Routine Hand Washing | Hospice Providers of the Desert

ROUTINE HAND WASHING

OBJECTIVE: To assess staff competency in performance of hand washing using own liquid antimicrobial soap and water.
EVALUATION: To be deemed competent a "YES" score must be achieved in ALL ACTION CRITERIA boxes.

InitialMonthlyQuarterlyAnnual

ACTION CRITERIA

ACTION PERFORMED CORRECTLY

COMMENTS

1.Remove all band and wrist jewelry from hands and fingers. Follow the following handwashing as per CDC guidelines.

YESNO

2.Wet hands with water

YESNO

3. Using own anti-microbial soap. Apply enough soap to cover all hand surfaces.

YESNO

4. Rub hands palm to palm.

YESNO

5. Right palm over left dorsum with interfaced fingers and vice versa.

YESNO

6. Palm to palm with fingers interlaced.

YESNO

7. Backs of fingers to opposing palms with fingers interlocked.

YESNO

8. Rotational rubbing of left thumb clasped in right palm and vice versa.

YESNO

9. Rotational rubbing backward and forward with clasped fingers of right hand in left palm and vice versa.

YESNO

10. Rinse hands with water.

YESNO

11. Pat dry thoroughly with a single use towel (i.e. paper towel).

YESNO

12. Use towel to turn off faucet ( if not hands free tap).

YESNO

NOTE: Entire procedure should take 40-60 SECONDS of hand washing

OVERALL COMMENTS:

Employee Name/Title *

Date

Signature *

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Evaluator Name/Title *

Date

Signature *

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