Template

Hand Hygiene and Glove Use Observation Tool

by Mae Eichelberger, from the Community

10+

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.

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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

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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
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AUS Hand Hygiene Audit Tool
This Australian hand hygiene audit tool helps healthcare facilities assess compliance with best practice, including the WHO 5 Moments for hand hygiene. Capture observations across roles such as nurses, medical practitioners, allied health, and students; verify actions like glove use and removal; and document each moment before and after patient contact or procedures. Use it to record findings by ward or site, identify trends, and support infection control programs. Customize to align with local policies and drive continuous improvement.
by National System Admin, from the Community
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CHEO Hand Hygiene Audits - IPAC
This hand hygiene audit template from CHEO supports Infection Prevention and Control (IPAC) programs. It guides observers through the 4 Moments of Hand Hygiene and proper technique, including use of alcohol-based hand rub for 15 seconds or soap and water for 40 seconds, with checks for fingertips, thumbs, and between fingers. Prompts cover washing before patient contact and glove use, after glove removal, on exiting the patient environment, and after exposure to body fluids. Additional checks reinforce best practice, such as hands and wrists free of jewelry, clean natural nails, and intact skin. Use this checklist to standardize audits, document compliance by location and observer, and drive quality and patient safety improvements.
by Colleen Fitzgibbons, 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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Hand Hygiene and Glove Use Observation Tool

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Hand Hygiene 5 Moments Observation Audit

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