aft.b.f Aft.b.f Aft.b.f
    Missed Missed Missed
    Aft.pat Aft.pat Aft.pat
    Aft.p.surr. Aft.p.surr. Aft.p.surr.
    3 Bef.pat HR 3 Bef.pat HR 3 Bef.pat HR
    Bef.asept, HW Bef.asept, HW Bef.asept, HW
    Aft.b.f Aft.b.f Aft.b.f
    Missed Missed Missed
    Aft.pat Aft.pat Aft.pat
    Aft.p.surr. Aft.p.surr. Aft.p.surr.
    4 Bef.pat HR 4 Bef.pat HR 4 Bef.pat HR
    Bef.asept, HW Bef.asept, HW Bef.asept, HW
    Aft.b.f Aft.b.f Aft.b.f
    Missed Missed Missed
    Aft.pat Aft.pat Aft.pat
    Aft.p.surr. Aft.p.surr. Aft.p.surr.
    5 Bef.pat HR 5 Bef.pat HR 5 Bef.pat HR
    Bef.asept, HW Bef.asept, HW Bef.asept, HW
    Aft.b.f Aft.b.f Aft.b.f
    Missed Missed Missed
    Aft.pat Aft.pat Aft.pat
    Aft.p.surr. Aft.p.surr. Aft.p.surr.
    6 Bef.pat HR 6 Bef.pat HR 6 Bef.pat HR
    Bef.asept, HW Bef.asept, HW Bef.asept, HW
    Aft.b.f Aft.b.f Aft.b.f
    Missed Missed Missed
    Aft.pat Aft.pat Aft.pat
    Aft.p.surr. Aft.p.surr. Aft.p.surr.
    7 Bef.pat HR 7 Bef.pat HR 7 Bef.pat HR
    Bef.asept, HW Bef.asept, HW Bef.asept, HW
    Aft.b.f Aft.b.f Aft.b.f
    Missed Missed Missed
    Aft.pat Aft.pat Aft.pat
    Aft.p.surr. Aft.p.surr. Aft.p.surr.
    8 Bef.pat HR 8 Bef.pat HR 8 Bef.pat HR
    Bef.asept, HW Bef.asept, HW Bef.asept, HW
    Aft.b.f Aft.b.f Aft.b.f
    Missed Missed Missed
    Aft.pat Aft.pat Aft.pat
    Aft.p.surr. Aft.p.surr. Aft.p.surr.

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