Form #2 Form #2 Observational Data Collection

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Overview

Hand Hygiene
Isolation

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Sheet 1: Hand Hygiene

							Hand Hygiene -	# Compliant
				Person Observed			Room ENTRY	Room EXIT
Hospital	Unit Name	# Obs.	Date	# MD	# RN	# Other	Foam or Soap	Foam or Soap	Notes	Observer
UH	MPCU (Obs Unit)	Goal: 200 N = 56	5/18, 7/09, 7/29, 7/28, 8/03, 8/12, 8/17/2009	8	44	4	20 / 41	28 / 34		Regenstrief (PH, AW); NH
UH	MICU	N = 14	4/08, 5/19, 7/29/2009	1	13	0	4 / 6	8 / 10		Regenstrief (PH); NH

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Sheet 2: Isolation

Hospital

Unit

# Observations

Persons Observed

Barrier Isolation - # Compliant

Observer

# Sign posted

# Cart available

Notes

Dates

Room ENTRY

Room EXIT

# MD

# RN

# Other

Hhyg

Glove

Gown

Gown

Glove

Hhyg

MH

CVCC

N = 58

MH

2N

N = 1

MH

ACC

N = 17

MH

SPCU

N = 6

MH

6N

N = 23

MH

2/3N

N = 5

MH

5S

N = 2

MH

NCC

N = 3

MH

5E

N = 3

MH

CMCC (obs Unit)

Goal: 70 N = 55

UH

TICU (Obs Unit)

N = 16

MH

MPCU (Obs Unit)

N = 26

UH

MICU

N = 1

UH

SICU

N = 10

UH

3NS

N = 1

?

CMPC

N = 8