Form Monitoring Kebersihan Tangan.docx

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FORMULIR MONITORING KEPATUHAN KEBERSIHAN TANGAN PENCEGAHAN DAN PENGENDALIAN INFEKSI RS PARU DR. ARIO WIRAWAN SALATIGA Ruang : Tanggal : NO

PPI.014.006/REV A/010214 WAKTU

1

Sebelum kontak dengan pasien

2

Sebelum melakukan tindakan aseptik

3

Setelah kontak dengan darah atau cairan tubuh pasien

4

Setelah kontak dengan pasien

5

Setelah kontak dengan peralatan di sekitar pasien

Total jumlah Ya Total Jumlah Ya dan Tidak

X 100 = ............................................

YA

TIDAK

KETERANGAN

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