Transcript Hand Hygiene Auditing - Hand Hygiene Australia

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:
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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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Patient Surroundings
From Ontario Just Clean Your Hands Program
The science behind Just clean your hands presentation
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From
Council for Remote Area Nurses of Australia
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Moment 1
Before Touching a Patient
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Moment 1
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)
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Moment 1
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
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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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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
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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 of
a pathogen into the patient’s body.
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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
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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 nonintact 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 3
After a Procedure or Body Fluid
Exposure Risk
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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
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Actual or potential contact
with:
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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 3
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
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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
•
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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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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 5
After touching a patient’s immediate
surroundings
when the patient has not been touched
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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
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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
www.hha.org.au
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
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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
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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 and
touches 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 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
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“Bonus” Moments
M1
M4
M2
M3
M1
M4
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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
•
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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
•
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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
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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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M1
M4
•
•
•
•
– Before touching a patient
M2
M3
M1
HCW walks in,
helps the patient to adjust
position in bed,
empties IDC,
takes urinal to pan room,
then leaves
M4
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
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