J U N E 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 1 5
It takes only a
few moments to fill
out the form. You
circle where in the
facility the observa-
tion took place as
well as if the person
used soap or sanitiz-
er. You also check if
the person washed
his hands before
patient care, after
patient care, after
touching a contami-
nated surface and
after glove removal.
We ask the person
doing the observing
to initial the form.
Our goal is to fill
out 1 sheet each
month.
Sheila Kritta,
CRCST, CIS,
CHMMC, CHL
Lakewood Surgery Center
Grand Rapids, Minn.
skritta@lakewoodsurgerycenter.org
• CHARTING CLEAN HANDS This hand hygiene observation form tracks the hand
hygiene of all employees, reps or anyone who enters the facility.
