Handhygiene checklist /Audit forms

Hospital Infection Control Committee

Department of Microbiology, Kurnool Medical College, Kurnool

S.No Hand Hygiene parameters Yes No

Are the alcohol based handrubs (ABHR) available at
the bedside?
2 Are the HCWs using ABHRs? (Observe Silently )
3 Are the HCWs following 5 moments of Hand hygiene
Before touching the patient
ii After touching the patient
ii Before performing aseptic procedures For eg: Drawing
blood cultures, Lumbar puncture, IV access, Central line
placement,urinary Catheter placement,Ryles tube
iv After blood & body fluid exp0sure
After coming in contact with patients environmental
surroundings
4 Are the sinks available at the work site ?
5 Are they performing hand wash with soap&water?
6 Observe whether all 8 steps of hand rub /hand wash
with soap &water are performed
Rub hands palm to palm
it Take the right hand over the left dorsum with fingers
iii
interlaced
With the fingers interlaced wash your hands
iv
VWith the fingers interlocked wash your hands perform
více versa
Take your right hand and clasp the left thumb &
perform
hands
the Same moment vice versa to wash your

vi
Perform Forward and backward movement of fingers
 towash your hands
vii Rub the finger tips on the palm with both hands
viii Take your right hand and rub your left wrist perform
vice versa the same mnoments
7 Durationwith soap & water 40 secs ?
8 Duration with Alcohol based hand rub for 20secs?
9 Are the sisters performing Handhygiene with
Rings
Bangles
watches
threads
nails
nail paints

Note: Hand Hygiene Compliance Rate formula

Total noof HH oppurtunities utilized completely(all steps) x100

No of oppurtunities of Hand Hygiene moments available