Hand Hygiene Questionnaire

Unit: ______

Job: Clinical ______Non Clinical______

Number of years in current role: ______

Shift: ______

1) Does our system have a Hand Hygiene policy? Yes ___ No___ Don’t Know ____

2) While at work, how would you rate your compliance with hand hygiene? __0-25% __25-50% __50-75% __75-100%

3) I can’t wash my hands at times because: ___too busy ___forget or don’t think about it ___out of product(s) ___products(s) not in convenient location ___products(s) or practice damages my skin ___don’t like product(s) available-please state why: ______other

4) Hand hygiene reduces chances of spreading infections. Strongly agree Agree Don’t know Disagree Strongly disagree 1 2 3 4 5

5) I feel comfortable reminding my peers to wash their hands. Strongly agree Agree Don’t know Disagree Strongly disagree 1 2 3 4 5

6) Hand hygiene is regularly talked about at staff meetings. Strongly agree Agree Don’t know Disagree Strongly disagree 1 2 3 4 5

7) In this organization I feel hand hygiene is an important part of my job. Strongly agree Agree Don’t know Disagree Strongly disagree 1 2 3 4 5

8) The best way to be reminded to wash my hands is by my: ___coworker ___leader ___patient

9) If we could do one thing to help you with practicing appropriate hand hygiene, what would it be?

10) Comments:

Please return to Infection Control by (date)