<p> Hand Hygiene Questionnaire</p><p>Unit: ______</p><p>Job: Clinical ______Non Clinical______</p><p>Number of years in current role: ______</p><p>Shift: ______</p><p>1) Does our system have a Hand Hygiene policy? Yes ___ No___ Don’t Know ____</p><p>2) While at work, how would you rate your compliance with hand hygiene? __0-25% __25-50% __50-75% __75-100%</p><p>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</p><p>4) Hand hygiene reduces chances of spreading infections. Strongly agree Agree Don’t know Disagree Strongly disagree 1 2 3 4 5</p><p>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</p><p>6) Hand hygiene is regularly talked about at staff meetings. Strongly agree Agree Don’t know Disagree Strongly disagree 1 2 3 4 5</p><p>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</p><p>8) The best way to be reminded to wash my hands is by my: ___coworker ___leader ___patient</p><p>9) If we could do one thing to help you with practicing appropriate hand hygiene, what would it be?</p><p>10) Comments:</p><p>Please return to Infection Control by (date)</p>