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Hand Hygiene Compliance Checklist Template

Use this hand hygiene compliance checklist to internally evaluate the hand hygiene techniques of healthcare workers. This checklist can be used to easily monitor performance quality and provide feedback with photo evidence.

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Hand Hygiene Compliance Checklist Template

Inspection

Hand Hygiene Compliance

The World Health Organization guidelines for Hand Hygiene Technique
Name of Healthcare Worker
Select healthcare worker category.
Please specify.

Hand Hygiene Technique

Identify the moment.
Which hand hygiene technique did the healthcare worker perform?
Hand Hygiene Technique with Alcohol-Based Formulation (20-30 seconds)
Is the healthcare worker not wearing a stoned ring?
Are the nails of the healthcare worker short and clean?
Did the healthcare worker perform correct hand hygiene technique?
Hand Hygiene Technique with Soap and Water (40-60 seconds)
Is the healthcare worker not wearing a stoned ring?
Are the nails of the healthcare worker short and clean?
Is the healthcare worker not wearing a wristwatch?
Is the clothing of the healthcare worker 'bare below the elbows'?
Did the healthcare worker perform correct hand hygiene technique?

Completion

Overall Recommendations
Full Name and Signature of Auditor
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