ReviewThe ‘My five moments for hand hygiene’ concept for the overcrowded setting in resource-limited healthcare systems
Introduction
The World Health Organization (WHO) ‘My five moments for hand hygiene’ was developed with a goal to standardize hand hygiene in clinical practice and reduce the burden of healthcare-associated infections (HCAIs).1, 2 This clinician-centred concept delineates indications for hand hygiene by healthcare workers (HCWs) according to the risk for micro-organism cross-transmission to patients and their environment, and provides a resource for educators and auditors assessing performance.1, 3, 4, 5, 6, 7, 8, 9, 10, 11 Hand hygiene is critical for HCAI prevention and the availability of alcohol-based hand rub (ABHR) at the point of care has been pivotal to compliance with ‘My five moments’ during clinical practice.2, 5, 6, 7, 12, 13, 14, 15, 16, 17, 18, 19 An important focus of the ‘My five moments’ concept is the visualization of the individual patient zone, which defines hand hygiene indications.17, 19
In resource-limited healthcare settings, overcrowding in general wards means that it is common for patients to share a bed; furthermore, there is usually limited or no space between beds. As a consequence, HCWs might have difficulties in identifying the patient zones and the healthcare zone and in recognizing the ‘My five moments for hand hygiene’ indications. This report discusses the practical application of the ‘My five moments for hand hygiene’ in overcrowded settings in accordance with the corresponding guidance by WHO to assist hand hygiene performance and monitoring.20
Section snippets
The ‘Five moments’ concept revisited
The central tenet of ‘My five moments for hand hygiene’ is the separation of micro-organism from one patient zone to the next zone and from critical sites where contamination could lead to infection.17 Continuous contact with patients, surfaces, devices, medical documents and waste results in a large number of daily opportunities for HCWs' hands to become colonized with potential pathogens.18, 21, 22 In the absence of correct hand hygiene, hand contamination has the potential for
The challenge for the zone concept in overcrowded hospital settings
During the trialling of ‘My five moments for hand hygiene’ in an overcrowded setting, we identified a unique challenge for hand hygiene trainers, the HCW, and hand hygiene monitors. Identifying the delineation between patient zones was difficult. Distinct variations in the patient zone exist in the overcrowded settings because of bed sharing; it is common to have patients with varying medical conditions or infectious status sharing a single bed. Bed configurations may include a bed platform
Infectious risk explained for shared patient zones
To understand the application of the ‘My five moments for hand hygiene’ concept to the overcrowded setting, it is useful to review the risk of hand transmission of pathogens. In the case of hand transmission of infectious agents, two negative events should be distinguished: cross-transmission of nosocomial pathogens between patients and HCAI. The ‘My five moments for hand hygiene’ concept addresses both negative events.
Cross-transmission of pathogens between patients and within the healthcare
The ‘Five moments for hand hygiene’ in shared patient zones
The adaptation of the ‘My five moments for hand hygiene’ follows the description provided in the ‘WHO guidelines for hand hygiene in healthcare’ main document under the title ‘Two patients within the same patient zone’.30 This allows for two or more close patients being viewed as occupying a single patient zone. As in the case of ‘true’ single-patient zones, it is crucial to define patient zones wisely to avoid spread of pathogens. The necessary adaptations are listed in detail in Box 1.
Two patient care stories in an overcrowded hospital setting
To further assist the comprehension of how to mitigate risk of infection or cross-transmission through the application of the ‘My five moments for hand hygiene’ concept in an overcrowded healthcare setting, it is helpful to imagine the following typical clinical stories.
Discussion
The ‘My five moments for hand hygiene’ concept has been designed to be applicable to any healthcare context – including the overcrowded setting addressed here.1, 17, 24 This guideline provides details and rationale behind the application of ‘My five moments for hand hygiene’ to the overcrowded setting based on the instructions in the WHO Guidelines.30
Yet, it is crucially important to recognize that overcrowded healthcare settings represent a high inherent risk for the spread of pathogens and
Acknowledgements
The authors would like to thank the World Health Organization First Global Patient Safety Challenge ‘Clean Care is Safer Care’ Lead, Professor B. Allegranzi, and Technical Advisor, Ms C. Kilpatrick, for their valuable input.
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Cited by (34)
Hand hygiene compliance among healthcare workers before and during the COVID-19 pandemic
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2021, Research in Social and Administrative PharmacyCitation Excerpt :In the ePharmacare project,45 the intention was to develop a new eHealth service for a specific setting such as community pharmacy, that could provide remote monitoring and follow up of patients supported by pharmaceutical care concepts.50 In the OSYRISH project,51 a gamification intervention to support hand hygiene, in a hospital setting, was designed aiming to increase nurses' adherence to hand hygiene's five moments, as prescribed by the WHO.52 Finally, the HAITooL project,53 developed a clinical decision-support system to support antibiotic stewardship programs in intensive care units.
Application of fluorescence method in the process of personal protective equipment removal
2020, American Journal of Infection ControlThe impact of automatic video auditing with real-time feedback on the quality and quantity of handwash events in a hospital setting
2020, American Journal of Infection ControlHand hygiene in low- and middle-income countries
2019, International Journal of Infectious DiseasesCitation Excerpt :The resulting loss of distinct patient zones complicates application of the ‘My 5 Moments’ approach (Salmon et al., 2015). Efforts have been made within the WHO Guidelines on Hand Hygiene in Health Care (World Health Organization, 2009b) and subsequent publications (Salmon et al., 2015) to adapt the ‘My 5 Moments’ strategy specifically for overcrowded settings. This has been done to provide clarity on the indications for hand hygiene in this context and ensure generalisability of the ‘My 5 Moments’ strategy.
Hands washing, glove use, and avoiding recontamination before aseptic procedures at birth: A multicenter time-and-motion study conducted in Zanzibar
2019, American Journal of Infection ControlCitation Excerpt :The most common was to attend different patients and procedures using the same gloves, consistent with other studies on the misuse of gloves.15,25 Although delineation between patient zones to address recontamination was studied in Vietnam,26 to our knowledge, ours is the first study that sought to quantify the contribution of avoiding recontamination to HH compliance. Our findings are supported by studies in the United Kingdom and Australia where health care workers were observed to touch privacy curtains between HH or glove donning and patient care.15,27