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International Accreditation of Healthcare Facilities

Free resource · Patient-safety tools · Toolkit 2 · Hand hygiene

Hand Hygiene Observation Form

Direct observation of the Five Moments — the WHO gold-standard method, one 20-minute session per sheet

Free A4 print-ready PDF · 1 page · keep the ASF mark · scan the QR on the print to return here

Hand Hygiene Observation Form

What it is

The WHO observation form: an observer records, for each opportunity, which Moment applied and whether a hand rub, a hand wash, or nothing was done. Produces a compliance rate per ward per profession.

Where to use it

Infection-control nurse or trained observer; one sheet per 20-minute session; at least 200 opportunities per ward per quarter. Evidence for: Universal Floor — hand hygiene; Hospital Standard 3 — environment and infection prevention. Evidence for: Universal Floor — hand hygiene; Hospital Standard 3 — environment and infection prevention. Evidence for: Universal Floor — hand hygiene; Hospital Standard 3 — environment and infection prevention. Evidence for: Universal Floor — hand hygiene; Hospital Standard 3 — environment and infection prevention. Evidence for: Universal Floor — hand hygiene; Hospital Standard 3 — environment and infection prevention. Evidence for: Universal Floor — hand hygiene; Hospital Standard 3 — environment and infection prevention. Evidence for: Universal Floor — hand hygiene; Hospital Standard 3 — environment and infection prevention. Evidence for: Universal Floor — hand hygiene; Hospital Standard 3 — environment and infection prevention. Evidence for: Universal Floor — hand hygiene; Hospital Standard 3 — environment and infection prevention. Evidence for: Universal Floor — hand hygiene; Hospital Standard 3 — environment and infection prevention.

Translate and adapt

English master edition. Georgian and other translations are added as they are clinically reviewed. Any facility may translate, add its logo and adapt wording to local practice — keeping the ASF block, the source attribution and the licence line on the sheet. Clinical thresholds and drug doses must be confirmed against national protocols before use.

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The same code is printed on the tool itself. Scan it in any facility to reach this page.

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Adapted by ASF from openly licensed WHO, IAEA, AHRQ, CDC and NHS material, or ASF original — source and licence stated on every sheet. Free for any facility. Keep the ASF block.
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