**[Instructions for Using the Hand Hygiene/Glove Use Observation
Tool:]{.underline}**

1\. The purpose of this tool is to collect baseline data in the ICU
about our current compliance with the CDC Guideline for hand hygiene.
This means using an alcohol based foam or gel or antimicrobial soap
before and after contact of any kind with an ICU patient or his/her
immediate environment (bedding, ventilator tubing, equipment in the
patient\'s room). There are a few other requirements that we will be
looking at as well. Under certain circumstances the Guidelines calls for
the use of non-sterile rubber gloves. There is also a circumstance in
which alcohol foam or gel is not sufficient and actual hand washing with
antimicrobial soap must take place. These are somewhat common sense
items and are spelled out in the observation tool. Ultimately we want to
use this data to help improve practice with hand hygiene throughout the
VA system.

2\. The collection of data needs to be done discreetly, ideally by
someone who would normally be in the unit, so that their presence is not
thought to be unusual. This might be an ICU nurse, nurse manager, ICU
physician, or respiratory therapist, for example. If the infection
control nurse does not ordinarily spend extended periods in the ICU,
they might not be ideal observers for this reason. Please keep the
observation tool in a discreet location. The reason for these measures
is not because we are trying to be secretive or to \"catch\" anyone in
poor practices. (See number 3 below). The reason for discretion is so
that we do not influence and change the behavior we are studying. That
will come later, through education. For now we just want reliable
baseline data about hand hygiene practice in ICUs throughout the VA.

3\. This tool is being used for quality improvement purposes only. It is
not part of a research project. It will not be used to grade or punish
anyone. No individual practitioner will be identified. The tool will not
be used for adverse action against anyone. It is simply to help
understand where we need to improve. We know from the literature that
most ICU\'s have a great deal of room for improvement with regard to
hand hygiene practices.

4\. Some suggestions on completing the tool:

Identify your unit, and date. At the top under staff category, identify
the job category of the person you are observing. A key is listed at the
bottom of the tool. For example, if you are observing a staff attending
physician the code is MDA, if you are observing a nurse the code is RN,
if you are observing a chaplain the code is CHAP, and so on. Under each
category there is a column for yes and no. Yes means the individual
observed proper hand hygiene as specified on the left-hand side of the
tool, or no they did not. Make a hash mark for each yes or no. You may
have multiple hash marks for each person you are observing in both
columns and even within one category of patient contact. Each hash mark
represents a discreet observation. Try to observe the behavior of every
job category, not just nurses and doctors. This includes any employee
who may have contact with the patient, including x-ray technicians,
social workers, respiratory therapists, etc. Try to get a representative
sample that reflects the true number of opportunities for hand hygiene
that occur in your unit. This means we would expect more hash marks for
nurses than doctors and more for doctors than chaplains. One way to do
this is to simply try to observe a single room for 5 minutes at a time.
The tool can be completed at different times.