HAND HYGIENE SURVEY 1. Is there a written hand hygiene plicy in yur rganizatin/facility/agency? (Hand hygiene is defined as the act f washing ne s hands with sap and water, r disinfecting them with an antiseptic agent.) Yes: If yes, has this plicy been signed and apprved by the CEO and/r the bard f directrs? Yes N N 2. Des yur rganizatin prvide educatinal prgrams t staff that are exclusively abut hand hygiene? Yes: If yes, is yur educatin prgram mandatry? Yes N N 3. Which hand hygiene prducts des yur rganizatin prvide fr staff? (Please check all that apply.) Alchl hand sanitizers: If yes, what brand(s): Hand ltins: If yes, what brand(s): Anti-bacterial sap Nn-antibacterial sap
4. Where in yur rganizatin are hand hygiene prducts placed? (Please check all that apply.) At dr t patient/resident/client rm In staff cmmn areas Staff washrm Public washrm Waiting areas/clinic receptin Main lbby/entrance Other, please specify: 5. What type f hand hygiene prmtinal/cmmunicatin materials are being used in yur rganizatin? (Please check all that apply.) Psters Badges Stickers Brchures Nne 6. Is hand hygiene adherence part f staff jb perfrmance reviews? Yes: If yes, are disciplinary actins taken fr nn-adherence? Yes N N
7. Is adherence t hand hygiene plicies/practice included in jb descriptins and/r jb psting infrmatin fr yur facility? Yes N 8. Has yur rganizatin implemented any initiatives t imprve hand hygiene in the last 2 years? Yes: Skip t questin.10 N: G t questin 9 9. Is yur rganizatin develping initiatives t imprve hand hygiene practices? Yes: Due t be implemented mnth year N: Skip 10. Des yur rganizatin have defined gals fr these hand hygiene initiatives? Yes: Please list tp 3 gals. 1. 2. 3. N 11. Wh in the rganizatin is/was targeted by these hand hygiene initiatives? (Check all that apply.) Staff Visitrs/family/members f the public Other, please specify:
12. Overall, hw wuld yu rate the hand sanitizer prvided by PAC Nt at all Successful 1 2 3 4 5 6 7 8 9 10 Extremely Successful 13. Overall, which hand hygiene initiatives implemented d yu think were the mst effective? Wuld yu recmmend anther brand, type? (Please explain briefly.) 14. Overall, which hand hygiene initiatives implemented d yu think were the least effective? (Please explain briefly.) 15. Please rate yur satisfactin with the prmtinal materials fr hand hygiene currently used in yur rganizatin. Nt at all Successful 1 2 3 4 5 6 7 8 9 10 Extremely Successful
16.Please rate yur satisfactin with the availability f the hand hygiene prducts in yur rganizatin. Nt at all Successful 1 2 3 4 5 6 7 8 9 10 Extremely Successful 17.Please rate yur satisfactin with the hand hygiene prducts currently used in yur rganizatin. Nt at all Successful 1 2 3 4 5 6 7 8 9 10 Extremely Successful 18. What are/were the majr challenges r barriers in implementing hand hygiene initiatives in yur rganizatin? Individual/staff challenges: 19. What is/has been invlved in yur hand hygiene initiatives? (Please check all that apply.) Staff educatin/infrmatin disseminatin Cllectin f baseline indicatrs, please specify: Tlkit (e.g. alchl hand rubs, prmtinal psters, implementatin guide, etc.) Other prmtinal material (e.g. badges, stickers, etc.) Staff invlvement in planning client invlvement in planning Baseline audits f hand hygiene adherence Pst-implementatin audits f hand hygiene adherence
Cmmunity educatin prgrams Interviews r fcus grups with staff Hand hygiene rle mdels/hand hygiene resurce persns Other, please specify: 20. D/did yur rganizatin receive any financial supprt fr the hand hygiene initiatives implemented/in prgress? Yes: If yes, what type f financial supprt? (Please check all that apply.) Funding frm research agency External funding (e.g. frm reginal health authrity) Funding frm industry Internally identified targeted funding Other, please specify: N Thank Yu