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  • Panitia Infeksi Rumah Sakit / Tim Ppirs (Pencegahan Dan Pengendalian Infeksi Rumah Sakit) Lembar Audit Kepatuhan Cuci Tangan

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    NORHIDA WIDIARTI
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    The document appears to be an audit form from the hospital infection prevention team monitoring healthcare workers' compliance with hand hygiene practices. It records observations of 12 healthcare workers (opportunities) and whether they performed proper hand hygiene before and after patient contact and other high risk situations (indications). Most workers complied with handwashing or scrubbing before aseptic procedures but often missed opportunities after patient contact. The form is being used to monitor and improve hand hygiene practices in the hospital.

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    The document appears to be an audit form from the hospital infection prevention team monitoring healthcare workers' compliance with hand hygiene practices. It records observations of 12 healthcare workers (opportunities) and whether they performed proper hand hygiene before and after patient contact and other high risk situations (indications). Most workers complied with handwashing or scrubbing before aseptic procedures but often missed opportunities after patient contact. The form is being used to monitor and improve hand hygiene practices in the hospital.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    Download as xlsx, pdf, or txt
    39 views14 pages

    Panitia Infeksi Rumah Sakit / Tim Ppirs (Pencegahan Dan Pengendalian Infeksi Rumah Sakit) Lembar Audit Kepatuhan Cuci Tangan

    Uploaded by

    NORHIDA WIDIARTI
    The document appears to be an audit form from the hospital infection prevention team monitoring healthcare workers' compliance with hand hygiene practices. It records observations of 12 healthcare workers (opportunities) and whether they performed proper hand hygiene before and after patient contact and other high risk situations (indications). Most workers complied with handwashing or scrubbing before aseptic procedures but often missed opportunities after patient contact. The form is being used to monitor and improve hand hygiene practices in the hospital.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 14

    PANITIA INFEKSI RUMAH SAKIT / TIM PPIRS

    (PENCEGAHAN DAN PENGENDALIAN INFEKSI RUMAH SAKIT)


    RSUD HADJI BOEJASIN PELAIHARI
    LEMBAR AUDIT KEPATUHAN CUCI TANGAN (1)

    Ruangan : indikasi 5 moment cuci tangan


    Tanggal : 1. sebelum kontak dengan pasien (bef-pat)
    Observer : 2. sebelum tindakan bersih/aseptik (bef-asept)
    Profesi : 3. setelah prosedur/resiko terpapar cairan tubuh (aft.b.f)
    Jumlah : 4. Setelah kontak dengan pasien (aft.pat)
    5. Setelah kontak dengan lingkungan (aft.p.surr)

    Opp indikasi Action Opp indikasi Action


    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    1 3. aft.b.f HW 7 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    2 3. aft.b.f HW 8 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    3 3. aft.b.f HW 9 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    4 3. aft.b.f HW 10 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    5 3. aft.b.f HW 11 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    6 3. aft.b.f HW 12 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Ket : Opp : : Oppurtunity/Peluang
    HR : : Handscrub
    HW : : Handwash
    PANITIA INFEKSI RUMAH SAKIT / TIM PPIRS
    (PENCEGAHAN DAN PENGENDALIAN INFEKSI RUMAH SAKIT)
    RSUD HADJI BOEJASIN PELAIHARI
    LEMBAR AUDIT KEPATUHAN CUCI TANGAN (1)

    Opp indikasi Action Opp indikasi Action


    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    1 3. aft.b.f HW 7 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    2 3. aft.b.f HW 8 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    3 3. aft.b.f HW 9 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    4 3. aft.b.f HW 10 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    5 3. aft.b.f HW 11 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    6 3. aft.b.f HW 12 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    6 3. aft.b.f HW 12 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves

    Tanda Tangan Surveilans PPI


    (............................................)
    Lampiran 8. Form kepatuhan cuci tangan (1)
    PANITIA INFEKSI RUMAH SAKIT / TIM PPIRS
    (PENCEGAHAN DAN PENGENDALIAN INFEKSI RUMAH SAKIT)
    RSUD HADJI BOEJASIN PELAIHARI
    LEMBAR AUDIT KEPATUHAN CUCI TANGAN (1)

    Ruangan : indikasi 5 moment cuci tangan


    Tanggal : 1. sebelum kontak dengan pasien (bef-pat)
    Observer : 2. sebelum tindakan bersih/aseptik (bef-asept)
    Profesi : 3. setelah prosedur/resiko terpapar cairan tubuh (aft.b.f)
    Jumlah : 4. Setelah kontak dengan pasien (aft.pat)
    5. Setelah kontak dengan lingkungan (aft.p.surr)

    Opp indikasi Action Opp indikasi Action


    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    1 3. aft.b.f HW 7 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    2 3. aft.b.f HW 8 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    3 3. aft.b.f HW 9 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    4 3. aft.b.f HW 10 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    5 3. aft.b.f HW 11 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    6 3. aft.b.f HW 12 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Ket : Opp : : Oppurtunity/Peluang
    HR : : Handscrub
    HW : : Handwash
    Lampiran 8. Form kepatuhan cuci tangan (2)
    PANITIA INFEKSI RUMAH SAKIT / TIM PPIRS
    (PENCEGAHAN DAN PENGENDALIAN INFEKSI RUMAH SAKIT)
    RSUD HADJI BOEJASIN PELAIHARI
    LEMBAR AUDIT KEPATUHAN CUCI TANGAN (1)

    Opp indikasi Action Opp indikasi Action


    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    1 3. aft.b.f HW 7 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    2 3. aft.b.f HW 8 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    3 3. aft.b.f HW 9 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    4 3. aft.b.f HW 10 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    5 3. aft.b.f HW 11 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    6 3. aft.b.f HW 12 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves
    Opp indikasi Action Opp indikasi Action
    1. bef-pat 1. bef-pat
    2. bef-asept HR 2. bef-asept HR
    6 3. aft.b.f HW 12 3. aft.b.f HW
    4. aft.pat Missed 4. aft.pat Missed
    5. aft.p.surr Gloves 5. aft.p.surr Gloves

    Tanda Tangan Surveilans PPI


    (............................................)
    PANITIA INFEKSI RUMAH SAKIT / TIM PPIRS
    (PENCEGAHAN DAN PENGENDALIAN INFEKSI RUMAH SAKIT)
    RSUD HADJI BOEJASIN PELAIHARI
    LEMBAR PENGHITUNGAN KEPATUHAN CUCI TANGAN (1)

    Fasilitas Periode Total Season :


    Profesi Profesi Profesi Profesi Profesi
    Opp (n) HW (n) HR (n) Miss (n) Opp (n) HW (n) HR (n) Miss (n) Opp (n) HW (n) HR (n) Miss (n) Opp (n) HW (n) HR (n) Miss (n) Opp (n) HW (n) HR (n) Miss (n)
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    13
    14
    15
    16
    17
    18
    19
    20
    Total
    Rum Act (n) = Act (n) = Act (n) = Act (n) = Act (n) =
    us Opp (n) = Opp (n) = Opp (n) = Opp (n) = Opp (n) =
    Hasil
    Ket : Opp (n) = Jumlah Peluang
    Act (n) = Tindakan Tindakan Berhasil (n)
    HR = Handscrub Rumus (%) = x 100
    HW = Handwash Peluang (n)
    Miss = Gagal
    PANITIA INFEKSI RUMAH SAKIT / TIM PPIRS
    (PENCEGAHAN DAN PENGENDALIAN INFEKSI RUMAH SAKIT)
    RSUD HADJI BOEJASIN PELAIHARI
    LEMBAR PENGHITUNGAN KEPATUHAN CUCI TANGAN (2)

    Fasilitas Periode Total Season :


    Profesi Profesi Profesi Profesi Profesi
    Opp (n) HW (n) HR (n) Miss (n) Opp (n) HW (n) HR (n) Miss (n) Opp (n) HW (n) HR (n) Miss (n) Opp (n) HW (n) HR (n) Miss (n) Opp (n) HW (n) HR (n) Miss (n)
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    13
    14
    15
    16
    17
    18
    19
    20
    Total
    Rum Act (n) = Act (n) = Act (n) = Act (n) = Act (n) =
    us Opp (n) = Opp (n) = Opp (n) = Opp (n) = Opp (n) =
    Hasil
    Ket : Opp (n) = Jumlah Peluang
    Act (n) = Tindakan Tindakan Berhasil (n) Tanda Tangan Surveilans PPI
    HR = Handscrub Rumus (%) = x 100
    HW = Handwash Peluang (n)
    Miss = Gagal (............................................)
    PANITIA INFEKSI RUMAH SAKIT / TIM PPIRS
    (PENCEGAHAN DAN PENGENDALIAN INFEKSI RUMAH SAKIT)
    RSUD HADJI BOEJASIN PELAIHARI
    LEMBAR PENGHITUNGAN 5 MOMENT CUCI TANGAN (1)

    Fasilitas Periode Total Season :


    sblm kontak dengan pasien (bef-pa sblm tindakan bersih/aseptik (b stlh prosedur terpapar cairan tubuh
    Profesi Profesi
    Indic (n) HW (n) HR (n) Indic (n) HW (n) HR (n) Indic (n) HW (n) HR (n) Indic (n) HW (n) HR (n) Indic (n) HW (n) HR (n)
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    13
    14
    15
    16
    17
    18
    19
    20
    Total
    Rum Act (n) = Act (n) = Act (n) = Act (n) = Act (n) =
    us Indic1 (n) = Indic2 (n) = Indic3 (n) = Indic4 (n) = Indic5 (n) =
    Rasio
    act/
    indic

    ket : Indic : Indikasi


    Act : Tindakan
    PANITIA INFEKSI RUMAH SAKIT / TIM PPIRS
    (PENCEGAHAN DAN PENGENDALIAN INFEKSI RUMAH SAKIT)
    RSUD HADJI BOEJASIN PELAIHARI
    LEMBAR PENGHITUNGAN 5 MOMENT CUCI TANGAN (2)

    Fasilitas Periode Total Season :


    sblm kontak dengan pasien (bef-pa sblm tindakan bersih/aseptik (b stlh prosedur terpapar cairan tubuh
    Profesi Profesi
    Indic (n) HW (n) HR (n) Indic (n) HW (n) HR (n) Indic (n) HW (n) HR (n) Indic (n) HW (n) HR (n) Indic (n) HW (n) HR (n)
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    13
    14
    15
    16
    17
    18
    19
    20
    Total
    Rum Act (n) = Act (n) = Act (n) = Act (n) = Act (n) =
    us Indic1 (n) = Indic2 (n) = Indic3 (n) = Indic4 (n) = Indic5 (n) =
    Rasio
    act/
    indic
    ket : Indic : Indikasi
    Act : Tindakan

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