Ambulatory Hand Hygiene Monitoring Question Title * 1. Please enter your Employee ID Number. Question Title * 2. Area observed for hand hygiene: Adult Emergency Dept. (DT) Bariatric Surgery - (CC) Breast Care Centers (All Locations) Cancer Center Adult/ Cancer Center Oswego Cancer Center Peds Cardiology - UHCC Connect Care CRU Dental Clinic - UHCC Dialysis - (DT) Emergency Dept. (CC) Family Medicine-Nappi Family Medicine (CC) Adult Medicine/University Internists/CIH Nappi Geriatrics-Nappi Inclusive Health Services-Nappi Joslin Center-Nappi Lab Services (All Locations) Medical Subspecialties - UHCC Neurology - (CC,IHP,UHCC) One Day Surgery/AP 1 - (DT) Ophthalmology - 550 Harrison Otolaryngology - 550 Harrison Outpt Rehab Outpt Surgery Center - 550 Harrison 3N Pre/Post-DT PACU/Surgery Center - CC 5E Pre/Post-DT Pediatrics- POB 725 Irving Ave Pediatrics- Baldwinsville Peds Emergency Dept. (DT) Perinatal - UHCC Radiation Oncology Radiology (CC) Radiology (DT) Radiology (550, UHCC, Nappi) Surgical Specialties (LL, 4835) TU3 UPAC-Nappi Urology - CC Urology - 550 Harrison Vascular Clinic (CC) Women's Health Services - UHCC Other (please specify) Question Title * 3. Anes/CRNA 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 4. Environmental Services (EVS) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO (Did Not Intervene) Hand Hygiene- NO (Did Not Intervene) 1 Hand Hygiene- NO (Did Not Intervene) 2 Hand Hygiene- NO (Did Not Intervene) 3 Hand Hygiene- NO (Did Not Intervene) 4 Hand Hygiene- NO (Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 5. Health Care Technician (HCT/UST/MOA) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 6. Lab Technician 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 7. Licensed Practical Nurse (LPN) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO (Did Not Intervene) Hand Hygiene- NO (Did Not Intervene) 1 Hand Hygiene- NO (Did Not Intervene) 2 Hand Hygiene- NO (Did Not Intervene) 3 Hand Hygiene- NO (Did Not Intervene) 4 Hand Hygiene- NO (Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 8. Medical Student 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 9. Nurse Practitioner 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 10. Nursing Student 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 11. Physical /Occupational/ Recreational / Speech Therapist 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 12. Physician 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 13. Physician's Assistant (PA) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 14. Radiology Tech (RT) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 15. Registered Nurse (RN) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 16. Respiratory Therapist (RRT) 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 17. Social Worker 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Question Title * 18. Transporter/Peri-Op 1 2 3 4 5 Hand Hygiene- YES Hand Hygiene- YES 1 Hand Hygiene- YES 2 Hand Hygiene- YES 3 Hand Hygiene- YES 4 Hand Hygiene- YES 5 Hand Hygiene- NO(Did Not Intervene) Hand Hygiene- NO(Did Not Intervene) 1 Hand Hygiene- NO(Did Not Intervene) 2 Hand Hygiene- NO(Did Not Intervene) 3 Hand Hygiene- NO(Did Not Intervene) 4 Hand Hygiene- NO(Did Not Intervene) 5 Hand Hygiene- NO (Intervened) Hand Hygiene- NO (Intervened) 1 Hand Hygiene- NO (Intervened) 2 Hand Hygiene- NO (Intervened) 3 Hand Hygiene- NO (Intervened) 4 Hand Hygiene- NO (Intervened) 5 Submit
