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1
 PEMERINTAH KABUPATEN LAMONGAN
2





RUMAH SAKIT UMUM DAERAH KARANGKEMBANG
3
 Jl. Raya - Jombang Km. 2 Babat, Lamongan, Jawa Timur 62271
4
Telepon (0322) 4651378, Faksimile (0322) 4651378,Pos-el rsudkarangkembang@gmail.com
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Laman : www.lamongankab.go.id
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FORMAT AUDIT KEPATUHAN CUCI TANGAN
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Ruang : Casemix
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Periode : Januari
12
NoTanggalNama PetugasRuangan5 Momen Cuci Tangan6 Langkah Cuci TanganWaktuNumDenum%
13
12345123456Handrub (20 -30 detik)Handwash (40-60 detik)
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11/2/2026NUR ACASEMIX66100%
15
21/2/2026NIKMACASEMIX66100%
16
31/3/2026NUR ACASEMIX66100%
17
41/3/2026NIKMACASEMIX66100%
18
51/5/2026NUR ACASEMIX66100%
19
61/5/2026NIKMACASEMIX66100%
20
71/6/2026NUR ACASEMIX66100%
21
81/6/2026NIKMACASEMIX66100%
22
91/7/2026NUR ACASEMIX66100%
23
101/7/2026NIKMACASEMIX66100%
24
111/8/2026NUR ACASEMIX66100%
25
121/8/2026NIKMACASEMIX66100%
26
131/9/2026NUR ACASEMIX66100%
27
141/9/2026NIKMACASEMIX66100%
28
151/10/2026NUR ACASEMIX66100%
29
161/10/2026NIKMACASEMIX66100%
30
171/12/2026NUR ACASEMIX66100%
31
181/12/2026NIKMACASEMIX66100%
32
191/13/2026NUR ACASEMIX66100%
33
201/13/2026NIKMACASEMIX66100%
34
211/14/2026NUR ACASEMIX66100%
35
221/14/2026NIKMACASEMIX66100%
36
231/15/2026NUR ACASEMIX66100%
37
241/15/2026NIKMACASEMIX66100%
38
251/17/2026NUR ACASEMIX66100%
39
261/17/2026NIKMACASEMIX66100%
40
271/19/2026NUR ACASEMIX66100%
41
281/19/2026NIKMACASEMIX66100%
42
291/20/2026NUR ACASEMIX66100%
43
301/20/2026NIKMACASEMIX66100%
44
311/21/2026NUR ACASEMIX66100%
45
3221/01/2026NIKMACASEMIX66100%
46
3322/01/2026NUR ACASEMIX66100%
47
341/22/2026NIKMACASEMIX66100%
48
3523/01/2026NUR ACASEMIX66100%
49
3623/01/2026NIKMACASEMIX66100%
50
371/24/2026NUR ACASEMIX66100%
51
3824/01/2026NIKMACASEMIX66100%
52
3926/01/2026NUR ACASEMIX66100%
53
401/26/2026NIKMACASEMIX66100%
54
4127/01/2026NUR ACASEMIX66100%
55
4227/01/2026NIKMACASEMIX66100%
56
431/28/2026NUR ACASEMIX66100%
57
4428/01/2026NIKMACASEMIX66100%
58
4529/01/2026NUR ACASEMIX66100%
59
461/29/2026NIKMACASEMIX66100%
60
4730/01/2026NUR ACASEMIX66100%
61
4830/01/2026NIKMACASEMIX66100%
62
491/31/2026NUR ACASEMIX66100%
63
5031/01/2026NIKMACASEMIX66100%
64
JUMLAH300300100%
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Keterangan :
Auditor
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Jika dilaksanakan beri tanda (√)
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Jika tidak dilaksanakan beri tanda (-)
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Jika tidak ada pelunag beri tanda (x)
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Patuh = 1
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Tidak Patuh = 0
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Kepatuhan Cuci tangan =
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Numerator (Jumlah kepatuhan cuci tangan yang dilaksanakan)
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Denumerator( Jumlah peluang kegiatan cuci tangan yang diobservasi)
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Target >85%
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perhari 3 orang
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78
 PEMERINTAH KABUPATEN LAMONGAN
79





RUMAH SAKIT UMUM DAERAH KARANGKEMBANG
80
 Jl. Raya - Jombang Km. 2 Babat, Lamongan, Jawa Timur 62271
81
Telepon (0322) 4651378, Faksimile (0322) 4651378,Pos-el rsudkarangkembang@gmail.com
82
Laman : www.lamongankab.go.id
83
84
85
FORMAT AUDIT KEPATUHAN CUCI TANGAN
86
87
Ruang : Casemix
88
Periode : Februari
89
NoTanggalNama PetugasRuangan5 Momen Cuci Tangan6 Langkah Cuci TanganWaktuNumDenum%
90
12345123456Handrub (20 -30 detik)Handwash (40-60 detik)
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12/2/20261. Nur Azizah, S.MCASEMIX66100%
92
22/2/20262. ST. Nikmatul Khoiriyah, S.Kep.NsCASEMIX66100%
93
32/3/20261. Nur Azizah, S.MCASEMIX66100%
94
42/3/20262. ST. Nikmatul Khoiriyah, S.Kep.NsCASEMIX66100%
95
52/4/20261. Nur Azizah, S.MCASEMIX66100%
96
62/4/20262. ST. Nikmatul Khoiriyah, S.Kep.NsCASEMIX66100%
97
72/5/20261. Nur Azizah, S.MCASEMIX66100%
98
82/5/20262. ST. Nikmatul Khoiriyah, S.Kep.NsCASEMIX66100%
99
92/6/20261. Nur Azizah, S.MCASEMIX66100%
100
102/6/20262. ST. Nikmatul Khoiriyah, S.Kep.NsCASEMIX66100%