5 Moments for Hh

8/13/2019 5 Moments for Hh

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5 Moments for HandHygiene

Based on the 'My 5 moments for Hand Hygiene', URL: http://www.who.int/gpsc/5may/background/5moments/en/index.html World Health Organization 2009. All rights reserved.


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Two Zones

The Patient Zone:

The patients

immediate surroundings

The patient &

Two Critical Sites

Clean siteBody fluid site

The Healthcare ZoneThe Healthcare Zone


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From Ontario Just Clean Your Hands Program

The science behind Just clean your hands presentation

Patient Zone


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Patient Zone

Assumptions

Patient flora rapidlycontaminates entirepatient zone

Patient zone is cleanedbetween patients


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Healthcare Zone

Assumptions

Contaminated withorganisms foreign andpotentially harmful toPatient X

Transmission results inexogenous infection


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Critical sites

Clean sites

Have to be protectedagainstmicroorganisms

Body fluid sites Lead to hand exposure

of body fluids


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The facts

Colonised or infected patients represent the mainreservoir for healthcare associated microorganisms

Environment in the healthcare facility contains a wide

variety of different healthcare-associated micro-organisms and represents a secondary source fortransmission to patients

The immediate patient environment becomes colonisedby the patient flora


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The facts

Most transmission of microorganisms results in

colonisation, not infection Most HCAIs, however, are of an endogenous nature, and

due to micro-organisms already colonising the patient

before the onset of infection


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Four negative outcomes targeted by

hand hygiene1. Cross colonisation of patients

2. Endogenous and exogenous infection in patients

3. Infection in HCWs

4. Cross-colonisation of the healthcare environment

including HCWs


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Possible cross contaminationbetween Patient A and Patient B


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Moment 1 Before Touching a

PatientPrevented negative

outcome:Patient colonisation withhealth-caremicroorganisms,exogenous infection


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Moment 2 Before A Procedure

Prevented negative

outcome:Patient infection,endogenous/exogenous

HCWs generally touch

another surface withinthe patient zone beforecontact with a clean site


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Moment 3 After A Procedure or

Body Fluid Exposure RiskPrevented negativeoutcome:Healthcare workerinfection, environmental

contamination

Prevents transmission of

microorganisms from acolonised to a cleanbody site on patient X


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Moment 4 After Touching A

PatientPrevented negative

outcome:Healthcare workercolonisation,environmentalcontamination

Minimises disseminationto healthcare environment


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Moment 5 After Touching A

Patients SurroundingsPrevented negative

outcome:Healthcare workercolonisation, environmentalcontamination

Minimises dissemination tohealthcare environment


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Moment 1

Before Touching a Patient


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Patient

Refers to any part of the patient, theirclothes, or any medical device that isconnected to the patient

If the patient were to get out of bedand walk off what would still beattached to them?


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Moment 1When: Examples:

Touching a patient in any way Shaking hands, Assisting a patient tomove, most All ied health interventions,Touching any invasive medical device

connected to the patient (eg. IV pump, IDC)

Any personal care activities Bathing, Dressing, Brushing hair, Puttingon personal aids eg. Glasses

Any non-invasive observations Taking a pulse, Blood pressure, Oxygensaturation, Temperature, Chestauscultation, Abdominal palpation,

Applying ECG electrodes, CTG

Any non-invasive treatment Applying an oxygen mask or nasalcannula, Fitting slings/braces, Applicationof incontinence aids (including condomdrainage)


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Preparation and administration of oralmedications

Oral medications, Nebulised medications

Oral care and feeding Feeding a patient, Brushing teeth or

dentures

Contacts with the patients surroundings

before, during and after any of the above

Bedside table, Medical chart


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Key Message for Moment 1

Hand Hygiene before touching a patient Where possible Hand Hygiene should occur

in front of the patient so that they canobserve it

Hand Hygiene on entering the patientsroom


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HCW walks in,helps the patient to sit up,moves the over bed table,

folds down the sheets,moves the chair into position,

then gets the patient out of bed

Moment 1 prior to touching patient

Example:


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Moment 2

Before a Procedure


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Procedure

Is an act of care for a patient where

there is a risk of direct introduction ofa pathogen into the patients body.


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Insertion of a needle into a patients skin,or into an invasive medical device

Venipuncture, Blood glucose level, Arterial blood gas, Subcutaneous orIntramuscular injections, IV flush

Preparation and administration of any

medications given via an invasivemedical device, or preparation of asterile field

IV medication, NGT feeds, PEG feeds,

Baby feeds, Dressing t rolley

Administration of medications wherethere is direct contact with mucousmembranes

Eye drop installation, Suppositoryinsertion, Vaginal pessary


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Insertion of, or disruption to, the circuitof an invasive medical device

Procedures involving the fol lowing: ETT,Tracheostomy, Nasopharyngeal airways,Suctioning of airways, Urinary catheter,Colostomy/ileostomy, Vascular accesssystems, Invasive monitoring devices,

Wound drains, PEG tube, NGT, Secretionaspiration

Any assessment, treatment and patientcare where contact is made with non-intact skin or mucous membranes

Wound dressings, Burns dressings,Surgical procedures, Digital rectalexamination, Invasive obstetric andgynaecological examinations andprocedures, Digital assessment ofnewborns palate


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Hand Hygiene immediately prior to a procedure

Once Hand Hygiene has been done, nothing elsein the patients environment should be touchedprior to the procedure starting


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Example:

HCW replaces an empty IV fluid bagwith a new IV fluid bag

Moment 2 prior to disconnecting the IV line


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Moment 3

After a Procedure or Body FluidExposure Risk


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Any situation where contact with bodyfluids may occur. Such contact may posea contamination risk to either the HCW orthe environment

Body Fluid Exposure Risk


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Actual or potential contactwith:

Blood, Lochia

Saliva or tears

Mucous, wax, or pus

Breast milk, Colostrum

Vomitus

Urine, faeces, semen, or meconium

Pleural fluid, ascitic fluid or CSF Tissue samples, including biopsy specimens, organs,bone marrow, cell samples


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After any Moment 2 See Moment 2

After any potential body fluid exposure Contact with a used urinary bottle /bedpan, Contact wi th sputum eitherdirectly or indirectly via a cup or tissue,Contact with used specimen jars /pathology samples, Cleaning dentures,

Cleaning spills of body fluid from patientsurroundings, After touching the outsideof a drain


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Hand Hygiene immediately after a procedure

or a body fluid exposure risk As hands are likely to be contaminated with

body fluid


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Example:

HCW replaces an empty IV fluid bagwith a new IV fluid bag

Moment 2 prior to disconnecting IV Moment 3 after reconnecting IV


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Example:

HCW walks into the room,empties IDC drainage bag,

disposes of urine in pan room

Moment 2 before opening IDC Moment 3 after disposing of urine (exposure risk)


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Moment 4

After Touching a Patient


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Hand Hygiene after touching a patient

This completes the basic message of HandHygiene before you enter the patient room,and before you leave the patient room

E l


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Example:

HCW walks in,helps the patient to sit up,

folds down the sheets,moves the chair into position,

then gets the patient out of bed,then leaves the room

Moment 1 prior to touching patient Moment 4 after touching the patient

M 5


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Moment 5 After touching a patients immediate

surroundingswhen the patient has not been touched


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Immediate Patient Surroundings

A space temporarily dedicated to anindividual patient for that patients stayIncludes :

Patient furniture and personal belongings Medical equipment BP machine, monitor Medical chart

Anything touched by HCW while caring for thatpatient


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After touching the patients immediatesurroundings when the patient has notbeen touched

Patient surroundings include: Bed,Bedrails, Linen, Table, Bedside chart,Bedside locker, Call bell/TV remotecontrol, Light switches, Personalbelongings, Chair, Foot stool, Monkey

bar


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Hand hygiene after touching the patients

surroundings when the patient has not beentouched


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Example:

HCW walks into patient room,moves the over bed table closer to the patient,

then leaves Moment 5 after touching the patient

surroundings (without touching the patient)

If patient had been touched, then this would havebeen recorded as:

Moment 1 and Moment 4

5 Moments for Hh

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