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OBSERVASI KEPATUHAN HAND HYGIENE

OBSERVER UNIT/INSTALASI
TGL OBSERVASI RUANG/LANTAI
PROFESI PROFESI PROFESI
KODE KODE KODE
WAKTU WAKTU WAKTU
Opp Indication HH Action Opp Indication HH Action Opp
1 Bef.Pat HR 1 Bef.Pat HR 1
Bef.Asept HW Bef.Asept HW
Aft.B.F Missed Aft.B.F Missed
Aft.Pat Gloves Aft.Pat Gloves
Aft.lgk.pat Aft.lgk.pat
2 Bef.Pat HR 2 Bef.Pat HR 2
Bef.Asept HW Bef.Asept HW
Aft.B.F Missed Aft.B.F Missed
Aft.Pat Gloves Aft.Pat Gloves
Aft.lgk.pat Aft.lgk.pat
3 Bef.Pat HR 3 Bef.Pat HR 3
Bef.Asept HW Bef.Asept HW
Aft.B.F Missed Aft.B.F Missed
Aft.Pat Gloves Aft.Pat Gloves
Aft.lgk.pat Aft.lgk.pat
4 Bef.Pat HR 4 Bef.Pat HR 4
Bef.Asept HW Bef.Asept HW
Aft.B.F Missed Aft.B.F Missed
Aft.Pat Gloves Aft.Pat Gloves
Aft.lgk.pat Aft.lgk.pat
5 Bef.Pat HR 5 Bef.Pat HR 5
Bef.Asept HW Bef.Asept HW
Aft.B.F Missed Aft.B.F Missed
Aft.Pat Gloves Aft.Pat Gloves
Aft.lgk.pat Aft.lgk.pat
6 Bef.Pat HR 6 Bef.Pat HR 6
Bef.Asept HW Bef.Asept HW
Aft.B.F Missed Aft.B.F Missed
Aft.Pat Gloves Aft.Pat Gloves
Aft.lgk.pat Aft.lgk.pat
7 Bef.Pat HR 7 Bef.Pat HR 7
Bef.Asept HW Bef.Asept HW
Aft.B.F Missed Aft.B.F Missed
Aft.Pat Gloves Aft.Pat Gloves
Aft.lgk.pat Aft.lgk.pat
8 Bef.Pat HR 8 Bef.Pat HR 8
Bef.Asept HW Bef.Asept HW
Aft.B.F Missed Aft.B.F Missed
Aft.Pat Gloves Aft.Pat Gloves
Aft.lgk.pat Aft.lgk.pat

LAIN - LAIN LAIN - LAIN LAIN - LAIN


Kuku Tangan 1. Ya 1 Kuku Tangan 1. Ya 1
panjang (>5mm) 2. Tidak panjang (>5mm) 2. Tidak
2 Kuku memakai 1. Ya 2 Kuku memakai 1. Ya 2
kuteks 2. Tidak kuteks 2. Tidak
3 Kuku Palsu 1. Ya 3 Kuku Palsu 1. Ya 3
2. Tidak 2. Tidak
4 Memakai Cincin 1. Ya 4 Memakai Cincin 1. Ya 4
2. Tidak 2. Tidak
5 Memakai 1. Ya 5 Memakai 1. Ya 5
Jam Tangan 2. Tidak Jam Tangan 2. Tidak
6 Memakai 1. Ya 6 Memakai 1. Ya 6
Gelang 2. Tidak Gelang 2. Tidak
GIENE

Indication HH Action
Bef.Pat HR
Bef.Asept HW
Aft.B.F Missed
Aft.Pat Gloves
Aft.lgk.pat
Bef.Pat HR
Bef.Asept HW
Aft.B.F Missed
Aft.Pat Gloves
Aft.lgk.pat
Bef.Pat HR
Bef.Asept HW
Aft.B.F Missed
Aft.Pat Gloves
Aft.lgk.pat
Bef.Pat HR
Bef.Asept HW
Aft.B.F Missed
Aft.Pat Gloves
Aft.lgk.pat
Bef.Pat HR
Bef.Asept HW
Aft.B.F Missed
Aft.Pat Gloves
Aft.lgk.pat
Bef.Pat HR
Bef.Asept HW
Aft.B.F Missed
Aft.Pat Gloves
Aft.lgk.pat
Bef.Pat HR
Bef.Asept HW
Aft.B.F Missed
Aft.Pat Gloves
Aft.lgk.pat
Bef.Pat HR
Bef.Asept HW
Aft.B.F Missed
Aft.Pat Gloves
Aft.lgk.pat

LAIN - LAIN
Kuku Tangan 1. Ya
panjang (>5mm) 2. Tidak
Kuku memakai 1. Ya
kuteks 2. Tidak
Kuku Palsu 1. Ya
2. Tidak
Memakai Cincin 1. Ya
2. Tidak
Memakai 1. Ya
Jam Tangan 2. Tidak
Memakai 1. Ya
Gelang 2. Tidak
OBSERVASI KEPATUHAN HAND HYGIENE
OBSERVER UNIT/INSTALASI
TGL OBSERVASI RUANG/LANTAI
PROFESI PROFESI PROFESI
KODE KODE KODE
WAKTU WAKTU WAKTU
Opp Indication HH Action Opp Indication HH Action Opp Indication
1 Bef.Pat HR 1 Bef.Pat HR 1 Bef.Pat
Bef.Asept HW Bef.Asept HW Bef.Asept
Aft.B.F Missed Aft.B.F Missed Aft.B.F
Aft.Pat Gloves Aft.Pat Gloves Aft.Pat
Aft.lgk.pat Aft.lgk.pat Aft.lgk.pat
2 Bef.Pat HR 2 Bef.Pat HR 2 Bef.Pat
Bef.Asept HW Bef.Asept HW Bef.Asept
Aft.B.F Missed Aft.B.F Missed Aft.B.F
Aft.Pat Gloves Aft.Pat Gloves Aft.Pat
Aft.lgk.pat Aft.lgk.pat Aft.lgk.pat
3 Bef.Pat HR 3 Bef.Pat HR 3 Bef.Pat
Bef.Asept HW Bef.Asept HW Bef.Asept
Aft.B.F Missed Aft.B.F Missed Aft.B.F
Aft.Pat Gloves Aft.Pat Gloves Aft.Pat
Aft.lgk.pat Aft.lgk.pat Aft.lgk.pat
4 Bef.Pat HR 4 Bef.Pat HR 4 Bef.Pat
Bef.Asept HW Bef.Asept HW Bef.Asept
Aft.B.F Missed Aft.B.F Missed Aft.B.F
Aft.Pat Gloves Aft.Pat Gloves Aft.Pat
Aft.lgk.pat Aft.lgk.pat Aft.lgk.pat
5 Bef.Pat HR 5 Bef.Pat HR 5 Bef.Pat
Bef.Asept HW Bef.Asept HW Bef.Asept
Aft.B.F Missed Aft.B.F Missed Aft.B.F
Aft.Pat Gloves Aft.Pat Gloves Aft.Pat
Aft.lgk.pat Aft.lgk.pat Aft.lgk.pat
6 Bef.Pat HR 6 Bef.Pat HR 6 Bef.Pat
Bef.Asept HW Bef.Asept HW Bef.Asept
Aft.B.F Missed Aft.B.F Missed Aft.B.F
Aft.Pat Gloves Aft.Pat Gloves Aft.Pat
Aft.lgk.pat Aft.lgk.pat Aft.lgk.pat
7 Bef.Pat HR 7 Bef.Pat HR 7 Bef.Pat
Bef.Asept HW Bef.Asept HW Bef.Asept
Aft.B.F Missed Aft.B.F Missed Aft.B.F
Aft.Pat Gloves Aft.Pat Gloves Aft.Pat
Aft.lgk.pat Aft.lgk.pat Aft.lgk.pat
8 Bef.Pat HR 8 Bef.Pat HR 8 Bef.Pat
Bef.Asept HW Bef.Asept HW Bef.Asept
Aft.B.F Missed Aft.B.F Missed Aft.B.F
Aft.Pat Gloves Aft.Pat Gloves Aft.Pat
Aft.lgk.pat Aft.lgk.pat Aft.lgk.pat

LAIN - LAIN LAIN - LAIN LAIN - LAIN


Kuku Tangan 1. Ya 1 Kuku Tangan 1. Ya 1 Kuku Tangan
panjang (>5mm) 2. Tidak panjang (>5mm) 2. Tidak panjang (>5mm)
2 Kuku memakai 1. Ya 2 Kuku memakai 1. Ya 2 Kuku memakai
kuteks 2. Tidak kuteks 2. Tidak kuteks
3 Kuku Palsu 1. Ya 3 Kuku Palsu 1. Ya 3 Kuku Palsu
2. Tidak 2. Tidak
4 Memakai Cincin 1. Ya 4 Memakai Cincin 1. Ya 4 Memakai Cincin
2. Tidak 2. Tidak
5 Memakai 1. Ya 5 Memakai 1. Ya 5 Memakai
Jam Tangan 2. Tidak Jam Tangan 2. Tidak Jam Tangan
6 Memakai 1. Ya 6 Memakai 1. Ya 6 Memakai
Gelang 2. Tidak Gelang 2. Tidak Gelang
KETEPATAN
LANGKAH
HAND HYGIENE
HH Action BAIK KURANG BAIK TIDAK
HR
HW
Missed
Gloves

HR
HW
Missed
Gloves

HR
HW
Missed
Gloves

HR
HW
Missed
Gloves

HR
HW
Missed
Gloves

HR
HW
Missed
Gloves

HR
HW
Missed
Gloves

HR
HW
Missed
Gloves

LAIN - LAIN
1. Ya
2. Tidak
1. Ya
2. Tidak
1. Ya
2. Tidak
1. Ya
2. Tidak
1. Ya
2. Tidak
1. Ya
2. Tidak