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Surgical Hand Hygiene
Surgical Hand Hygiene
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Created by Qualaris Staff
Infection Prevention
Surgical Site Infections
Table of Contents
Audit Form
Audit Form
Surgical Hand Hygiene
Description
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Required
Observed Date
Unit
ED
ICU
Med-Surg
PACU
Rehab
Occupation
Facilities
MD-NP-PA
NA
RN
Other
Shift
AM
PM
Night
Hygiene Opportunity
Before touching pt
Before clean/aeseptic procedure
After touching pt
After touching pt surroundings
Hygiene Method
Antimicrobial soap
Alcohol-based sanitizer
Other approved method/product
Surgical Hand Hygiene Checklist
Mark all as...
Surgical antisepsis performed on hands and forearms?
Yes
No
All hand and arm jewelry removed?
Yes
No
Natural nails only?
Yes
No
Nail 1/4 inch or shorter?
Yes
No
Debris removed from under nails?
Yes
No
Antimicrobial soap used?
Yes
No
N/A
Adequate scrubbing time?
Yes
No
N/A
Hands and arms allowed to dry before donning gloves?
Yes
No
Sterile gloves used?
Yes
No
