Hand Hygiene and PPE
The WHO Five Moments
Hand hygiene is required: (1) before touching a patient; (2) before a clean or aseptic procedure; (3) after body-fluid exposure risk; (4) after touching a patient; (5) after touching patient surroundings. These five moments cover the contacts that actually transmit organisms.
Six steps and timings
Rub palm to palm; right palm over left dorsum and vice versa; palm to palm with interlaced fingers; backs of fingers to opposing palms; rotational rubbing of each thumb; rotational rubbing of fingertips in each palm. Hand rub with 70–80 % alcohol takes 20–30 seconds; soap-and-water wash takes 40–60 seconds. Use soap and water when hands are visibly soiled and for C. difficile or norovirus, because alcohol does not kill spores.
PPE rules
- Order of donning: gown, mask or respirator, goggles/face shield, gloves (gloves last).
- Order of doffing: gloves, goggles, gown, mask (mask last, outside the room).
- Perform hand hygiene immediately after removing gloves.
- Change masks when moist; never let a mask hang below the chin.
- N95 needs a fit check each time – seal around the face.
- No nail polish, artificial nails, wrist watches or rings in clinical areas.
Worked example
You will assist a nurse with a dressing change. Reasoning: this is a clean/aseptic procedure, so moment 2 applies. Perform hand rub, don gown, mask, goggles and sterile gloves in that order; after the dressing, remove gloves and gown inside the room, perform hand hygiene, remove goggles and mask outside the room, then hand hygiene again.
Traps
- Washing gloved hands instead of changing gloves.
- Touching the mask front during doffing.
- Skipping hand hygiene because “the gloves were clean”.
- Using alcohol rub on visibly soiled hands.