Hand Hygiene Compliance Checklist
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This Template was installed 4 times.
Availability of Hand Hygiene Facilities
Ensures adequate and accessible hand hygiene resources are available throughout the facility.
Number of Sinks with Soap Available
Number of ABHR Dispensers Available
Are sinks easily accessible to staff and patients?
Are ABHR dispensers placed at strategic points (e.g., entrances, exits, patient rooms)?
Location of nearest hand hygiene facility for high-risk areas (e.g., isolation rooms, surgical suites)
Are hand hygiene facilities adequately lit?
Any observed barriers to access or usability of hand hygiene facilities?
Soap and Water Availability
Focuses on the presence and functionality of sinks and soap dispensers.
Number of Sinks Available
Soap Type Available (Liquid, Bar, Powder)
Soap Dispenser Functionality
Number of Functional Soap Dispensers
Water Temperature - Acceptable?
Comments/Observations regarding Soap and Water Availability
Hot and Cold Water Mixing Valve Functionality
Alcohol-Based Handrub (ABHR) Availability
Focuses on the presence and accessibility of ABHR dispensers.
Number of ABHR dispensers present
Locations of ABHR dispensers (list all)
ABHR dispenser type (e.g., wall-mounted, freestanding)
ABHR dispenser functionality
ABHR volume remaining in each dispenser (in liters/oz)
Date of last ABHR refill
Notes on dispenser condition or issues (if any)
Are dispensers accessible to patients/visitors?
Signage & Education
Verifies appropriate signage and educational materials are in place to promote hand hygiene.
Number of Hand Hygiene Signage Posters Displayed in Patient Care Areas
Number of Hand Hygiene Signage Posters Displayed in Staff Areas
Signage Content - Does it include 'When to Clean Hands?'
Signage – Are signs in appropriate languages for the patient population?
Describe any educational materials available to staff regarding hand hygiene (e.g., training modules, quick reference guides)
Upload a sample copy of the staff hand hygiene training material
Are patient education brochures or materials on hand hygiene readily available?
Describe how patient/visitor hand hygiene is promoted (e.g., reminders at entrances, posters in waiting areas)
Observation of Staff Hand Hygiene Practices
Direct observation of staff adherence to hand hygiene guidelines.
Number of Staff Observed
Number of Opportunities for Hand Hygiene Observed
Number of Times Staff Performed Hand Hygiene with Soap & Water
Number of Times Staff Used Alcohol-Based Handrub
Number of Times Hand Hygiene Was Missed (Opportunity Present, Not Performed)
Was appropriate technique used (Soap & Water)?
Was appropriate technique used (ABHR)?
Comments/Notes on Staff Hand Hygiene Practices (e.g., specific observations, deviations from protocol)
Did staff wear appropriate PPE (gloves) when indicated?
Waste Disposal
Ensures proper disposal of used wipes, gloves, and other materials used during hand hygiene.
Are designated waste containers for contaminated materials readily available near hand hygiene stations?
Are waste containers properly labeled for infectious waste?
How many waste containers are dedicated for disposal of used gloves and wipes?
Are waste containers lined with appropriate bags?
Describe any observations related to improper waste disposal practices (e.g., overflowing bins, mixed waste streams).
Date of last waste container liner replacement
Are staff trained on proper waste segregation procedures?
Maintenance and Replenishment
Evaluates the system for ensuring supplies are regularly replenished and equipment is maintained.
Frequency of Soap Replenishment (days)
Frequency of ABHR Replenishment (days)
Date of Last Soap Dispenser Inspection
Date of Last ABHR Dispenser Inspection
Details of Any Maintenance Issues Found During Inspection (e.g., leaks, malfunctions)
Condition of Soap Dispensers (Post-Inspection)
Condition of ABHR Dispensers (Post-Inspection)
Notes Regarding Supply Levels (e.g., consistently low stock, storage conditions)
Number of ABHR Dispensers Currently in Use
Patient/Visitor Hand Hygiene Promotion
Focuses on encouraging and enabling patients and visitors to practice hand hygiene.
Are hand hygiene stations clearly visible to patients/visitors?
What types of promotional materials are available to patients/visitors regarding hand hygiene?
Are instructions for hand hygiene prominently displayed?
Describe any patient/visitor feedback received regarding hand hygiene promotion (e.g., through surveys, complaints).
Estimated number of informational materials (posters, brochures, etc.) available for patient/visitor use.
Are staff actively encouraging hand hygiene among patients/visitors?
Upload a sample of a patient/visitor hand hygiene informational brochure/poster.
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