1. Your Five Moments explained Hospital non ward based care WHO Five Moments approach to hand hygiene April 2009

2. What are the Five Moments?  An approach to hand hygiene developed by The World Health Organisation  Aims to ensure hand hygiene is geographically appropriate  Aims to ensure hand hygiene is temporally appropriate

3. Why was the Five moments approach developed?  To reduce unnecessary hand hygiene  To stress the importance of the correct location and time for hand hygiene  To ensure the chain of transmission is broken by hand hygiene and thus prevent HCAI

4. What is a Moment for hand hygiene?  A moment is a temporal point, i.e. a specific time marked by a point in staff workflow  A moment is not a reason, or indicator, for hand hygiene  Each moment is a time when many indicators for hand hygiene can occur

5. Your 5 moments for hand hygiene Based on WHO poster ‘Your 5 moments for hand hygiene’ and reproduced with their kind permission

7. What is an indicator for hand hygiene?  An indicator for hand hygiene is an individual action carried out by a staff member  This can be any action that can be considered as belonging to one of the Five Moments  This specifically applies to actions which take place within a patient zone  Actions which do not take place within a patient zone are in the healthcare zone

8. Patient zone  This is an area in the immediate vicinity of the patient where care is provided  The patient zone is an important concept in transmission dynamics  It is an area which is likely to be heavily colonised with the flora of a specific patient  It can be difficult to describe in certain care settings and may be mobile in others

10. When do patient zones exist?  Only when a patient is assigned to an area  Only when that area is used for care provision  Once dedicated to a patient the patient zone exists even when the patient is not there  The patient zone ceases to exist when the area is clean and vacant between patients  It includes objects and furniture allocated, even temporarily, to the zone

11. The boundary The boundary between the patient zone and the healthcare zone is key This must be decided locally It may or may not be a physical boundary The boundary must be decided and agreed for the Five Moments approach to work

12. WHEN? Clean your hands when approaching a patient at the point of care WHY? To protect the patient from harmful germs carried on your hands

13.  Occurs before first contact with a patient  Occurs regardless of glove use  Occurs within the patient zone  May occur in combination with another moment Moment one

14. WHEN? Clean your hands immediately before any clean/aseptic procedure WHY? To protect the patient from harmful germs from the environment, and themselves, being introduced invasively

15.  Important to stop introduction of environmental pathogens to the patient  Also stops invasive introduction of the patient own flora  May be combined with moment one, but ONLY if the first patient contact is a clean/aseptic procedure Moment two

16. WHEN? Clean your hands immediately after an exposure risk to body fluids, including after glove removal WHY? To protect yourself and the healthcare environment against harmful germs from the patient and patient zone

17.  The rationale for moment three is to prevent contamination of staff and the area outside the patient zone, i.e. the healthcare zone, with germs carried in patients body fluids  It is important to realise that even if gloves have been worn during a task this constitutes an exposure risk, once gloves have been removed the hands cannot be considered clean until moment 3 has been complied with Moment three

18. WHEN? Clean your hands after touching a patient when leaving the point of care WHY? To protect yourself and the healthcare environment against harmful germs from the patient

19.  The aim here is to prevent patient germs crossing the boundary between the patient zone and the healthcare zone Moment four

20. WHEN? Clean your hands after touching any object or furniture in the patient zone, even if the patient is not present or has not been touched WHY? To protect yourself and the healthcare environment against harmful germs from the patient zone

21. Equipment  Once in use at the point of care a piece of equipment should be considered part of the patient zone  This is due to the fact that the equipment will become colonised with the flora of the patient and may remain colonised until decontaminated  Ftika 2008

22. Summary There are some key definitions within the Five Moments approach  Moments  Indicators  Patient zone  Healthcare zone  Compliance These are illustrated and explained in the DVD My Five Moments for hand hygiene and supporting presentations

23. Reference and support  For references see the resource pack reference list  For support contact the cleanyourhands campaign coordinator in your organisation  For more information see the cleanyourhands campaign website at www.npsa.nhs.uk/cleanyourhands www.npsa.nhs.uk/cleanyourhands