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 patient, i.e. direct bodily contact (Category IB)

Why

To protect the patient from the transmission of potential pathogens, including pathogens on the patient’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)^*
• When moving between colonized / contaminated and clean parts of the body in the course of patient care (Category IB)^*

Why

To protect staff and the expanded patient environment, including future patients, 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 patient care (Category IB)^*
• AFTER removing gloves (Category IB)^*

Why

To protect staff and the expanded patient environment, including future patients, from potential pathogenic agents

WHO Recommendation

• AFTER direct contact with a patient, i.e. direct bodily contact (Category IB) *
• AFTER removing gloves (Category IB)^*

Why

To protect staff and the expanded patient environment, including future patients, from potential pathogens.

WHO Recommendation

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

It is not possible to use the model’s distinction between direct and expanded patient environment in outpatient medicine. Here are relevant indications for hand disinfection.

1. BEFORE contact with patient (before intensive skin contact, for example a physical examination
2. BEFORE aseptic activities (for example, injections, punctures, changing of bandages, etc.)
3. AFTER contact with potentially infectious materials (for example, blood, vomit, wound secretions, nasal secretions, sputum etc.)
4. AFTER contact with patient (after intensive skin contact, for example physical examination)

In the case of patients who are immediately consecutive, “before or after contact with patient“ should be understood as “between patients.”

Definition: Patient contact:

Patient contact refers to medical or nursing contact, i.e. extensive or intensive skin contact in which the privacy of the patient is no longer maintained. (for example physical examination).

Applying the model is always reasonable when a patient receives a treatment or a procedure in a defined location (e.g. dialysis, endoscopy, radiology). In such cases the materials used are exclusively for that patient and must be sterilized or disposed of afterwards.

In addition, surfaces must be disinfected immediately afterwards. Only in such situations is it possible to refer to direct and extended patient environments.

Surgical procedures in an operating room are subject to special rules and are not considered here.

Outpatient Dialysis:

The patient’s bed or recliner and dialysis equipment, all personal objects belonging to the patient remaining near the bed as well as all additional materials or devices remaining on the patient during dialysis.

Outpatient Endoscopy:

Examination table, endoscope with accessories, tables that may be present to place materials on, as well as all additional materials or devices remaining on the patient during the examination.

Interventional radiology:

Examination table, tables that may be present to place materials on, as well as all additional materials or devices remaining on the patient (not including the X-ray machine, MRI, CT).

All other areas (except surgery), for example procedure rooms:

Examination tables, tables that may be present to place materials on, as well as all additional materials or devices remaining on the patient during the examination.

All other areas beyond the direct patient environment.