Professional Documents
Culture Documents
Form Hand Hygiene
Form Hand Hygiene
Form Hand Hygiene
Ruangan :
(initials)
Tanggal: Durasi
: :
(dd/mm/yy) Observasi
Mulai/Berakhir :
Lembar :
waktu: (hh:mm)
FORMULIR MONITORING HAND HYGIENE
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