5 Moments for Hand Hygiene

Transcription

1 5 Moments for Hand Hygiene

2

3 Moment 1 Before Touching a Patient

4 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?

5 Patient Zone Patient + patient s immediate surroundings

6 From Ontario Just Clean Your Hands Program The science behind Just clean your hands presentation

7 Moment 1 WHEN: EXAMPLES: Touching a patient in any way Any personal care activities Any non-invasive observations Any non-invasive treatment Shaking hands, assisting a patient to move, Allied health interventions Bathing, Dressing, Brushing hair, Putting on personal aids such as glasses Taking a pulse, blood pressure, oxygen saturation, temperature, Chest auscultation, Abdominal palpation, Applying ECG electrodes, CTG Applying an oxygen mask or nasal cannula, Fitting slings/braces, application of incontinence aids (including condom drainage)

8 Moment 1 WHEN: EXAMPLES: Preparation and administration of oral medications Oral care and feeding Contacts with a patient s surroundings before, during & after any of the above Oral medications, nebulised medications Feeding a patient, Brushing teeth or dentures, Bedside table, medical chart

9 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

10 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

11 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

12 Moment 2 Before a Procedure

13 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.

14 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 Administration of medications where there is direct contact with mucous membranes IV medication, NGT feeds, PEG feeds, Baby formula Eye drop instillation, Suppository insertion, Vaginal pessary

15 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 tubes, 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 examination of a newborn s palate

16 Education for Moment 2 When Hand Hygiene immediately prior to a procedure Why Once Hand Hygiene has been done, nothing else in the patient s environment should be touched prior to the procedure starting To protect the patient from harmful germs (including their own) from entering their body during a procedure

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

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

19 Moment 3 After a Procedure or Body Fluid Exposure Risk

20 Procedure As described for Moment 2 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

21 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

22 Moment 3 WHEN: EXAMPLES: After any moment 2 See Moment 2 After any potential body fluid exposure Contact with a used urinary bottle / bedpan, with sputum either directly or indirectly via a cup or tissue, contact with used specimen jars / pathology samples, cleaning dentures, cleaning spills of urine, faeces or vomit from patient surroundings

23 Education for Moment 3 When 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

24 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 (e.g. urinary catheter, wound drain, chest tube drain, CSF drain), even when the circuit is not broken, is considered a Moment 3 since there is a risk of body fluid exposure

25 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 - e.g. cleaning a spill of vomit, urine or faeces

26 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

27 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)

28 Moment 4 After Touching a Patient

29 Education for Moment 4 When 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

30 Rules for Auditing Moment 4 HH Moment 4 should be performed after touching the patient Moment 4 will usually be paired with 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 patient surroundings, this is recorded as a Moment 4

31 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

32 Moment 5 After touching a patient s immediate surroundings when the patient has not been touched

33 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

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 (including books, Mobility aids), 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, Unless the auditor does not witness the action Moment 1 is equally paired with Moment 3 or Moment 4 Moment 2 is generally paired with Moment 3 Moment 5 is not paired with other Moments There are only 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 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. 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 M1 M4 M2 M3 M1 M4

50 M1 M4 M2 M3 M1 M4

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52 More examples

53 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)

54 HCW walks into patient room, adjusts the patient s sheets, picks up IDC to read it, brushes the patient s hair, then leaves the room Moment 1 pre patient Moment 3 after touching IDC (body fluid exposure risk) Moment 1 pre patient Moment 4 after patient

55 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

56 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 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

58 HCW walks into patient room, checks the patient s BP, moves curtain aside, moves the over bed table closer to the patient, then leaves Moment 1 pre patient Moment 4 after patient pre-curtain (by touching the curtain the HCW has left the patient zone) Moment 5 after touching the patient surroundings (it s a new moment as the HCW re-entered room)

59 HCW picks up the medication chart, gets the medications out of the patient drawer, prepares medication, gives medication via NGT, signs the medication chart, then leaves Moment 2 immediately prior to preparing medications Moment 3 after giving medications Moment 4 after chart after continuum of patient care

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

61 HCW walks in, cleans up vomit from the floor, moves patient chair out of the way, then leaves Moment 3 after clean up due to the body fluid exposure risk Moment 5 after touching the patient surroundings

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

63 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

64 M1 M4 M2 M3 M1 M4 HCW walks in, helps the patient to adjust position in bed, empties IDC, takes urinal to pan room, then leaves Before touching a patient 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

65 HCW walks in, picks up IDC to read, puts it back, picks up NGT drainage bag to review, puts it back, picks up wound drain to review, puts it back, then leaves 1 prior to touching the patient (IDC) 3 after body fluid exposure risk (IDC) 1 prior to touching the patient (NGT drainage bag) 3 after body fluid exposure risk (NGT drainage bag) 1 prior to touching the patient (wound drain) 3 after body fluid exposure risk (wound drain)

66 HHA WHO 5 Moments for Hand Hygiene DVD