WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...

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<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE Table I.21.3 Requirement specifications for a user-centred hand hygiene application concept Consistent with evidence-based risk assessment of HCAI and spread of multi-resistant microorganisms Integrated into a natural care workflow Easy-to-learn Logical clarity of the concept Applicable in a wide range of health-care settings Minimising the density of the need for hand hygiene Maximal know-how congruence between trainers, observers, and HCWs Table I.21.4 “My five moments for hand hygiene”: explanations and link to evidence-based recommendations Moment Endpoints of hand transmission Prevented negative outcome 1. Before touching a patient 2. Before clean/ aseptic procedure 3. After body fluid exposure risk Donor surface: any surface in the health-care area Receptor surface: any surface in the patient zone Donor surface: any other surface Receptor surface: critical site with infectious risk for the patient or critical site with combined infectious risk Donor surface: critical site with body fluid exposure risk or critical site with combined infectious risk Patient colonization with health-care microorganisms; exceptionally, exogenous infection Patient endogenous infection; exceptionally exogenous infection HCW infection 4. After touching a patient Receptor surface: any other surface Donor surface: any surface in the patient zone with touching a patient HCW colonization; environment contamination 5. After touching patient surroundings Receptor surface: any surface in the health-care area Donor surface: any surface in the patient zone without touching the patient Receptor surface: any surface in the health-care area HCW cross-colonization; environment contamination 112
PART I. REVIEW OF SCIENTIFIC DATA RELATED TO HAND HYGIENE Table I.21.4 “My five moments for hand hygiene”: explanations and link to evidence-based recommendations (Cont.) Moment Examples of care situations when the moment occurs <strong>WHO</strong> recommendation (ranking for scientific evidence a ) Comments: changes since Advanced Draft of these guidelines 1. Before touching a patient Shaking hands, helping a patient to move around, getting washed, taking pulse, blood pressure, chest auscultation, abdominal palpation Before and after touching patients (IB) The two moments before and after touching a patient were separated because of their specific sequential occurrence in routine care, unequal negative outcome in case of failure to adhere, and usual adherence level 2. Before clean/ aseptic procedure Oral/dental care, secretion aspiration, skin lesion care, wound dressing, subcutaneous injection; catheter insertion, opening a vascular access system; preparation of food, medication, dressing sets Before handling an invasive device for patient care, regardless of whether or not gloves are used (IB) If moving from a contaminated body site to a clean body site during patient care (IB) This concept was enlarged to cover all transfer of microorganisms to vulnerable body sites potentially resulting in infection Since it is not possible to determine these body sites objectively, this indication was not retained as a separate item, but covered by within patient zone moments 3. After body fluid exposure risk Oral/dental care, secretion aspiration; skin lesion care, wound dressing, subcutaneous injection; drawing and manipulation any fluid sample, opening draining system, endotracheal tube insertion and removal; clearing up urines, faces, vomit; handling waste (bandages, napkin, incontinence pads); cleaning of contaminated and visibly soiled material or areas (lavatories, medical instruments) After removing gloves (IB) After contact with body fluids or excretions, mucous membranes, non intact skin, or wound dressings (IA) If moving from a contaminated body site to a clean body site during patient care (IB) After body fluid exposure risk covers this recommendation; see text for further comments This risk was generalized to include all tasks that can potentially result in hand exposure to body fluids. A paradox of body fluid exposure was resolved by including the notion of exposure risk instead of actual exposure. See comment 2 in Moment 2 (before clean/aseptic procedure) 4. After touching a patient Shaking hands, helping a patient to move around, getting washed, taking pulse, taking blood pressure, chest auscultation, abdominal palpation Before and after touching patients (IB) See comment in Moment 1(before touching a patient) 5. After touching patient surroundings Changing bed linen, perfusion speed adjustment, monitoring alarm, holding a bed rail, clearing the bedside table After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient (IB) Retained to cover all situations where the patient’s immediate and potentially contaminated environment is touched but not the patient a Ranking system for evidence (see Part II): category IA, strongly recommended for implementation and strongly supported by welldesigned experimental, clinical, or epidemiological studies; category IB, strongly recommended for implementation and supported by some experimental, clinical, or epidemiological studies and a strong theoretical rationale. 113
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