1. 5 Moments for Hand Hygiene

3. 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?

4. 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

5. Patient Surroundings From Ontario Just Clean Your Hands Program
The science behind Just clean your hands presentation

6. From
Council for Remote Area Nurses of Australia

7. Moment 1 Before Touching a Patient

8. Moment 1 Touching a patient in any way
When:
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)

9. Moment 1 Preparation and administration of oral medications
When:
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

10. Education for Moment 1 Hand Hygiene before touching a patient
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

11. 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

12. Example:
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

13. Moment 2 Before a Procedure

14. 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.

15. Moment 2
When:
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

16. Moment 2
When:
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

17. Education for Moment 2 Hand Hygiene immediately prior to a procedure
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

18. Rule for Auditing Moment 2
HH Moment 2 must be performed immediately prior to any procedure

19. Example: HCW replaces an empty IV fluid bag with a new IV fluid bag
Moment 2 – prior to disconnecting the IV line

20. Moment 3 After a Procedure or Body Fluid Exposure Risk

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

22. 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

23. Moment 3 After any Moment 2 See Moment 2
When:
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

24. 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

25. 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

26. 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

27. 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

28. 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)

29. Moment 4 After Touching a Patient

30. Education for Moment 4 Hand Hygiene after touching a patient
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

31. 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

32. 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

33. Moment 5 After touching a patient’s immediate surroundings when the patient has not been touched

34. Moment 5
When:
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

35. 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

36. 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

37. 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

38. 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

39. 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)

40. Note 2
For every procedure there should be a Moment 2 and Moment 3 recorded

41. 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

42. 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

43. Moment 1 – before touching the patient HH action missed
Example: HCW walks in and touches the patient on the shoulder without being observed to perform hand hygiene
Moment 1 – before touching the patient
HH action missed

44. 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.

45. Example: Observation commences whilst HCW is emptying IDC drainage bag
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.

46. 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

47. Example: HCW walks into patient room opens the curtains up, then walks out
No Moment - as the curtain is outside the patient zone

48. “Bonus” Moments
The Aussie 5 Moments audit tool rewards staff who clean their hands at the most important times
Eg1. Moving between patients
One HH is recorded as two Moments – M4 and M1
Eg2. Moving from touching a patient to doing a procedure
One HH is recorded as two Moments – M4 and M2 and vice versa M3 and M1

49. “Bonus” Moments

50. More examples

51. 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”

52. 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)

53. 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

54. HCW changes IV fluid bag that is connected to the patient, then leaves
Moment 2 – prior to disconnecting IV
Moment 3 – after reconnecting IV

55. 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

56. Moment 1 – prior to touching patient
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

57. 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

58. Moment 4 – after patient pre curtain
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

59. HCW walks in, cleans up urine from the floor, then leaves
Moment 3 – after clean up due to the body fluid exposure risk

60. Moment 1 – before touching first patient
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

61. HCW picks up the medication chart and walks out of the room with it
Nil as the Moment has not finished

62. Moment 1 – prior to touching the patient
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

63. Moment 1 – prior to touching the patient
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

64. 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

65. 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)

66. Moment 1 – prior to touching the patient
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