Throughout the day, healthcare workers need to perform hand hygiene events countless times for a myriad of reasons. It’s hard to keep track of each of the specific instances in which a hand wash is needed. In an effort to make these times easier to remember The World Health Organization defined the 5 Moments of Hand Hygiene. The 5 moments of hand hygiene explain when a healthcare worker needs to be washing up in order to maintain the utmost health and safety for everyone in their facility.

In order to prevent the patient from being colonized with healthcare-associated microorganisms, hand hygiene must take place before touching the patient or entering the patient zone. The patient zone contains the patient and his/her immediate surroundings, including surfaces touched by the patient (such as the bed rails, infusion tubing) and surfaces frequently touched by staff (such as monitors, knobs and buttons). Examples: Before shaking hands, helping a patient to move around, clinical examination.

2. Before a clean/aseptic procedure

Before performing a clean/aseptic procedure, hand hygiene is critical in order to prevent HCAI. Hand hygiene should take place between the last exposure to a surface and immediately before access to a critical site with infectious risk for the patient or a critical site with combined infectious risk. Examples: Before wound dressing, catheter insertion, preparation of food, medications.

3. After body fluid exposure risk

After performing a task associated with a risk to expose hands to body fluids, hand hygiene must take place instantly and before a new hand-to-surface exposure, even if you stay within the patient zone. This action reduces both your risk of being colonized or infected by infectious agents, and the risk of transmitting microorganisms from a “colonized” to a “clean” body site within the same patient. Examples: After drawing and manipulating blood, clearing up urine, feces, handling waste.

4. After touching a patient

After touching the patient and before touching an object in the area outside of the patient, hand hygiene is important to minimize the risk of dissemination to the healthcare environment. This action also protects you by significantly reducing contamination of your hands with the flora from the patient. Examples: After shaking hands, helping a patient to move around, clinical examination.

5. After touching patient surroundings

The final moment for hand hygiene occurs between hand exposure to a surface in the patient zone and a subsequent hand exposure to a surface in the area outside of the patient - but without touching the patient. Hand hygiene is required in this moment since exposure to patient objects, even without physical contact with the patients, is associated with hand contamination. Examples: After changing bed linen, perfusion speed adjustment.

WHO# My 5 Moments for Hand Hygiene

Focus on caring for a patient with a post-operative wound

Hand Hygiene and the surgical patient journey

WHO click ที่นี้เพื่อดูรูปขนาดใหญ่

My 5 Moments for Hand Hygiene

Focus on caring for a patient with a post-operative wound# WHO Click ที่นี้เพื่อดูรูปภาพขนาดใหญ่

'Based on the 'My 5 moments for Hand Hygiene' © World Health Organization 2009. All rights reserved.'

Moment 1 - Before touching a patient

When

Immediately before touching the patient.

Why?

To protect the patient against microorganisms from the hands of the healthcare worker.

In detail

Before touching a patient Shaking hands, assisting a patient to move, allied health interventions, touching any medical device connected to the patient (for example, intravenous line pump, urinary catheter) Before any personal care activities that require physical contact Bathing, dressing, brushing hair, putting on personal aids such as glasses Before taking any non-invasive observations Taking a pulse, blood pressure, oxygen saturation, temperature, chest auscultation, abdominal palpation, applying ECG electrodes, cardiotocography Before providing any non-invasive treatment Applying an oxygen mask or nasal cannula, fitting slings/braces, application of incontinence aids (including condom drainage), conducting an oral examination without using a sharp instrument (such as using a mirror probe), performing oral X-ray Before the preparation or administration of oral medications Oral medications, nebulised medications Before providing oral care and feeding Feeding a patient (excluding feeding via nasogastric tube or percutaneous endoscopic gastrostomy), brushing teeth or dentures

Moment 2 - Before a procedure

When

Immediately before a procedure. Once hand hygiene has been performed, nothing else in the patient's environment should be touched prior to the procedure starting.

Why?

To protect the patient against microorganisms from entering the patient’s body, including the patient’s own microorganisms.

In detail

Before inserting a needle into a patient’s skin or into an invasive medical device connected to the patient Venepuncture, blood glucose level, arterial blood gas, subcutaneous or Intramuscular injections, intravenous line flush Before administration of any medications given via an invasive medical device Intravenous medication, nasogastric tube (NGT) feeds, percutaneous endoscopic gastrostomy (PEG) feeds Before the preparation of an aseptic field Dressing trolley set up for an aseptic procedure Before the administration of medications where there is direct or potentially direct contact with mucous membranes Eye drop instillation, suppository insertion, vaginal pessary Before the insertion of, or contact with, an invasive medical device Procedures involving endotracheal tube, tracheostomy, nasopharyngeal airways, suctioning of airways, urinary catheter, colostomy/ileostomy, vascular access systems, invasive monitoring devices, wound drains, percutaneous endoscopic gastrostomy tubes, nasogastric tube, secretion aspiration Before any assessment, treatment or patient care where contact is made with non-intact skin or mucous membranes or there is a likelihood of penetration of tissue or a cavity Wound dressings, surgical procedures, digital rectal examination, invasive obstetric and gynaecological examinations and procedures, digital assessment of newborn palate, invasive dental examinations, dental extractions, dental restoration Before preparation and administration of any medications or materials for any oral health/dental procedure Administering topical medication such as fluoride, topical anaesthetic, local anaesthetic or tooth mousse or restorative materials used for restoration procedure

Moment 3 - After a procedure or body fluid exposure risk

When

Immediately after a procedure or body fluid exposure risk.

Even if you have had gloves on you should still perform hand hygiene after removing them as gloves are not always a complete impermeable barrier. Hands may also have been contaminated in the process of removing the gloves.

Why?

To protect the healthcare worker and the healthcare environment from becoming contaminated with the patient’s microorganisms.

What is the 5 moments for hand hygiene approach?

The 5 Moments for Hand Hygiene approach was designed by the World Health Organization to minimise the risk of transmission of microorganisms between a healthcare worker, the patient, and the environment. 'Based on the ' My 5 moments for Hand Hygiene ' © World Health Organization 2009. All rights reserved.' Immediately before touching the patient.

Who is hand hygiene for?

Know the 5 Moments for Hand Hygiene HAND HYGIENE IS FOR EVERYBODY including older people, nurses, doctors, allied health, support workers, domestic staff, contractors, administration staff, families and volunteers.

Where is hand hygiene Australia located?

'Based on the ' My 5 moments for Hand Hygiene ' © World Health Organization 2009. All rights reserved.' Hand Hygiene Australia (HHA) is located at the Austin Hospital in Melbourne, Australia. The HHA team is headed by Professor Lindsay Grayson as Director.

When should you clean your hands?

Your 5 Moments WHEN? Clean your hands before touching a patient when approaching him/her. WHY? To protect the patient against harmful germs carried on your hands. WHEN? Clean your hands immediately before performing a clean/aseptic procedure. WHY? To protect the patient against harmful germs, including the patient's own, from entering his/her body.