WHO Guidelines promote the concept of five moments for hand hygiene in healthcare institutions. The concept is based on five principal moments of hand hygiene as standard precaution, that has to be done in every patient and every circumstance. The concept is simple to understand and simple to teach.

These five moments are:

  1. before touching a patient
  2. before clean/aseptic procedure
  3. after body fluid exposure risk
  4. after touching a patient
  5. after touching patient surroundings

What about at least saying there are some issues somewhere and or refer to the community approach they have now published where it is a little modified?

The Government of Ontario, Canada, has combined patient and environment contact, so they have four moments:

  1. before initial patient/patient environment contact
  2. before aseptic procedure
  3. after body fluid exposure risk
  4. after patient/patient environment contact

In simple situations, all standard precautions hand hygiene indications (see above) can be put into these five moments. The most important addition certainly is to perform hand hygiene before and after using gloves. In some more complex situations, especially if there is a staff shortage, it is necessary to use medical (common sense) judging and perform hand hygiene based on actual risk assessment.

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Link to IC/HH Core competencies: 

Area 4 Infection control activities: Domain Elaborating infection control intervention ICA 1-2

References:

1. WHO Guidelines on Hand Hygiene in Health Care. World Health Organization 2009 WHO/IER/PSP/2009.07 http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf

2. Best Practices for Hand Hygiene in All Health Care Settings http://www.publichealthontario.ca/en/eRepository/2010-12%20BP%20Hand%20Hygiene.pdf

3. Government of Ontario. Four moments of hand hygiene adapted from WHO poster.
http://www.handhygiene.ca/English/Documents/Tools%20and%20Templates/Your%204%20Moments%20for%20Hand%20Hygiene%20(Poster).pdf