Indications for Hand Disinfection - Terminology and Concepts

The WHO program “My Five Moments for Hand Hygiene” was originally developed for the hospital sector. It is based on findings regarding how pathogens are transmitted in hospitals.

The indications for hand hygiene in nursing homes have been discussed in detail by international experts. As a result, Aktion Saubere Hände, in cooperation with the World Health Organization (WHO), has undertaken adapting the WHO program for use in nursing homes.

This model is applicable in all areas of healthcare and is a useful aid to staff for clearly recognizing situations. Its content corresponds to the guidelines for hand hygiene of the Robert Koch Institute.

The Indications

An indication is defined as a situation in which hand disinfection is necessary because of the risk that pathogens could be transmitted. Hand disinfection effectively prevents such transmission.

An indication is designated BEFORE contact or AFTER contact, which is nonetheless should not necessarily be considered as the beginning or end of a medical sequence or activity. It is defined as movement between various areas (the direct and expanded patient environment, colonized or not colonized parts of the body).

The indications for hand disinfection correspond to clear situations in the normal course of patient care. Given the number of possible situations, a program has been created by WHO (World Health Organization), broken down into five indication groups:

Immobile residents

  1. BEFORE contact with resident
  2. BEFORE aseptic activities
  3. AFTER contact with possibly infectious material
  4. AFTER contact with resident
  5. AFTER contact with a resident’s direct environment

Mobile residents

In areas where mobile and for the most part independent residents are cared for, four indications for hand disinfection apply since residents are active in several communal areas.

  1. BEFORE contact with resident
  2. BEFORE aseptic activities
  3. AFTER contact with possibly infectious material
  4. AFTER contact with resident

Definition Contact with residents

Contact with a resident refers to medical or nursing contact, i.e. skin contact that is extensive, intensive, or over a large area, in which the privacy of the resident is no longer maintained. This can occur, for example, during personal hygiene, assistance with personal hygiene, or when moving a resident.

5 Moments for Hand Hygiene

Why

To protect the patient from colonization by pathogens which may be temporarily present on the hands of staff.

WHO Recommendation

  • BEFORE direct contact with a resident, i.e. direct bodily contact (Category IB)

Why

To protect the resident from the transmission of potential pathogens, including pathogens from the resident’s own body, to sterile / not colonized parts of the body.

WHO Recommendation

  • BEFORE the connection or disconnection of an invasive device regardless whether gloves are being worn (Category IB)*
  • BEFORE moving between colonized / contaminated and clean parts of the body in the course of care of resident (Category IB)*
  • BEFORE for example, subcutaneous injections, administration of eye drops, maintenance of a PEG tube, changing bandages, etc.

Why

To protect staff and the expanded resident environment, including future residents, from potential pathogenic agents

WHO Recommendation

  • AFTER contact with bodily fluids and excretions, with mucous membranes, skin that is not intact, or bandages (Category IA)*
  • When moving between colonized / contaminated and clean parts of the body in the course of resident care (Category IB)*
  • AFTER removing gloves (Category IB)*

Why

To protect staff and the expanded resident environment, including future residents, from potential pathogenic agents

WHO Recommendation

  • After direct contact with resident, i.e. direct bodily contact (Category IB)*
  • AFTER removing gloves (Category IB)*
  • Particularly for mobile residents with known or suspected colonization or infections with MRSA or other multiresistant pathogens

Why

To protect staff and the expanded resident environment, including future residents, from potential pathogenic agents

WHO Recommendation

  • AFTER contact with surfaces and medical devices in the resident’s immediate environment (Category IB)*
  • AFTER removing gloves (Category IB)*

The direct resident environment is defined as the following areas:

  • Resident’s room, when it is ashared room: The resident’s bed together with its nightstand and the resident’s personal belongings as well as medical devices assigned to the resident.
  • Resident’s room,when it is a single room: The entire room is defined as the resident’s direct environment.

Staff compliance with hand hygiene guidelines has a direct influence on reducing the transmission of pathogens and the development of heathcare associated infections.

Hand hygiene is not merely an option or a question of opportunity.