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  • Instrumen Audit HH

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    This document appears to be an observation form used to monitor healthcare workers' compliance with hand hygiene practices at a hospital in Sidoarjo, Indonesia. The form tracks opportunities for hand hygiene, whether hand rubbing (HR) or handwashing (HW) was performed, and notes any missed opportunities or failures to use gloves. The form includes spaces to record data for 7 healthcare professionals over multiple periods.

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    Instrumen audit HH

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    This document appears to be an observation form used to monitor healthcare workers' compliance with hand hygiene practices at a hospital in Sidoarjo, Indonesia. The form tracks opportunities for hand hygiene, whether hand rubbing (HR) or handwashing (HW) was performed, and notes any missed opportunities or failures to use gloves. The form includes spaces to record data for 7 healthcare professionals over multiple periods.

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

    Instrumen Audit HH

    Uploaded by

    aishitoaoshi29
    This document appears to be an observation form used to monitor healthcare workers' compliance with hand hygiene practices at a hospital in Sidoarjo, Indonesia. The form tracks opportunities for hand hygiene, whether hand rubbing (HR) or handwashing (HW) was performed, and notes any missed opportunities or failures to use gloves. The form includes spaces to record data for 7 healthcare professionals over multiple periods.

    Copyright:

    © All Rights Reserved
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    of 1

    PEMERINTAH KABUPATEN SIDOARJO

    RUMAH SAKIT UMUM DAERAH


    J JalanMojopahit No. 667 Telepon (031) 8961649 Fax. (031) 8964800
    SIDOARJO

    Formulir Observasi Kepatuhan Hand Hygiene


    :
    UNIT : ................................................. PERIODE : ...................................................
    TANGGAL : ................................................. OBSERVER : ...................................................

    Profesi Profesi Profesi Profesi


    Kode Kode Kode Kode
    n n n n
    Opp. Indikasi HH Action Opp. Indikasi HH Action Opp. Indikasi HH Action Opp. Indikasi HH Action
    bef-pat. bef-pat. bef-pat. bef-pat.
    1 HR 1 HR 1 HR 1 HR
    bef-asept. bef-asept. bef-asept. bef-asept.
    HW HW HW HW
    aft-b.f. aft-b.f. aft-b.f. aft-b.f.
    aft-pat.
    missed aft-pat.
    missed aft-pat.
    missed aft-pat.
    missed
    gloves gloves gloves gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.
    bef-pat. bef-pat. bef-pat. bef-pat.
    2 HR 2 HR 2 HR 2 HR
    bef-asept. bef-asept. bef-asept. bef-asept.
    HW HW HW HW
    aft-b.f. aft-b.f. aft-b.f. aft-b.f.
    aft-pat.
    missed
    aft-pat.
    missed
    aft-pat.
    missed
    aft-pat.
    missed
    gloves gloves gloves gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.
    bef-pat. bef-pat. bef-pat. bef-pat.
    3 HR 3 HR 3 HR 3 HR
    bef-asept. bef-asept. bef-asept. bef-asept.
    HW HW HW HW
    aft-b.f. aft-b.f. aft-b.f. aft-b.f.
    aft-pat. missed aft-pat. missed aft-pat. missed aft-pat. missed
    gloves gloves gloves gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.
    bef-pat. bef-pat. bef-pat. bef-pat.
    4 HR 4 HR 4 HR 4 HR
    bef-asept. bef-asept. bef-asept. bef-asept.
    HW HW HW HW
    aft-b.f. aft-b.f. aft-b.f. aft-b.f.
    aft-pat.
     missed
    aft-pat.
    missed
    aft-pat.
    missed
    aft-pat.
    missed
    gloves gloves gloves gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.
    bef-pat. bef-pat. bef-pat. bef-pat.
    5 HR 5 HR 5 HR 5 HR
    bef-asept. bef-asept. bef-asept. bef-asept.
    HW HW HW HW
    aft-b.f. aft-b.f. aft-b.f. aft-b.f.
    aft-pat.
    missed
    aft-pat.
    missed
    aft-pat.
    missed
    aft-pat.
    missed
    gloves gloves gloves gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.
    bef-pat. bef-pat. bef-pat. bef-pat.
    6 HR 6 HR 6 HR 6 HR
    bef-asept. bef-asept. bef-asept. bef-asept.
    HW HW HW HW
    aft-b.f. aft-b.f. aft-b.f. aft-b.f.
    aft-pat. missed aft-pat. missed aft-pat. missed aft-pat. missed
    gloves gloves gloves gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.
    bef-pat. bef-pat. bef-pat. bef-pat.
    7 HR 7 HR 7 HR 7 HR
    bef-asept. bef-asept. bef-asept. bef-asept.
    HW HW HW HW
    aft-b.f. aft-b.f. aft-b.f. aft-b.f.
    aft-pat.
    missed
    aft-pat.
    missed
    aft-pat.
    missed
    aft-pat.
    missed
    gloves gloves gloves gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.

    bef-pat. bef-pat. bef-pat. bef-pat.


    8 HR 8 HR 8 HR 8 HR
    bef-asept. bef-asept. bef-asept. bef-asept.
    HW HW HW HW
    aft-b.f. aft-b.f. aft-b.f. aft-b.f.
    aft-pat.
    missed
    aft-pat.
    missed
    aft-pat.
    missed
    aft-pat.
    missed
    gloves gloves gloves gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.

    Keterangan :
    Bef-pat : Sebelum kontak dengan pasien
    Bef-asept : Sebelum tindakan aseptik
    Aff-b.f : Setelah terkena cairan tubuh pasien
    Aff-pat : Setelah kontak dengan pasien
    Aff.p.suur : Setelah kontak dengan lingkungan pasien
    Opp : Opportunity/kesempatan melakukan Hand Hygiene
    Indikasi : Indikasi melakukan Hand Hygiene (5 moment)
    HR : Handrub
    HW : Handwash Sidoarjo, .......................
    Missed : Tidak Melakukan HR atau HW Auditor
    Gloves : Memakai Sarung Tangan
    HH : Hand Hygiene
    n : Jumlah sample ( .................................. )

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