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Five Moments FAQs

Below is a set of frequently asked questions and answers about the Five Moments for hand hygiene. The list is not exhaustive and will be updated and added to as new information becomes available. We have also produced a downloadable version [Word doc - 229KB].

 

At present, only alcohol-based handrubs have been proven to rapidly and effectively inactivate a wide range of potentially harmful microbes on hands, and as such are considered as the gold standard for hand hygiene in healthcare.

 

 

 
Q. What are the Five Moments?

A. The Five Moments for hand hygiene were developed by the World Health Organization (WHO) to identify the critical moments during patient care when staff need to clean their hands in order to prevent the transmission of microbes that can cause healthcare associated infection (HCAI).

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Q. What is the aim of the Five Moments approach?

A. The Five Moments approach aims to promote and support a positive patient outcome by helping to prevent infection caused by hand transmission; clarifying to healthcare staff how best to integrate hand hygiene into a sequence of care in a way that is simple and easy to remember. The central aim of the approach is to prevent transmission of microbes from the healthcare zone into a patient zone and vice versa.

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Q. What is the benefit of the Five Moments approach?

A.The Five Moments is a simple and easy to remember approach to hand hygiene, which is based on microbiological risk and is easily observable. Furthermore, it reduces the burden of work on staff by removing unnecessary hand hygiene. Application of the Five Moments approach means minimum hand hygiene for maximum safety.

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Q. Why have zones?

A. The Five Moments attempt to create a geographical visualisationof the key moments for hand hygiene. With the patient at the centre of treatment and care, the environment in which healthcare is being provided is divided into two virtual geographical areas: the patient zone and the healthcare zone. The central aim of the approach is to prevent transmission of microbes from the healthcare zone into a patient zone and vice versa.

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Q. What is the patient zone?

A.The patient zone contains the patient and everything in their immediate vicinity. It is not concerned solely with a patient in an acute hospital bed, but any patient in any environment in which healthcare is being provided. The zone concept assumes that everything within the patient zone is contaminated with patient flora. Therefore, any equipment dedicated solely to one patient and kept close to them should be considered to be in the patient zone The exact dimensions of the patient zone are not precisely defined and should be agreed by staff working in that area.

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Q. What is the healthcare zone?

A. The healthcare zone relates to the wider healthcare environment; anything outside of the patient zone (e.g. hospital ward, GP practice, community hospital or other clinic). The concept assumes that surfaces in the healthcare zone are contaminated with microbes that will be potentially harmful to the patient in the patient zone. In some settings, such as a patient’s home, there may not be a healthcare zone.

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Q. Does the definition of what constitutes a patient zone need to be standardised across a trust?

A. While the approach is straightforward there may be instances within a trust where the dimensions of the zone differ. For example, the zone concept may be applied differently within a critical care environment to a conventional ward, particularly in relation to which pieces of equipment are deemed to be inside or outside the patient zone. Likewise in primary care or mental health, the dimensions of the zone and the extent of equipment contained within it might differ from standard definitions. Individual trusts should aim for simple and consistent approaches, to support standardizing practice, with flexibility to enable some units to modify the concept.

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Q. What about patient zones in midwifery and paediatrics, with mother and child in one space?

A. This area would be defined as one patient zone as the mother and child will be occupying the same space so it should be accepted that they share the same microbiological flora.

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Q. What constitutes a Moment?

A. A Moment is a critical point, i.e. a moment in time within staff workflow, when hand hygiene should occur. One Moment may contain multiple indications for hand hygiene.

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Q. What is an indicator?

A. An indicator or indication is a specific task or activity which warrants a hand hygiene action e.g. taking a pulse or helping a patient eat. One Moment may be made up of multiple indications clustered together. This means that healthcare staff no longer have to remember specific individual indications for hand hygiene; the need for hand hygiene is triggered by considering whether it constitutes one of the Five Moments for hand hygiene.

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Q. What about hand washing?

A. Hand washing remains a central element of hand hygiene and hands should always be washed with liquid soap and warm water when hands are visibly soiled; there has been potential or actual exposure to body fluids; there is a known case or outbreak of Norovirus or Clostridium difficile or other diarrhoeal illness, or when a patient/s is experiencing vomiting.

 

The difficulties of undertaking hand hygiene at the point of care in these circumstances is appreciated, so it may be necessary to leave the patient zone in order to comply with the requirement to clean hands with soap and water in these instances.

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Q. What about healthcare equipment?

A. Any equipment dedicated solely to one patient and kept close to them should be considered to be in the patient zone. Any other piece of equipment which is used communally is not part of the patient zone. No equipment should move between patient zones without being decontaminated adequately.

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Q. What about the curtains? Are they in the patient or the healthcare zone?

A. As a general rule, curtains are part of the healthcare zone as they are generally not dedicated to one patient or routinely changed when that patient gets discharged. The curtains will be touched by multiple healthcare staff and patients and thus heavily colonised with mixed flora. It is important to note that the correct application of the Five Moments approach will help prevent transmission to or from curtains via hands.

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Q. What about notes and charts?

A.In many settings, notes or charts at the end of the patient bed are dedicated to an individual patient and as such logically will be contaminated with a single patient’s flora and therefore part of the patient zone. If notes are held in a communal/locked trolley outside the bed-space they are not part of the patient zone but become part of the healthcare zone.

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Q. What about contamination of the wider healthcare environment?

A. Everything outside a patient zone will be colonized with a wide variety of mixed microbes. The central aim of the Five Moments approach is to prevent transmission of microbes from the healthcare zone into a patient zone and vice versa.

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Q. What about an encounter in a corridor – do the Five Moments and zoning still occur?

A. The Five Moments relates to hand hygiene at the point of care provision with the patient. If care is being provided, then there is a patient zone and the principle of the Five Moments should be complied with. This could be in a corridor e.g. incubators. In an emergency situation, the requirement for hand hygiene needs to be balanced against the immediate care requirement and will have to be decided by the individual healthcare worker.

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Q. What about protecting staff from infection?

A. The Five Moments aims to protect both staff and patients from the risk/transmission of infection. The vast majority of patients are at heightened risk of infection due to their underlying conditions and treatments and the Five Moments addresses these risks. Healthcare staff are exposed to infection risks largely from blood and body fluid exposure; Moments 3 and 4 address the minimisation of these risks to staff.

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Q. What about needing to clean your hands during an aseptic task?

A. This is dependant on the maintenance of asepsis during the performance of a task. Careful preparation should mean that, before a clean/aseptic task (Moment 2) and after blood/body fluid exposure risk (Moment 3), is sufficient. However, if workflow is interrupted, for example if more equipment or consumables are needed, then hand hygiene will be required in accordance with the Five Moments approach.

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Q. What about social contact? Does a handshake really constitute a Moment?

A. Foreign microbes can be brought into a patient zone and have the potential to cause infection, regardless of the reason why the patient is being touched. Microbes will transfer with touch; they do not differentiate between a social handshake or a contact that is part of “treatment.” It is important that if a Moment for hand hygiene occurs (e.g. before patient contact on entering the patient zone - Moment 1), healthcare staff of any discipline should comply. In some instances, it may be more appropriate to perform covert hand hygiene out of sight of the patient in order not to seem offensive. NPSA actively encourages local discussion and agreement since the Five Moments is not intended to negatively impact on any element of care or practice.

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Q. How does the Five Moments link to the Clostridium difficile guidance?

A. The guidelines for the management of Clostridium difficile link well with the Five Moments approach to hand hygiene. If complied with, the Five Moments are an effective way to stop microbe transmission regardless of what that microbe is. What should be remembered is that when dealing with specific microbes and their symptoms, there may be other factors to consider. In the case of Clostridium difficile for example, this would include the necessity for hand washing with soap and water rather than the use of alcohol handrub, which would be ineffective in this instance.

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Q. What about gloves?

A. The wearing of gloves, as with all other personal protective equipment (PPE), does not compromise the Five Moments approach to hand hygiene. If a Moment for hand hygiene occurs, it should be complied with. This is especially true when gloves have been worn if autoinfection is to be prevented. For further guidance on glove use as it relates to hand hygiene and the Five Moments, see the World Health Organization’s Guidelines for Hand Hygiene in Healthcare, section 23.1.

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Q. What about auditing compliance?

A. There are currently a number of different observational tools in use across the NHS within the UK, some of which have already integrated the Five Moments approach within them. It is clear that with the introduction and spread of the Five Moments approach, audit tools which focus on compliance with the Moments makes sense. The Infection Prevention Society (IPS) has been commissioned by the four UK governments to produce universal infection prevention quality improvement tools, which will include a hand hygiene observational tool. The NPSA is contributing to this work and hopes to play an active role in promoting its adoption once available. This tool will be based on the Five Moments.

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Q. What about housekeepers, cleaners and domestic staff?

A. The Five Moments applies to all staff disciplines working in healthcare. If any of the Five Moments occur they should be complied with; importantly, if none of the Moments occur there is no reason for the member of staff to perform hand hygiene routinely. This will be dictated by how staff work and what tasks they are performing.  Some Moments are more relevant than others for certain groups of staff. Tailored training is the gold standard when educating our NHS cleaning and domestic staff. The Five Moments resources provided should help with this work at local level. The Five Moments are also referenced in the NHS cleaning manual.

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Q. Should furniture, such as a chair, be decontaminated between patients in an outpatient setting?

A.The Five Moments approach assumes that appropriate cleaning is taking place. For advice on cleaning please see the NHS cleaning manual.

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Q. Is Moment 2 required before food (feeding with utensils)?

A. Yes, this is a clean procedure where the patient’s oral mucosa is exposed to potential risk from transmission of microbes.

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