Data Collection Tool Sponsored by the Hand Hygiene Targeted Solutions Tool™

 

The products, technology and/or processes described and/or used on TST may be the subject of intellectual property rights reserved by the Center, The Joint Commission or other third parties. Nothing contained herein shall be construed as conferring to you in any manner, whether by implication, estoppel or otherwise, any license, title, or ownership of or to any intellectual property right of the Center, The Joint Commission or any third party.  

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Data Collection Tool Sponsored by the Hand Hygiene Targeted Solutions Tool™

 

The products, technology and/or processes described and/or used on TST may be the subject of intellectual property rights reserved by the Center, The Joint Commission or other third parties. Nothing contained herein shall be construed as conferring to you in any manner, whether by implication, estoppel or otherwise, any license, title, or ownership of or to any intellectual property right of the Center, The Joint Commission or any third party.  

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Instructions:  • Step  1:  Watch  “Improving  Care  with  TST”  video  (6  minutes)  at  

http://www.centerfortransforminghealthcare.org/multimedia/improving-­‐care-­‐with-­‐the-­‐tst/    • Step  2:  Review  the  data  collection  tool  provided  by  Joint  Commission  for  Center  for  Transforming  

Healthcare  (see  Page  3  to  5)  • Step  3:  Go  out  to  your  patient  care  area  and  “test  it”  on  3  to  5  observations  before  Session  2.  • Come  back  next  webinar  and  tell  us  your  experience  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Data Collection Tool Sponsored by the Hand Hygiene Targeted Solutions Tool™

 

The products, technology and/or processes described and/or used on TST may be the subject of intellectual property rights reserved by the Center, The Joint Commission or other third parties. Nothing contained herein shall be construed as conferring to you in any manner, whether by implication, estoppel or otherwise, any license, title, or ownership of or to any intellectual property right of the Center, The Joint Commission or any third party.  

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Definitions  of  Contributing  Factors  

Observable contributing factors (11): Column  #  

Contributing  Factor  Definition  

6    Dispenser  location     The  alcohol  based  hand-­‐rub  dispenser(s)  is  not  optimally  located  in  the  path  of  the  health  care  provider’s  workflow,  and/or  the  access  to  the  dispensers  are  either  obstructed  or  hidden.  

7    Dispenser  empty     The  alcohol  based  hand-­‐rub  dispenser(s)  accessible  to  the  observed  health  care  provider  is  empty.  

8    Dispenser  broken     The  alcohol  based  hand-­‐rub  dispenser(s)  accessible  to  the  observed  health  care  provider  is  broken  or  not  functional.  

9    Equipment  shared     The  health  care  provider  did  not  wash  hands  due  to  the  use  of  shared  equipment  between  patients  (e.g.,  vital  sign  machine,  portable  x-­‐ray,  etc.).  

10    Hands  full  supplies     Health  care  provider’s  hands  are  full  of  supplies  or  equipment  (e.g.,  food  trays,  lab  supplies).  

11    Hands  full  meds     Health  care  provider’s  hands  are  full  of  medications.  12    Improper  use  of  gloves     Health  care  provider  did  not  wash  hands  before  putting  on  gloves  or  

after  taking  gloves  off.  13    Follow  person  entry  or  exit     Health  care  providers  entering  or  exiting  the  patient  care  area  followed  

someone  who  did  not  wash  hands.  14    Frequent  entry  and  exit     Frequent  entry  and  exit  of  patient  care  area.  15    Admissions  or  discharge  process     Lack  of  streamlined  admission  or  discharge  process  led  to  unnecessary,  

frequent  entry  or  exit  o  the  patient  care  area  by  the  health  care  provider.  

16    Isolation  area  (gown  +  gloves)     Prior  to  entering  or  exiting  the  isolation  patient  care  area,  the  health  care  provider  did  not  wash  hands  before  or  after  putting  on  personal  protective  equipment  (e.g.,  gloves  or  gowns,  when  required).    

Non-observable contributing factors (4):

Column  #  

Contributing  Factor  Definition  

17    Lack  of  immediate  feedback     Lack  of  feedback  to  the  health  care  provider  for  hand  hygiene  compliance  coaching.  

18    Distracted  or  forgot     Distracted/  forgot/  lack  of  knowledge/  chose  not  to  wash  19    Perception  HH  not  required     Perception  that  hand  hygiene  is  not  necessary  if  nothing  is  touched  in  

the  patient  care  area.  

 

Data Collection Tool Sponsored by the Hand Hygiene Targeted Solutions Tool™

 

The products, technology and/or processes described and/or used on TST may be the subject of intellectual property rights reserved by the Center, The Joint Commission or other third parties. Nothing contained herein shall be construed as conferring to you in any manner, whether by implication, estoppel or otherwise, any license, title, or ownership of or to any intellectual property right of the Center, The Joint Commission or any third party.  

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Column  #  

Contributing  Factor  Definition  

20    Perception  of  skin  irritation     Health  care  provider  perceive  that  the  following  will  cause  skin  irritation:    

• Alcohol  based  hand  rub  is  more  drying  that  soap  and  water  • Frequent  hand  hygiene  at  work  causes  skin  irritation  • The  use  of  gloves  eliminates  the  need  for  hand  hygiene  and  avoids  

skin  irritation        

Other contributing factors: Column  #  

Contributing  Factor  Definition  

21    Other  contributing  factor     Please  specify  other  observable  or  non-­‐observable  contributing  factors  that  are  not  listed  above.  

 

 

 

 

 

 

 

 

 

 

1. Use a separate row for each entry or exit.2. When there is a defect (wash in/out=no), check any applicable observed contributing factor.3. The “observed by asking” section is for JIT coaches only.4. Emergency situations are EXCLUDED from the data collection process.

Collected by: Role (circle one): Observer Coach Unit:

Non Observable

Date of observations:Hand Hygiene Observation and Contributing Factor FormPossible Contributing Factors to Washing

Observable

1

2

3

4

5

6

7

8

9

10

Instructions:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22Disp

ense

r loca

tion

Did pe

rson w

ash?

Entry o

r exit

?

Observ

ation

Num

ber

Check

box i

f obs

erved

durin

g rou

nds

RN = Nurs

e

NA = Nurs

ing Assi

stant

MD = Doct

or

RT = Repi

ratory T

herapy

PT = Phys

ical Ther

apy

Diet = D

ietary T

echnic

ian

Lab = L

ab Tec

hnicia

n

HSK = Hous

ekeepi

ng

all oth

ers ple

ase ide

ntify in

comment

s

Enter h

our o

f obs

ervati

on

in

24-ho

ur (m

ilitary

) time

Dispen

ser e

mpty

Dispen

ser b

roken

Equipm

ent s

hared

Hands

full s

uppli

es

Hands

full m

eds

Impro

per u

se of

glov

es

Follow

perso

n entr

y or e

xit

Freque

nt en

try or

exit

Admiss

ions o

r disc

harge

s proc

ess

Isolat

ion ar

ea (g

own +

glov

es)

Lack

of im

mediat

e fee

dbac

k

Distrac

ted or

forgo

t

Percep

tion H

H not re

quire

d

Percep

tion o

f skin

irrita

tion

Other c

ontrib

uting

facto

r

Comments

EN EX

EN EX

EN EX

EN EX

EN EX

EN EX

EN EX

EN EX

EN EX

EN EX

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

6. Dispenser location is not in path of person or is obstructed or hidden7. Dispenser is empty8. Dispenser is broken9. Equipment shared or disposal area (use of equipment shared between patients i.e. vital sign machine, portable x-ray, etc)10. Hands full: supplies or equipment (e.g., food trays, lab supplies)11. Hands full meds12. Gloves (e.g., improper use of or not washing before or after putting gloves on or off)13. Person entering or exiting followed someone who did not wash14. Frequent entry and exit of patient area

15. Admissions or discharge process16. Isolation area (gown + gloves when required)17. Lack of immediate feedback to person for hand hygiene compliance18. Distractions/forgets/lack of knowledge/chose not to wash19. Perception that if nothing is touched in the patient care area hand hygiene is not necessary20. Perception of skin irritation or dislike of alcohol-based hand rub21. Other

Contributing Factors

Circle role of health careprofessional observed

RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other

CM / SW = C

ase Mgm

t / Soci

al Work

er

Pharm = P

harmaci

st

Rad = R

adiolo

gy Tec

h

RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other

RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other

RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other

RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other

RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other

RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other

RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other

RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other

RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other