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for
Hand Hygiene
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Patient
Refers to any part of the patient, their
clothes, or any medical device that is
connected to the patient
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Immediate Patient Surroundings
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Patient Surroundings
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From
Council for Remote Area Nurses of Australia
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Moment 1
Before Touching a Patient
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Moment 1
When: Examples:
Touching a patient in any way Shaking hands, Assisting a patient to move,
most Allied health interventions, Touching
any invasive medical device connected to
the patient (eg. IV pump, IDC)
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Moment 1
When: Examples:
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Education for Moment 1
When
Why
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Rule for Auditing
Moment 1
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Example:
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Moment 2
Before a Procedure
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Procedure
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Moment 2
When: Examples:
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Moment 2
When: Examples:
Insertion of, or disruption to, the circuit of Procedures involving the following: ETT,
an invasive medical device Tracheostomy, Nasopharyngeal airways,
Suctioning of airways, Urinary catheter,
Colostomy/ileostomy, Vascular access
systems, Invasive monitoring devices,
Wound drains, PEG tube, NGT, Secretion
aspiration
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Education for Moment 2
When
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Rule for Auditing
Moment 2
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Example:
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Moment 3
After a Procedure or Body Fluid
Exposure Risk
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Body Fluid Exposure Risk
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Actual or potential contact
with:
• Blood, Lochia
• Saliva or tears
• Mucous, wax, or pus
• Breast milk, Colostrum
• Vomitus
• Urine, faeces, semen, or meconium
• Pleural fluid, ascitic fluid or CSF
• Tissue samples, including biopsy specimens, organs,
bone marrow, cell samples
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Moment 3
When: Examples:
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 body fluid from patient
surroundings, After touching the outside
of a drain
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Education for Moment 3
When
Why
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Rule for Auditing
Moment 3
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Example:
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Example:
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Moment 4
After Touching a Patient
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Education for Moment 4
When
Why
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Rules for Auditing
Moment 4
• HH Moment 4 should be performed after touching
the patient
• Moment 4 will usually be proceeded by a Moment 1
• Touching the patient surroundings after touching
the patient is recorded as a single Moment 4.
• If after a Moment 3 there is touching of the patient
surroundings, this is recorded as a Moment 4
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Example:
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Moment 5
After touching a patient’s immediate
surroundings
when the patient has not been touched
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Moment 5
When: Examples:
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Education for Moment 5
When
Why
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Rule for Auditing
Moment 5
• HH Moment 5 is performed when there has
been no touching of the patient but there has
been touching of the patient’s immediate
surroundings
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Example:
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Note 1
• Generally for every “before” Moment there should
be an “after” Moment recorded
– Moment 1 can either be followed by a Moment 4 or a
Moment 3
– Moment 2 is generally followed by Moment 3
– Moment 5 is a stand alone Moment as there is no patient
contact
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Example:
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Note 2
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Example:
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Note 3
• The HCW must be observed to perform HH as they
approach the patient.
• If HH is not observed it should be recorded as a
“missed” action (i.e. HH not performed).
• In such circumstances the HCW can be asked
(at the conclusion of the sequence of care)
if they performed HH immediately prior to
entering the room
• If they did then the Moment should be scored as HH performed
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Example:
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Note 4
• No “before” Moment can be recorded if
auditing commences after a HCW is
already touching a patient, or in the
process of performing a procedure.
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Example:
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Note 5
• Patient bed curtains are outside the patient
zone and are frequently contaminated
• Touching the curtains is considered to be
leaving the patient zone
• HH should be performed between touching
the curtains and touching the patient
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Example:
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“Bonus” Moments
• The Aussie 5 Moments audit tool rewards
staff who clean their hands at the most
important times
Eg1. Moving between patients
One HH is recorded as two Moments – M4 and M1
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“Bonus” Moments
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More examples
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HCW walks in,
silences IV alarm that is connected to the patient,
then leaves
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HCW walks in,
picks up IDC to read it,
puts it down,
then leaves
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HCW walks into the room,
picks up the IDC to read it,
puts it down,
writes on the medical chart, then leaves
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HCW changes IV fluid bag that is connected to
the patient, then leaves
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HCW prepares oral medications with
medications sitting on the patient’s medical
chart, signs the chart whilst giving the
medications, then moves the curtain aside
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HCW walks in,
shakes the patient’s hand,
does hand hygiene,
picks up the chart to read it,
then leaves
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HCW walks into the room opens the patient’s
curtains, then leaves the room
• Nil as the curtains are external to the patient’s surroundings and are
not a Moment
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HCW walks into patient room,
helps the patient out of bed,
moves the curtain back,
then helps the patient to walk out of the room
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HCW assists a patient back to bed,
then assists another patient to stand up,
then leaves
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HCW picks up the medication chart and walks
out of the room with it
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HCW walks in,
moves the overbed table,
does Hand Hygiene,
helps the patient out of bed,
does hand hygiene,
then leaves
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HCW walks in,
does Hand Hygiene,
moves the overbed table,
helps the patient out of bed,
does hand hygiene,
then leaves
• Moment 1 – prior to touching the patient
• Moment 4 – after touching the patient
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Food services worker walks in with food
trolley, places tray on patient’s table then
walks back to trolley and leaves the room
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Food services worker walks in with food
trolley, moves patient’s belongings off the
overbed table, goes back to trolley to get food
tray, places tray on patient’s table then walks
back to trolley and leaves the room
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HCW walks in,
helps the patient to adjust
position in bed,
empties IDC,
takes urinal to pan room,
then leaves