Template

Caregiver Masking and Hand Hygiene Compliance

by Meghan Engbretson, from the Community

10+

Use this audit to monitor caregiver masking and hand hygiene performance across care units. Capture room details and isolation status, verify signage and precautions, and observe key HH moments before entry, before patient or environment contact, and after exit. Record whether masks are worn in hallways and patient rooms, and assess PPE use and compliance trends. Add comments to highlight gaps and actions to strengthen infection prevention and patient safety.

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Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Hand Hygiene 5 Moments Observation Audit
This hand hygiene 5 moments observation checklist helps healthcare teams audit compliance with infection prevention standards. Use it to observe staff before and after patient contact, before aseptic procedures, after exposure to bodily fluids, and after touching patient surroundings. The tool supports isolation precautions, appropriate PPE use, equipment cleaning, sterile technique, and proper glove changes. Record findings, add coaching notes, and create performance improvement plans to strengthen hand hygiene practices across home care and clinical environments.
by Monica Conti, from the Community
Downloads: 0
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Template
Hand Hygiene and Glove Use Observation Tool
Use this hand hygiene and glove use observation tool to monitor compliance across care moments: before aseptic tasks, before and after patient contact, after exposure to body fluids, after touching patient surroundings, and after glove or PPE removal. Capture observations across disciplines including physicians, nurses, students, and support staff. Reinforce correct glove indications, immediate removal after use, and hand hygiene following removal. Ideal for audits, training, and continuous improvement in infection prevention and patient safety. Includes observer details and sign off.
by Mae Eichelberger, from the Community
Downloads: 10+
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Template
Hand Hygiene Audit Checklist
This hand hygiene audit checklist helps assess technique and compliance for healthcare staff and visitors across key moments of care. Capture location and context, record who was audited and their role, verify whether hand hygiene was performed, the method used (soap and water or ABHR), and whether the wash lasted 15–20 seconds with full surface coverage. Observe hand hygiene moments such as entry or exit of suites, before and after glove use, after bodily fluid exposure, before dining, after using the washroom, resident contact, screening, and more. Confirm fingernails meet policy requirements and note any barriers like empty dispensers or improper glove use. Use and adapt this template to strengthen infection prevention and control.
by Melissa Therrien, from the Community
Downloads: 40+
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Template
Transmission Based Precautions Checklist
This Transmission Based Precautions checklist helps healthcare teams implement and audit infection control for patients requiring isolation. It covers airborne, contact, and droplet precautions, including placement in appropriate rooms, door and signage checks, and PPE availability such as N95 or P2 masks, gowns, gloves, and level 2 or 3 masks. Staff can verify correct donning and doffing, ensure hand hygiene with alcohol based hand rub is accessible, and confirm documentation like infectious disease notes or safety alerts. The template prompts checks for patient masking when leaving rooms, availability of disinfectant wipes, correct clinical waste disposal, cleaning procedures, and whether patient information leaflets were provided.
by Curt Werner, from the Community
Downloads: 0
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Hand Hygiene 5 Moments Observation Audit

This hand hygiene 5 moments observation checklist helps healthcare teams audit compliance with infection prevention standards. Use it to observe staff before and after patient contact, before aseptic procedures, after exposure to bodily fluids, and after touching patient surroundings. The tool supports isolation precautions, appropriate PPE use, equipment cleaning, sterile technique, and proper glove changes. Record findings, add coaching notes, and create performance improvement plans to strengthen hand hygiene practices across home care and clinical environments.

by Monica Conti, from the Community

Get

Template

Hand Hygiene and Glove Use Observation Tool

Use this hand hygiene and glove use observation tool to monitor compliance across care moments: before aseptic tasks, before and after patient contact, after exposure to body fluids, after touching patient surroundings, and after glove or PPE removal. Capture observations across disciplines including physicians, nurses, students, and support staff. Reinforce correct glove indications, immediate removal after use, and hand hygiene following removal. Ideal for audits, training, and continuous improvement in infection prevention and patient safety. Includes observer details and sign off.

by Mae Eichelberger, from the Community

10+

Get

Template

Hand Hygiene Audit Checklist

This hand hygiene audit checklist helps assess technique and compliance for healthcare staff and visitors across key moments of care. Capture location and context, record who was audited and their role, verify whether hand hygiene was performed, the method used (soap and water or ABHR), and whether the wash lasted 15–20 seconds with full surface coverage. Observe hand hygiene moments such as entry or exit of suites, before and after glove use, after bodily fluid exposure, before dining, after using the washroom, resident contact, screening, and more. Confirm fingernails meet policy requirements and note any barriers like empty dispensers or improper glove use. Use and adapt this template to strengthen infection prevention and control.

by Melissa Therrien, from the Community

40+

Get

Template

Transmission Based Precautions Checklist

This Transmission Based Precautions checklist helps healthcare teams implement and audit infection control for patients requiring isolation. It covers airborne, contact, and droplet precautions, including placement in appropriate rooms, door and signage checks, and PPE availability such as N95 or P2 masks, gowns, gloves, and level 2 or 3 masks. Staff can verify correct donning and doffing, ensure hand hygiene with alcohol based hand rub is accessible, and confirm documentation like infectious disease notes or safety alerts. The template prompts checks for patient masking when leaving rooms, availability of disinfectant wipes, correct clinical waste disposal, cleaning procedures, and whether patient information leaflets were provided.

by Curt Werner, from the Community

Get

Caregiver Masking and Hand Hygiene Compliance

About author

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Hand Hygiene 5 Moments Observation Audit

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