Hand hygiene involves cleaning the hands to remove or kill microorganisms, preventing the spread of infectious agents within any healthcare environment. The World Health Organization (WHO) developed the “Five Moments for Hand Hygiene” framework to standardize infection control. This model guides healthcare professionals on the precise timing for hand cleaning to interrupt the transmission of pathogens during patient care.
Why the Five Moments are Essential
The framework minimizes the movement of germs between the healthcare worker, the patient, and the environment. Microorganisms easily transfer from surfaces or patients onto a healthcare worker’s hands. Hand hygiene at the correct times breaks this cycle of germ transmission.
Adherence to this protocol directly reduces the incidence of Healthcare-Associated Infections (HAIs), which affect millions of patients worldwide. HAIs increase morbidity, mortality, and the overall burden on healthcare systems. The Five Moments ensure that hand cleaning occurs exactly when contamination or transmission is most likely, safeguarding the patient and protecting the healthcare worker.
The Specific Five Moments
The WHO framework identifies five specific moments when hand hygiene must be performed:
- Before Patient Contact: Requires hand cleaning when approaching a patient. This protects the patient from any harmful germs the healthcare worker may be carrying. Examples include before taking a pulse or assisting with mobility.
- Before a Clean or Aseptic Procedure: Occurs before procedures such as inserting an intravenous line or dressing a wound. This protects the patient from germs that could enter their body during an invasive procedure. Hand hygiene must be performed immediately before the procedure.
- After Body Fluid Exposure Risk: Hands must be cleaned immediately following potential or actual contact with bodily fluids. This includes instances like emptying a catheter bag or handling blood samples, and primarily protects the healthcare worker and the general healthcare environment.
- After Patient Contact: Should happen after touching the patient or their immediate surroundings upon leaving the patient’s side. Performing hand hygiene at this time protects the healthcare worker and the environment from the patient’s microorganisms.
- After Contact with Patient Surroundings: Required even if the patient was not touched. Pathogens can persist on surfaces like bed rails, monitors, or charts, making indirect contact a risk for cross-contamination.
Proper Hand Hygiene Technique
Alcohol-Based Hand Rubs
The practical execution of hand hygiene involves selecting the correct product and following a specific procedure. Alcohol-based hand rubs are generally the preferred method for routine hand antisepsis if the hands are not visibly soiled. When using an alcohol rub, the hands should be covered completely with the product and rubbed for a duration of 20 to 30 seconds until completely dry.
Soap and Water Washing
Washing hands with soap and water is necessary when hands are visibly dirty, soiled with body fluids, or after using the toilet. It is also the preferred method if exposure to spore-forming pathogens, such as Clostridium difficile, is suspected or proven. The recommended duration for thorough handwashing with soap and water is longer, typically 40 to 60 seconds.
Technique and Skin Care
The technique for both methods requires covering all surfaces of the hands, including rubbing the palms together, interlacing the fingers, and cleaning the backs of the hands and under the fingernails. Using a single-use towel to dry hands completely after washing is also important, as wet hands are more easily recontaminated. Healthcare workers are also encouraged to use moisturizing lotions to prevent skin damage, as dry skin can increase the risk of infection transmission.