Non-Acute Facilities: Hand Hygiene Core And Non-Core Data Collection Form
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1Non-acute facilities: Hand Hygiene Core and Non-Core Data Collection Form
Form no
__________
1
Healthcare facility________________ Unit/Ward/Dept.________________ Date of observation ___________
Start time______ End time_________ Duration_______ Auditor_________
HCW codes
Core Data Set
Optional Data Set
HCW
Opp
Hand Hygiene
Hand Hygiene
Time
Barriers to technique
Technique as per
Comments
2
Nurse
1.0 Any nurse or midwife
code
indication
Action
SARI 2005 or as
1.1 Nurse
determined locally
1.2 Midwife
None
1
Bef- pat
HR
≥ 15 mins
Correct
1.3 Student nurse/midwife
4
Bef-asept
HW
< 15 mins
Wearing more than one plain ring
3
1.4 Non-core nurse/midwife
Wearing a wrist watch
Aft-b.f.
Incorrect
1.5 Dental nurse
Missed
Not
Auxiliary
Sleeves to wrist
Aft-pat
observed
Gloves
2.0 Any auxiliary
Nail varnish present
Aft-p.surr.
Not observed
2.1 Porters
False nails present
2.2 Catering
Bef- pat
None
Correct
2
HR
≥ 15 mins
2.3 Healthcare assistants
3
Bef-asept
HW
< 15 mins
Wearing more than one plain ring
2.4 Household services
Wearing a wrist watch
Aft-b.f.
Incorrect
2.5 Security
Missed
Not
Sleeves to wrist
2.6 Other auxiliary
Aft-pat
observed
Gloves
4
Nail varnish present
2.7 Non-core auxiliary
Aft-p.surr.
Not observed
2.8 Multi-task attendant
False nails present
5
Medical staff
3
Bef- pat
HR
≥ 15 mins
None
Correct
3.0 Any medical staff
Bef-asept
Wearing more than one plain ring
3
HW
< 15 mins
3.6 Consultant
Wearing a wrist watch
Aft-b.f.
Missed
Not
Incorrect
3.7 Medical student
Sleeves to wrist
4
Aft-pat
observed
3.8 Non-core medical staff
Gloves
Nail varnish present
3.9 NCHD
Aft-p.surr.
Not observed
False nails present
3.11 General practitioner/medical officer
3.12 Dentists/Orthodontists
4
Bef- pat
HR
≥ 15 mins
None
Correct
5
Allied health/Other HCW
Bef-asept
Wearing more than one plain ring
3
HW
< 15 mins
4.0 Any allied health/other HCW
Wearing a wrist watch
Aft-b.f.
Missed
Not
Incorrect
4.1 Physiotherapist
Sleeves to wrist
Aft-pat
observed
4.2 Speech & language
Gloves
Nail varnish present
4.6 Dietician
Aft-p.surr.
Not observed
False nails present
4.7 Social worker
None
5
Bef- pat
HR
≥ 15 mins
Correct
4.8 Pharmacist
4.9 Students of other HCW
Bef-asept
HW
< 15 mins
Wearing more than one plain ring
3
4.11 Occupational therapist
Wearing a wrist watch
Aft-b.f.
Missed
Not
Incorrect
4.13 Pastoral care
Sleeves to wrist
Aft-pat
observed
4
Gloves
4.15 Non-core allied heath/other
Nail varnish present
Aft-p.surr.
Not observed
4.16 Chiropodist/podiatrist
False nails present
4.17 Activities therapist
1: To be completed when entering data into MS Excel tool
4.18 Alternative therapist
2: As per local guidelines
HCWs can be classified by using; generic
3: One stone-less ring may be worn for social and antiseptic hand hygiene
codes (e.g. 1.0,2.0), specific codes (e.g.
4: Non-core refers to staff who are not regular members of the multidisciplenary team
2.1,3.1) or a combination of both generic
5: To standardise the data collection process, it is preferable if the same code is used for the same role across acute and non-acute services. Roles (and their assigned
and specific codes
codes) usually associated with acute services are not included on this form. Refer to the acute data collection form to manually add these codes if required.
September 2014
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