In 2005, WHO launched the First Global Patient Safety Challenge as part of its World Alliance for Patient Safety Initiative, of which one challenge was for participants to develop campaigns specifically to promote and improve both practice and compliance with hand hygiene amongst healthcare workers (Allegranzi et al., 2007).
In September 2004, the National Patient Safety Agency (NPSA) had issued a Patient Safety Alert announcing the phased rollout of the Cleanyourhands campaign during 2004–2005 (National Patient Safety Agency, 2004). The aim of the campaign was to minimise the risk to patient safety posed by poor hand hygiene, and it was implemented in all Acute and Primary Care, Ambulance and Mental Health NHS Trusts in England and Wales, and launched in Ireland in 2008. Scotland’s hand hygiene campaign, ‘Germs. Wash your hands of them’, was successfully launched in 2007.
Fact Box 12.5 Alcohol hand rubs or gels
While they are active immediately against a wide range of organisms and are approximately 100 times more effective against viruses than any other form of hand-washing product (Rotter, 1999), there are some disadvantages to alcohol hand rubs or gels. They are not cleansing agents, they do not work in the presence of organic material such as dirt or blood and they are ineffective against C. difficile spores (see Chapter 22), so hand washing with liquid soap and water is absolutely essential in these situations.
Box 12.1 Advantages and disadvantages of hand washing (soap and water)
Advantages of soap and water
•
Cheap and readily available•
Effectively removes transient microorganisms.Disadvantages of soap and water
•
Requires facilities for washing and drying•
Requires space and plumbing•
Requires time•
Can damage the skin.Source: Pratt et al., 2001; CDC, 2002; Pratt et al., 2007; NPSA, 2008; WHO, 2009a
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The aim of the campaign overall was to increase hand hygiene compliance amongst healthcare professionals through a national strategy of improvement. This involved the placement of alcohol hand rubs or gels at the patient’s bedside, the use of posters and other promotional material to inform and influence healthcare staff and patients (see Figures 12.1 and 12.2), and the involvement of patients and the public, encouraging them to ask healthcare workers if they had cleaned their hands.
My 5 Moments for Hand Hygiene
Box 12.2 Advantages and disadvantages of alcohol hand rubs or gels
Advantages of alcohol hand rubs or gels
•
Requires no additional facilities•
Useful for community-based healthcare workers where access to hand-washing facilities may be lacking•
Active immediately against a wide range of microorganisms•
More effective in destroying transient microorganisms•
Kinder to the skin due to added emollients•
Useful for rapid bedside or point-of-care hand decontamination between patients•
Can be used for surgical hand decontamination.Disadvantages of alcohol hand rubs or gels
•
Not a cleansing agent – not effective in the presence of dirt, blood or body fluids•
Ineffective against bacterial spores•
Astringent – makes the skin sting if it comes into contact with skin breaks or minor abrasions•
Can be highly irritant if exposure to the eyes occurs•
Can be harmful if accidentally or deliberately ingested•
Flammable – restrictions on storage.Source: Pratt et al., 2001; CDC, 2002; Pratt et al., 2007; NPSA, 2008; WHO, 2009a.
Fact Box 12.6 The placement of alcohol hand rub or gel dispensers
Soon after the launch of the Cleanyourhands campaign, in addition to being placed at the bedside, hand rubs and gels started appearing at hospital entrances, in ward corridors and in areas where their use could not be adequately supervised. Slips, trips and falls as a result of product spillage, accidental and/or deliberate ingestion, and incidences whereby hand rub or gel had been splashed into the eyes prompted the NPSA to issue a second Patient Safety Alert, re-directing the attention of healthcare staff and the public to hand hygiene at the point of care and requiring hospitals and other organisations to undertake audits and risk assessments in relation to product placement. It was apparent that although the profile of hand hygiene had been raised, it still was not being undertaken at the most appropriate opportunity, and attention had to be focused on improving compliance with hand hygiene at the point of care, leading to the national adoption of the 5 Moments approach.
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Figure 12.1 ‘5 Moments for Hand Hygiene’ poster (bed) (WHO, 2009).
Your 5 Moments
for Hand Hygiene
May 2009
1 2 3 4 5
WHEN? Clean your hands before touching a patient when approaching him/her.
WHY? To protect the patient against harmful germs carried on your hands.
WHEN? Clean your hands immediately before performing a clean/aseptic procedure.
WHY? To protect the patient against harmful germs, including the patient’s own, from entering his/her body.
WHEN? Clean your hands immediately after an exposure risk to body fluids (and after glove removal).
WHY? To protect yourself and the health-care environment from harmful patient germs.
WHEN? Clean your hands after touching a patient and her/his immediate surroundings, when leaving the patient’s side.
WHY? To protect yourself and the health-care environment from harmful patient germs.
WHEN? Clean your hands after touching any object or furniture in the patient’s immediate surroundings, when leaving – even if the patient has not been touched.
WHY? To protect yourself and the health-care environment from harmful patient germs.
BEFORE TOUCHING A PATIENT BEFORE CLEAN/
ASEPTIC PROCEDURE AFTER BODY FLUID EXPOSURE RISK AFTER TOUCHING A PATIENT AFTER TOUCHING PATIENT SURROUNDINGS
1 2
3
BEFORE TOUCHING
A PATIENT
4
AFTERTOUCHINGA PATIENT5
AFTERTOUCHING PATIENT SURROUNDINGS BEFORECLEAN/ASEPTIC PROCEDURE
RISKFLUID EXPOSURE AFTER BODY
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material.
Figure 12.2 ‘5 Moments for Hand Hygiene’ poster (chair). (WHO, 2009)
WHEN? Clean your hands before touching a patient when approaching him/her.
WHY? To protect the patient against harmful germs carried on your hands.
WHEN? Clean your hands immediately before performing a clean/aseptic procedure.
WHY? To protect the patient against harmful germs, including the patient’s own, from entering his/her body.
WHEN? Clean your hands immediately after an exposure risk to body fluids (and after glove removal).
WHY? To protect yourself and the health-care environment from harmful patient germs.
WHEN? Clean your hands after touching a patient and her/his immediate surroundings, when leaving the patient’s side.
WHY? To protect yourself and the health-care environment from harmful patient germs.
WHEN? Clean your hands after touching any object or furniture in the patient’s immediate surroundings, when leaving – even if the patient has not been touched.
WHY? To protect yourself and the health-care environment from harmful patient germs.
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The 5 Moments for Hand Hygiene approach to hand hygiene, which was developed as part of the Swiss National Hand Hygiene Campaign and integrated into WHO’s Multimodal Hand Hygiene Strategy, recognises three important factors that significantly increase the risk of cross-infection within the healthcare environment (Sax et al., 2007):
•
Colonised or infected patients are the main reservoir for many of the microorganisms that are responsible for HCAIs.•
Transmission of infection from the environment can occur because of the variety of microorganisms that can be found there (environmental microorganisms and those shed from patients).•
The immediate patient environment (known in the 5 Moments as the patient zone) will be heavily contaminated with microorganisms from the patient.The patient’s environment is separated into two distinct geographical zones: the patient zone and the healthcare zone.