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  • Form Hand Hygiene

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    Ratnayuniari
    18 views2 pages
    The document appears to be a form for monitoring hand hygiene in a healthcare facility. It includes tables to record opportunities for hand hygiene, the actions taken (HW for handwashing, HR for use of alcohol-based hand rub), and compliance calculations over multiple time periods and professions. Compliance is calculated as the number of hand hygiene actions divided by the number of opportunities.

    Original Description:

    FORMULIR

    Original Title

    03. FORM HAND HYGIENE

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    © © All Rights Reserved

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    The document appears to be a form for monitoring hand hygiene in a healthcare facility. It includes tables to record opportunities for hand hygiene, the actions taken (HW for handwashing, HR for use of alcohol-based hand rub), and compliance calculations over multiple time periods and professions. Compliance is calculated as the number of hand hygiene actions divided by the number of opportunities.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    18 views2 pages

    Form Hand Hygiene

    Uploaded by

    Ratnayuniari
    The document appears to be a form for monitoring hand hygiene in a healthcare facility. It includes tables to record opportunities for hand hygiene, the actions taken (HW for handwashing, HR for use of alcohol-based hand rub), and compliance calculations over multiple time periods and professions. Compliance is calculated as the number of hand hygiene actions divided by the number of opportunities.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    : Observer:

    Ruangan :
    (initials)
    Tanggal: Durasi
    : :
    (dd/mm/yy) Observasi
    Mulai/Berakhir :
    Lembar :
    waktu: (hh:mm)
    FORMULIR MONITORING HAND HYGIENE

    Profesi Profesi Profesi Profesi


    Kode Kode Kode Kode
    Profesi Profesi Profesi Profesi
    Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action
    bef-pat. HR bef-pat. HR bef-pat. HR bef-pat. HR
    1 bef-asept. HW 1 bef-asept. HW 1 bef-asept. HW 1 bef-asept. HW
    aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed
    aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.

    Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action
    bef-pat. HR bef-pat. HR bef-pat. HR bef-pat. HR
    2 bef-asept. HW 2 bef-asept. HW 2 bef-asept. HW 2 bef-asept. HW
    aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed
    aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.

    Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action
    bef-pat. HR bef-pat. HR bef-pat. HR bef-pat. HR
    3 bef-asept. HW 3 bef-asept. HW 3 bef-asept. HW 3 bef-asept. HW
    aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed
    aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.

    Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action
    bef-pat. HR bef-pat. HR bef-pat. HR bef-pat. HR
    4 bef-asept. HW 4 bef-asept. HW 4 bef-asept. HW 4 bef-asept. HW
    aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed
    aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.

    Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action
    bef-pat. HR bef-pat. HR bef-pat. HR bef-pat. HR
    5 bef-asept. HW 5 bef-asept. HW 5 bef-asept. HW 5 bef-asept. HW
    aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed
    aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.

    Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action
    bef-pat. HR bef-pat. HR bef-pat. HR bef-pat. HR
    6 bef-asept. HW 6 bef-asept. HW 6 bef-asept. HW 6 bef-asept. HW
    aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed
    aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.

    Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action
    bef-pat. HR bef-pat. HR bef-pat. HR bef-pat. HR
    7 bef-asept. HW 7 bef-asept. HW 7 bef-asept. HW 7 bef-asept. HW
    aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed
    aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.

    Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action
    bef-pat. HR bef-pat. HR bef-pat. HR bef-pat. HR
    8 bef-asept. HW 8 bef-asept. HW 8 bef-asept. HW 8 bef-asept. HW
    aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed aft-b.f.  missed
    aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves aft-pat.  gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.
    Form Observasi f t
    d ra
    Facility: Period: Setting:
    Profesi Profesi Profesi Profesi
    Total per session
    Session N° Opp HW HR Opp HW HR Opp HW HR Opp HW HR Opp HW HR
    (n) (n) (n) (n) (n) (n) (n) (n) (n) (n) (n) (n) (n) (n) (n)
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    13
    14
    15
    16
    17
    18
    19
    20
    Total
    Calculation Act (n) = Act (n) = Act (n) = Act (n) = Act (n) =

    Opp (n) = Opp (n) = Opp (n) = Opp (n) = Opp (n) =
    Compliance

    Compliance (%) = Actions x 100


    Opportunities

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