Colorado Dialysis Collaborative Hand Hygiene and Gloving Observation Audit Tool Facility Name _____________KEY__________________ Month _____________

1. Enter date/initials and role of Healthcare worker (HCW) observed (see key at right). 2. Enter ‘ √ ‘ in box if action was performed. If no hand hygiene or gloving performed, enter ‘ √ ‘ under last (far right) column. 3. Strive for => 20 observations per month. Strive for diverse examples. See additional guidance on back.

Color Key: Dark green is the correct method of H/H and Gloving Light green is also considered acceptable

Obs #

Date/ Observer

initials

HCW Observed (key top)

Hand Hygiene Opportunity

Category

Specific Examples of Hand Hygiene and Gloving Opportunities

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1. Before touching

a patient

a. Before entering dialysis station to provide care to patient

2. b. Before moving from machine to patient

3.

After touching a patient

a. When leaving dialysis station after performing patient care

4.

b. After removing gloves

5.

c. After casual contact with patient

6.

Aseptic (sterile) procedures

a. Before contact with vascular access site

7.

b. Before cannulation or accessing catheter

8.

c. Before performing catheter site care

9.

d. Before adjusting or removing cannulation needles

10.

e. Before parenteral medication preparation

11.

f. Before administering parenteral medication or infusions

12.

Touching patient’s

environment

a. BEFORE touching potentially contaminated equipment (e.g., glucometer, infusion pump, BP cuff, thermometer)

13. b. AFTER touching potentially contaminated equipment

(e.g., glucometer, infusion pump, BP cuff, thermometer)

14.

c. After touching dialysis machine and machine attachments

15.

d. After using chairside computers for charting

16.

e. After leaving dialysis station

17.

f. After removing gloves

18.

Body fluid exposure

(always don gloves)

a. After exposure to any blood or body fluids (dressings, non-intact skin, mucous membranes, feces, vomitus)

19. b. After contact with other contaminated fluids

(e.g., spent dialysate)

20. c. After handling used dialyzers, blood tubing, or prime

buckets

21.

d. After performing wound care or dressing changes

22.

Other Hand Hygiene

Opportunities

a. Upon entering or leaving the general patient care area

23.

b. When hands are visibly soiled

24. c. After exposure to patient with spore-forming organisms

(e.g., C. difficile, B. anthracis)

25. d. After using the restroom

26.

e. Before accessing or restocking supplies

KEY: RN/LPN PCT MD SW

RD (dietitian) O (other)