www.hha.org.au 5 moments for hand hygiene

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5 Moments for

Hand Hygiene

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Patient

Refers to any part of the patient, their clothes, or any medical device that is connected to the patient

If the patient were to get out of bed and walk off – what would still be attached to them?

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Immediate Patient Surroundings

A space temporarily dedicated to an individual patient for that patient’s stay

Includes:• Patient furniture and personal belongings • Medical equipment – BP machine, monitor• Medical chart • Anything touched by HCW while caring for that

patient

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From Ontario Just Clean Your Hands Program

The science behind Just clean your hands presentation

Patient Surroundings

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From

Council for Remote Area Nurses of Australia

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Moment 1Before Touching a Patient

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Moment 1When: Examples:

Touching a patient in any way Shaking hands, Assisting a patient to move, most Allied health interventions, Touching any invasive medical device connected to the patient (eg. IV pump, IDC)

Any personal care activities Bathing, Dressing, Brushing hair, Putting on personal eg. Glasses

Any non-invasive observations Taking a pulse, Blood pressure, Oxygen saturation, Temperature, Chest auscultation, Abdominal palpation, Applying ECG electrodes, CTG

Any non-invasive treatment Applying an oxygen mask or nasal cannula, Fitting slings/braces, Application of incontinence aids (including condom drainage)

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Moment 1When: Examples:

Preparation and administration of oral medications

Oral medications, Nebulised medications

Oral care and feeding Feeding a patient, Brushing teeth or dentures

Contacts with the patient’s surroundings before, during and after any of the above

Bedside table, Medical chart

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Education for Moment 1

When

• Hand Hygiene before touching a patient– Where possible Hand Hygiene should occur in front

of the patient so that they can observe it– Hand Hygiene on entering the patient’s room

Why

• To protect the patient against acquiring harmful germs from the hands of the HCW

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Rule for Auditing Moment 1

HH Moment 1 should be performed prior to touching the patient – Only record Moment 1 once the HCW

touches the patient

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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 2Before a Procedure

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Procedure

Is an act of care for a patient where there is a risk of direct introduction of a pathogen into the patient’s body.

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Moment 2When: Examples:

Insertion of a needle into a patient’s skin, or into an invasive medical device

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

Preparation and administration of any medications given via an invasive medical device, or preparation of a sterile field

IV medication, NGT feeds, PEG feeds, Baby feeds, Dressing trolley

Administration of medications where there is direct contact with mucous membranes

Eye drop installation, Suppository insertion, Vaginal pessary

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Moment 2When: Examples:

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

Procedures involving the following: ETT, Tracheostomy, Nasopharyngeal airways, Suctioning of airways, Urinary catheter, Colostomy/ileostomy, Vascular access systems, Invasive monitoring devices, Wound drains, PEG tube, NGT, Secretion aspiration

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

Wound dressings, Burns dressings, Surgical procedures, Digital rectal examination, Invasive obstetric and gynaecological examinations and procedures, Digital assessment of newborns palate

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Education for Moment 2

When • Hand Hygiene immediately prior to a procedure

– Once Hand Hygiene has been done, nothing else in the patient’s environment should be touched prior to the procedure starting

Why • To protect the patient from harmful germs

(including their own) from entering their body during a procedure

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Rule for Auditing Moment 2

HH Moment 2 must be performed immediately prior to any procedure

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Example:

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

• Moment 2 – prior to disconnecting the IV line

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Moment 3After a Procedure or Body Fluid

Exposure Risk

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Any situation where contact with body fluids may occur. Such contact may pose a contamination risk to either the HCW or the environment

Body Fluid Exposure Risk

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Actual or potential contact with:

• 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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Moment 3When: Examples:

After any Moment 2 See Moment 2

After any potential body fluid exposure Contact with a used urinary bottle / bedpan, Contact with sputum either directly or indirectly via a cup or tissue, Contact with used specimen jars / pathology samples, Cleaning dentures, Cleaning spills of body fluid from patient surroundings, After touching the outside of a drain

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Education for Moment 3

When

• Hand Hygiene immediately after a procedure or a body fluid exposure risk– As hands are likely to be contaminated with

body fluid

Why

• To protect yourself and the healthcare surroundings from harmful patient germs

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Rule for Auditing Moment 3

• HH Moment 3 must be performed immediately after a procedure or body fluid exposure risk

• Touching the outside of a drain or drainage bag even when the circuit is not broken, is considered a Moment 3 since there is a risk of body fluid exposure

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Rule for Auditing Moment 3

• Moment 3 will usually be paired with a Moment 2 except that:– Moment 3 may be recorded as a stand alone HH

Moment when there is a body fluid exposure risk, but the HCW has not touched the patient

• Cleaning up a spill of vomit, urine or faeces• Moving pathology specimens• Moving items contaminated with body fluids

– Sputum cup, urinal bottle, incontinence pad / nappy

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Example:

HCW replaces an empty IV fluid bag with 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 4After Touching a Patient

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Education for Moment 4

When

• Hand Hygiene after touching a patient– This completes the education of Hand

Hygiene before you enter the patient room, and before you leave the patient room

Why

• To protect yourself and the healthcare surroundings from harmful patient germs

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Rules for Auditing Moment 4

• HH Moment 4 should be performed after touching the patient

• Moment 4 will usually be proceeded by a Moment 1

• Touching the patient surroundings after touching the patient is recorded as a single Moment 4.

• If after a Moment 3 there is touching of the patient surroundings, this is recorded as a Moment 4

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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

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Moment 5After touching a patient’s immediate

surroundings when the patient has not been touched

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Moment 5When: Examples:

After touching the patient’s immediate surroundings when the patient has not been touched

Patient surroundings include: Bed, Bedrails, Linen, Table, Bedside chart, Bedside locker, Call bell/TV remote control, Light switches, Personal belongings, Chair, Foot stool, Monkey bar

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Education for Moment 5

When

• Hand hygiene after touching the patient’s surroundings

Why

• To protect yourself and the healthcare surroundings from harmful patient germs

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Rule for Auditing Moment 5

• HH Moment 5 is performed when there has been no touching of the patient but there has been touching of the patient’s immediate surroundings

• When multiple items in the patient surroundings are touched, only one Moment 5 is recorded

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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 have been recorded as:

• Moment 1 and Moment 4

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Note 1

• Generally for every “before” Moment there should be an “after” Moment recorded

– Moment 1 can either be followed by a Moment 4 or a Moment 3

– Moment 2 is generally followed by Moment 3

– Moment 5 is a stand alone Moment as there is no patient contact

• There are a few situations when two “afters” may be recorded sequentially

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Example:

HCW walks in, picks up drain bottle to view it, puts it down,

writes on the medical chart, then leaves

• Moment 1 – prior to touching the drain (patient)

• Moment 3 – after drain (body fluid exposure risk)

• Moment 4 – after chart (continuum of patient care)

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Note 2

• For every procedure there should be a Moment 2 and Moment 3 recorded

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Example:

HCW checks blood glucose level of patient

• Moment 2 – Immediately prior to pricking finger with lancet

• Moment 3 – Immediately after disposing of sample strip & used lancet, prior to touching anything else

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Note 3

• The HCW must be observed to perform HH as they approach the patient.

• If HH is not observed it should be recorded as a “missed” action (i.e. HH not performed).

• In such circumstances the HCW can be asked

(at the conclusion of the sequence of care)

if they performed HH immediately prior to entering the room

• If they did then the Moment should be scored as HH performed

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Example:

HCW walks in andtouches the patient on the shoulder without

being observed to perform hand hygiene

• Moment 1 – before touching the patient

• HH action missed

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Note 4

• No “before” Moment can be recorded if auditing commences after a HCW is already touching a patient, or in the process of performing a procedure.

• No “after” Moment can be recorded unless the Moment is observed.

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Example:

Observation commences whilst HCW is emptying IDC drainage bag. The HCW then leaves the room to dispose of the urine in

panroom

• No Moment can be recorded as the start of the procedure and the end of the procedure/body fluid exposure risk have not been observed.

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Note 5

• Patient bed curtains are outside the patient zone and are frequently contaminated

• Touching the curtains is considered to be leaving the patient zone

• HH should be performed between touching the curtains and touching the patient

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Example:

HCW walks into patient room opens the curtains up, then walks out

• No Moment - as the curtain is outside the patient zone

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“Bonus” Moments

• The Aussie 5 Moments audit tool rewards staff who clean their hands at the most important timesEg1. Moving between patientsOne HH is recorded as two Moments – M4 and M1

Eg2. Moving from touching a patient to doing a procedureOne HH is recorded as two Moments – M4 and M2 and vice versa M3 and M1

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M1 – Before touching a patient

M4 M2 M3 M1 M4 M1

“Bonus” Moments

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More examples

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HCW walks in, silences IV alarm that is connected to the patient,

then leaves

• Moment 1 – prior to touching the “patient”• Moment 4 – after touching the “patient”

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HCW walks in, picks up IDC to read it,

puts it down, then leaves

• Moment 1 – pre IDC as IDC is considered to be a part of the patient

• Moment 3 – after IDC (potential body fluid risk)

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HCW walks into the room, picks up the IDC to read it,

puts it down, writes on the medical chart, then leaves

• Moment 1 – pre IDC as the IDC is considered to be a part of the patient

• Moment 3 – after IDC (potential body fluid risk)• Moment 4 – after chart – after continuum of

patient care

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HCW changes IV fluid bag that is connected to the patient, then leaves

• Moment 2 – prior to disconnecting IV• Moment 3 – after reconnecting IV

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HCW prepares oral medications with medications sitting on the patient’s medical

chart, signs the chart whilst giving the medications, then moves the curtain aside

• 1 – pre-giving the medications to the patient• 4 – prior to moving the curtain

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HCW walks in, shakes the patient’s hand,

does hand hygiene, picks up the chart to read it,

then leaves

• Moment 1 – prior to touching patient

• Moment 4 – on leaving (after chart – after continuum of patient care)

• The hand hygiene that was done in the scenario was not required at that time

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HCW walks into the room opens the patient’s curtains, then leaves the room

• Nil as the curtains are external to the patient’s surroundings and are not a Moment

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HCW walks into patient room, helps the patient out of bed,

moves the curtain back, then helps the patient to walk out of the room

• Moment 1 – pre patient

• Moment 4 – after patient pre curtain

• Moment 1 – after curtain pre patient

• No Moment 4 is recorded as HCW has not left the patient

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HCW walks in, cleans up urine from the floor,

then leaves

• Moment 3 – after clean up due to the body fluid exposure risk

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HCW assists a patient back to bed, then assists another patient to stand up,

then leaves

• Moment 1 – before touching first patient

• Moment 4 – after touching first patient

• Moment 1 – prior to touching second patient

• Moment 4 – after touching second patient

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HCW picks up the medication chart and walks out of the room with it

• Nil as the Moment has not finished

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HCW walks in, moves the overbed table,

does Hand Hygiene, helps the patient out of bed,

does hand hygiene, then leaves

• Moment 1 – prior to touching the patient

• Moment 4 – after touching the patient

• Hand hygiene was done correctly

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HCW walks in, does Hand Hygiene,

moves the overbed table, helps the patient out of bed,

does hand hygiene, then leaves

• Moment 1 – prior to touching the patient

• Moment 4 – after touching the patient

• Hand hygiene was done correctly

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Food services worker walks in with food trolley, places tray on patient’s table then walks back to trolley and leaves the room

• Nil as Food services worker has not touched the patient’s surroundings

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Food services worker walks in with food trolley, moves patient’s belongings off the

overbed table, goes back to trolley to get food tray, places tray on patient’s table then walks

back to trolley and leaves the room

• Moment 5 – after touching patient’s surroundings (before getting food tray out of trolley)

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HCW walks in, helps the patient to adjust

position in bed, empties IDC,

takes urinal to pan room, then leaves

• Moment 1 – prior to touching the patient

• Moment 4 – after touching the patient

• Moment 2 – prior to opening the IDC

• Moment 3 – after disposing of body fluid

M1 – Before touching a patient

M4 M2 M3 M1 M4 M1