5 Moments For Hand Hygiene

NHHI

The 5 Moments for Hand Hygiene approach was designed by the World Health Organization to minimise the risk of transmission of microorganisms between a healthcare worker, the patient, and the environment.

The 5 Moments

Click on a Moment to view a list of related activities and video examples

5 moments

Moment 1 Moment 4 Moment 5 Moment 2 Moment 3

'Based on the 'My 5 moments for Hand Hygiene' © World Health Organization 2009. All rights reserved.'

Moment 1 - before touching a patient

When

Perform hand hygiene on entering the patient's zone before touching the patient.

Why?

To protect the patient against acquiring harmful germs from the hands of the HCW.

In detail

Touching a patient in any way Shaking hands, assisting a patient to move, allied health interventions, touching any medical device connected to the patient 
(for example, intravenous line pump, urinary catheter)
Any personal care activities Bathing, dressing, brushing hair, putting on personal aids such as glasses
Any non-invasive observations Taking a pulse, blood pressure, oxygen saturation, temperature, chest auscultation, abdominal palpation, applying ECG electrodes, cardiotocography 
Any non-invasive treatment Applying an oxygen mask or nasal cannula, fitting slings/braces, application of incontinence aids (including condom drainage)
Preparation and administration of oral medications Oral medications, nebulised medications
Oral care and feeding Feeding a patient, brushing teeth or dentures

Moment 2 - before a procedure

When

Immediately before a procedure. Once hand hygiene has been performed, nothing else in the patient's environment should be touched prior to the procedure starting.

Why?

To protect the patient from potential pathogens (including their own) from entering their body during a procedure.

In detail

Insertion of a needle into a patient’s skin, or into an invasive medical device Venepuncture, blood glucose level, arterial blood gas, subcutaneous or Intramuscular injections, intravenous line flush
Preparation and administration of any medications given via an invasive medical device, preparation of a sterile field Intravenous medication, nasogastric tube (NGT) feeds, percutaneous endoscopic gastrostomy (PEG) feeds, dressing trolley set up
Administration of medications where there is direct contact with mucous membranes Eye drop instillation, suppository insertion, vaginal pessary
Insertion of, or disruption to, the circuit of an invasive medical device Procedures involving the following: endotracheal tube, 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 assessment of newborn palate

Moment 3 - after a procedure or body fluid exposure risk

When

Hand hygiene immediately after a procedure or body fluid exposure risk as hands could be contaminated with body fluid.

Even if you have had gloves on you should still perform hand hygiene after removing them as gloves are not always a complete impermeable barrier. Hands may also have been contaminated in the process of removing the gloves.

Why?

To protect yourself and the healthcare surroundings from becoming contaminated with potential pathogens.

In detail

After 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 urine, faeces or vomit from patient surroundings, after touching the outside of a drain

Contact with any of the following: blood, saliva, mucous, semen, tears, wax, breast milk, colostrum, urine, faeces, vomitus, pleural fluid, cerebrospinal fluid, ascites fluid, organic body samples (for example, biopsy samples, cell samples, lochia, meconium, pus, bone marrow, bile).

Moment 4 - after touching a patient

When

Hand hygiene after touching a patient. Perform hand hygiene before you leave the patient zone.

Why

To protect yourself and the healthcare surroundings from becoming contaminated with potential pathogens.

Moment 5 - after touching a patient's surroundings

When

Hand hygiene after touching a patient's surroundings even when the patient has not been touched.

Always hand hygiene before leaving the room.

Why?

To protect yourself and the healthcare surroundings from becoming contaminated with microorganisms.

In detail

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