10-xxxx Semmelweis Hand Hygiene Survey Form - 6 per sheet

Infection Prevention It’s in your Hands Clinic:__________________________ Date:__________________________ Healthcare worker Performed hand hygiene? □Physician □Yes □No □Nurse □Yes □No □Other □Yes □No		Infection Prevention It’s in your Hands Clinic:__________________________ Date:__________________________ Healthcare worker Performed hand hygiene? □Physician □Yes □No □Nurse □Yes □No □Other □Yes □No
Infection Prevention It’s in your Hands Clinic:__________________________ Date:__________________________ Healthcare worker Performed hand hygiene? □Physician □Yes □No □Nurse □Yes □No □Other □Yes □No		Infection Prevention It’s in your Hands Clinic:__________________________ Date:__________________________ Healthcare worker Performed hand hygiene? □Physician □Yes □No □Nurse □Yes □No □Other □Yes □No
Infection Prevention It’s in your Hands Clinic:__________________________ Date:__________________________ Healthcare worker Performed hand hygiene? □Physician □Yes □No □Nurse □Yes □No □Other □Yes □No		Infection Prevention It’s in your Hands Clinic:__________________________ Date:__________________________ Healthcare worker Performed hand hygiene? □Physician □Yes □No □Nurse □Yes □No □Other □Yes □No

Be Involved with Your Care! Using soap & water or alcohol rubs is one of the ways that helps us to prevent the spread of germs. Please observe our healthcare provider to see they wash or use the alcohol rub before providing your care. Take an active part in your care by completing the reverse side of this card and placing in receptacle in the reception area.		Be Involved with Your Care! Using soap & water or alcohol rubs is one of the ways that helps us to prevent the spread of germs. Please observe our healthcare provider to see they wash or use the alcohol rub before providing your care. Take an active part in your care by completing the reverse side of this card and placing in receptacle in the reception area.
Be Involved with Your Care! Using soap & water or alcohol rubs is one of the ways that helps us to prevent the spread of germs. Please observe our healthcare provider to see they wash or use the alcohol rub before providing your care. Take an active part in your care by completing the reverse side of this card and placing in receptacle in the reception area.		Be Involved with Your Care! Using soap & water or alcohol rubs is one of the ways that helps us to prevent the spread of germs. Please observe our healthcare provider to see they wash or use the alcohol rub before providing your care. Take an active part in your care by completing the reverse side of this card and placing in receptacle in the reception area.
Be Involved with Your Care! Using soap & water or alcohol rubs is one of the ways that helps us to prevent the spread of germs. Please observe our healthcare provider to see they wash or use the alcohol rub before providing your care. Take an active part in your care by completing the reverse side of this card and placing in receptacle in the reception area.		Be Involved with Your Care! Using soap & water or alcohol rubs is one of the ways that helps us to prevent the spread of germs. Please observe our healthcare provider to see they wash or use the alcohol rub before providing your care. Take an active part in your care by completing the reverse side of this card and placing in receptacle in the reception area.