Your Five Moments for hand hygiene

Transcription

1 ward Your Five Moments for hand hygiene Notes and discussion points to accompany the film and workshop Page 1

2 ward Introduction These notes are for use with the My Five Moments for hand hygiene DVD and workshop The notes explain the in the film and highlight points for discussion The notes specifically relate to how the Five Moments approach to hand hygiene is applied in practice These notes, and the film, act as an introduction to the Five Moment approach to hand hygiene Using these materials the basics can be understood Then the approach can be considered in more complex situations locally The film follows one patient s journey through the NHS Care is received in a number of settings Although these settings are specific to the journey shown the geographical principles apply more widely, hence the names you will see on the sections Page 2

3 ward Pre-hospital care This section looks at: The Five Moments approach to hand hygiene Its application in the pre-hospital environment Discussion points that may emerge Page 3

4 Your 5 Moments for hand hygiene ward Based on WHO poster Your 5 Moments for hand hygiene and reproduced with their kind permission. Page 4

5 ward Pre-hospital care A This scene will show: The paramedic is present with the patient The paramedic places an oxygen mask on the patient He then prepares to insert an IV line Watch the film and decide which, if any, Moment(s) occur Which Moment(s) occur? Would you have done the same? Why? Page 5

6 Pre-hospital care A What is within the patient zone in this scene? ward Page 6

7 Pre-hospital care A ward Page 7

8 ward Pre-hospital care A Moment 1, before patient contact Moment 2, before a clean/aseptic procedure What needs to be considered about workflow before Moment 2? Page 8

9 ward Pre-hospital care B The paramedic has finished inserting the IV line Watch the film and decide which, if any, Moment(s) occur Which Moment(s) occur? Would you have done the same? Why? Page 9

10 ward Pre-hospital care B Moment 3, after body fluid exposure risk What impact does wearing gloves have on Moment 3? What impact does dealing with a known infection have on Moment 3? Page 10

11 ward Pre-hospital care B Moment 3 exists regardless of glove use Moment 3 should be complied with in the same way at all times regardless of infection status of the care recipient/patient Do you agree? Why? Page 11

12 ward Pre-hospital care C In the next scene; The ambulance has arrived at the hospital, the paramedics leave the vehicle with the patient The paramedic who has been treating the patient remains in A+E to handover The paramedic who has been driving and assisted moving the patient into A+E returns to the vehicle Which Moment(s) occur? Would you have done the same? Why? Page 12

13 ward Pre-hospital care C Moment 5, after contact with patient surroundings What are the particular issues for this Moment in pre-hospital care? Page 13

14 ward Pre-hospital care D The paramedic who has handed over the patient to A+E staff is back in his vehicle He is in the process of making the vehicle ready for the next call Watch the film and decide which, if any, Moment(s) occur Which Moment(s) occur? Would you have done the same? Why? Do you have any other issue with this scene? Page 14

15 ward Pre-hospital care D Moment 5 has occurred, after contact with patient surroundings Why does Moment 4 after patient contact, not occur in this scene? Page 15

16 ward The next section looks at the based in a hospital, in a non ward environment In this case A+E, however the Five Moments approach is not specific to any particular care setting This section looks at the application of the Five Moments approach to hand hygiene in a hospital areas Page 16

17 Your 5 Moments for hand hygiene ward Based on WHO poster Your 5 Moments for hand hygiene and reproduced with their kind permission. Page 17

18 ward Page 18

19 ward Hospital non ward A In this scene; The patient has arrived in A+E A Nurse enters, places an oxygen mask on the patient He then prepares to take blood from the patient Watch the film and decide which, if any, Moment(s) occur Page 19

20 Hospital non ward A What is within the patient zone in this scene? ward Page 20

21 Hospital non ward A ward Which Moment(s) occur? Would you have done the same? Why? Page 21

22 ward Hospital non ward A Moments 1 and 2 have occurred Moment 1, before patient contact Moment 2, before a clean/aseptic procedure What consideration should be given to workflow before Moment 2? Page 22

23 ward Hospital non ward B The nurse has finished taking blood Watch the film and decide which, if any, Moment(s) occur Which Moment(s) occur? What impact does wearing gloves have on this Moment? Would you have done the same? Why? Page 23

24 ward Hospital non ward B Moment 3 has occurred After body fluid exposure risk This Moment occurs regardless of glove use Do you agree? Page 24

25 ward Hospital non ward C The nurse is speaking to the patient He reassures her and tells her she will be moved to a ward Watch the scene and decide which, if any, moment(s) occur Which Moment(s) occur? Would you have done the same? Why? Page 25

26 ward Hospital non ward C Moment 4 has occurred After patient contact Has Moment 5 occurred in this scene? Page 26

27 ward Hospital non ward D Before the patient is moved to the ward an Occupational Therapist visits to start discharge planning Watch the scene and decide which, if any, Moment(s) occur Which Moment(s) occur? Would you have done the same? Why? Page 27

28 ward Hospital, non-ward D Moments 1 and 4 have occurred Moment 1, before patient contact Moment 4, after contact with patient surroundings Did the Occupational Therapist comply with both Moments? Page 28

29 ward ward The next section looks at the based in a hospital ward environment This section looks at the application of the Five Moments approach to hand hygiene in hospital wards Page 29

30 Your 5 moments for hand hygiene ward Based on WHO poster Your 5 Moments for hand hygiene and reproduced with their kind permission. Page 30

31 ward Hospital in-patient A A doctor comes to examine the patient Watch the scene and decide which, if any, Moment(s) occur Which Moment(s) occur? Would you have done the same? Why? Page 31

32 ward Hospital in-patient A Moment 1 has occurred Before patient contact Where is the patient zone in this scene and what is within it? Page 32

33 Hospital in-patient A What is within the patient zone within this scene? ward Page 33

34 Hospital in-patient A ward Page 34

35 ward Hospital in-patient B The patient tells the doctor her IV cannula has moved The doctor removes the cannula The doctor then tells the patient she will prepare her discharge papers Watch the scene and decide which, if any, Moment(s) occur Which Moment(s) occur? Would you have done the same? Why? Page 35

36 ward Hospital in-patient B Moments 2 and 3 occurred Moment 2, before a clean/aseptic procedure Moment 3, after body fluid exposure risk What impact does wearing gloved have on these Moments? Page 36

37 ward Hospital in-patient C The doctor comes to tell the patient all of the preparations have been made for her discharge Watch the scene and decide which, if any, Moment(s) occur Which Moment(s) occur Would you have done the same? Why? Page 37

38 ward Hospital in-patient C Moment 4 has occurred After patient contact Do you agree? Page 38

39 ward Hospital in-patient D The doctor returns to make an entry in the patients notes The patient is not present Watch the scene and decide which, if any, Moment(s) occur Which Moment(s) occur? Would you have done the same? Why? Page 39

40 ward Hospital in-patient D Moment 5 has occurred After contact with patient surroundings What do you think the risks would be if staff do not comply with Moment 5? Is the trolley in the scene part of the patient zone? Page 40

41 ward Hospital in-patient E The patient has called a nurse to help her sit up The nurse enters and assists the patient Watch the scene and decide which, if any, Moment(s) occur Which Moment(s) occur? Would you have done the same? Why? Page 41

42 ward Hospital in-patient E Moments 1 and 4 have occurred Moment 1, before patient contact Moment 4, after patient contact Has Moment 5 occurred also? Page 42

43 ward Hospital in-patient F The nurse prepares the patients bed for her to return to. Watch the scene and decide which, if any, Moment(s) occur Which, if any, Moment(s) occur Would you have done the same? Why? Page 43

44 ward based care The next section looks at the based in the home This section looks at the application of the Five Moments approach to hand hygiene when care is provided in the home environment The example used is a nurse but the Five Moments approach is not specific to certain professionals or types of care Page 44

45 Home based care A ward Page 45

46 ward Home based care A A nurse has come to visit the patient in her home Watch the scene and decide which, if any, Moment(s) occur Which Moment(s) occur? Page 46

47 Home based care A Where is the patient zone in this scene? ward Page 47

48 Home based care A ward Page 48

49 ward Home based care A Moments 1 occurs Before patient contact Would you have done the same? Why? Page 49

50 ward Home based care B The nurse has finished her visit Watch the scene and decide which, if any, Moment(s) occur Which Moment(s) occur? Would you have done the same? Does it matter that the nurse chose to wash her hands instead of use the alcohol handrub? Would the alcohol handrub have been sufficient? Page 50

51 ward Home based care B Moments 4 and 5 have occurred Moment 4, after patient contact Moment 5, after contact with patient surroundings Has the nurse complied with both Moments? Page 51

52 ward based care The next section looks at the based in the community This section looks at the application of the Five Moments approach to hand hygiene when care is provided in the community setting The example used is a GP practice but the Five Moments approach is not specific to certain professionals or types of care Page 52

53 Community A ward Page 53

54 ward Community A The patient is attending her GP The GP and patient agree that a flu vaccination will be given Watch the scene and decide which, if any, Moment(s) occur Which Moment(s) occur? Would you have done the same? Why? Page 54

55 ward Community A Moments 1 & 2 occur Moment 1 before patient contact Moment 2 before a clean/aseptic procedure Do you agree? Page 55

56 ward Community B The GP has finished administering the vaccination. Watch the scene and decide which, if any, Moment(s) occur Which Moment(s) occur Would you have done the same? Why? Page 56

57 ward Community B Moments 3 and 4 have occurred Moment 3, after body fluid exposure risk Moment 4, after patient contact Do you agree? Was handwashing required? Or would the use of alcohol handrub be sufficient? Page 57

58 ward In this section Moments for hand hygiene occur but may not be complied with at all times. Observe each scene and decide: Which Moments have occurred Which have been complied with Which have not been complied with Page 58

59 ward A The patient is in an ambulance The paramedic is initiating treatment Observe the scene Do any Moments for hand hygiene occur? If so what are they? Does the paramedic comply? When should the paramedic have performed hand hygiene? Page 59

60 ward A Moments 1 and 2 occur What are these? The paramedic does not comply He should perform hand hygiene before touching the patient and before inserting the cannula Page 60

61 ward B The patient is in A+E. She calls the nurse as she is uncomfortable The nurse helps the patient reposition Observe the scene Did any Moments for hand hygiene occur? If so what where they? Did the nurse comply with them? When should the nurse have performed hand hygiene? Page 61

62 ward B Moments 1 and 4 occur What are these? The nurse does not comply The nurse should perform hand hygiene before touching the patient and after touching the patient when leaving the patient zone Page 62

63 ward C The patient is on the ward The nurse has been called He comes to see the patient but is called to the adjacent bed Observe the scene Do any Moments for hand hygiene occur? If so what are they? Does the nurse comply with them? When should the nurse have performed hand hygiene? Page 63

64 ward C Moment 1, 4, and 1 occur What are these? The nurse complies with Moment 1 He fails to comply with Moment 4, and 1 Do you think Moment 5 occurs also? The nurse should perform hand hygiene after touching the first patient and so before touching the second patient. Page 64

65 ward D The patient is at home A nurse has come to visit Observe the scene Do any Moments for hand hygiene occur? If so, what are they? Does the nurse comply with them? When should the nurse perform hand hygiene? Page 65

66 ward D Moment 1 occurs What is this? The nurse complies She then performs an extra, unnecessary hand hygiene The nurse could have complied by performing hand hygiene once Page 66

67 ward E The patient has attended her GP The GP welcomes the patient Observe the scene Do any Moments for hand hygiene occur? If so what are they? Does the GP comply with them? When should the GP perform hand hygiene? Page 67

68 ward E No Moment occurred The GP did not need to perform any hand hygiene Page 68

69 ward F The patient has visited her GP The consultation is over and the patient is ready to leave Observe the scene Do any Moments for hand hygiene occur? If so what are they? Does the GP comply with them? When should the GP perform hand hygiene? Page 69

70 ward F Moments 3 and 4 occur What are these? The GP complies with Moment 3 then fails to comply with Moment 4 The GP should have performed hand hygiene administering the vaccination and after patient contact This could have been achieved with one episode of hand hygiene if she did not touch the patient again after hand washing Page 70

71 ward There are a number of challenges facing staff in relation to hand hygiene The Five Moment approach aims to eliminate unnecessary hand hygiene by ensuring hand hygiene is performed at the right moments within the patient zone Hand hygiene is the single most effective way to prevent healthcare associated infection To Five Moments approach can facilitate hand hygiene and so improve compliance For this to work other issues need to be addressed including glove use, work flow and decontamination of equipment Page 71

72 ward The film and presentation aim to provide you with the basics of the Five Moments approach to hand hygiene When you try to apply these in practice questions will emerge It is always useful to share such questions and challenges within, and outside, your organisation Page 72

73 ward 2 hour training session Time into session Activity Notes Session 1 00:00 Session 2 00:20 00:50 Break Session 3 01:00 Five Moments presentation Select the one most relevant to your care setting from your resource pack Patient zone group work See activity 1 in the group work document in your resource pack Film and discussion Use the DVD in your resource pack, showing the most relevant for your audience and using the training notes to prompt discussion PowerPoint presentation outlining what the Five Moments approach is A group work session to teach the patient zone/ healthcare zone elements A chance to see the Five Moment in practice by looking at relevant from the DVD My Five Moments for hand hygiene Session 4 01:40 Quiz See group activity 3 in the group work document in your resource pack A chance to assess delegate s knowledge by using either group written work or observation from DVD My Five Moments for hand hygiene 01:50 and close Recap using Five Moments diagram Page 73

74 ward Full day training session Time into session Activity Notes Session 1 00:00 Session 2 00:20 Five Moments presentation Select the one most relevant to your care setting from your resource pack Patient zone group work See activity 1 in the group work document in your resource pack PowerPoint presentation outlining what the Five Moments approach is A group work session to teach the patient zone/ healthcare zone elements Session 3 01:00 Question and answers An opportunity for delegates to ask questions about the approach Session 4 01:45 Film and discussion Use the DVD in your resource pack, showing the most relevant for your audience and using the training notes to prompt discussion A chance to see the Five Moment in practice by looking at relevant from the DVD My Five Moments for hand hygiene Session 5 02:45 Film observation A chance to observe to identify moment and compliance Page 74

75 ward Full day training session (continued) Time into session Activity Notes 03:15 Lunch + discussion board See group activity 4 in the group work document in your resource pack Session 6 04:00 Session 7 04:30 Question time See group activity 3 in the group work document in your resource pack Identifying problems See group activity 4 in the group work document in your resource pack During lunch a board is available for delegates to list problems they will have with the approach in their work setting A chance for delegates to explore some difficult issues that may arise when applying the Five Moments approach Use the message board to list problems, give each group a problem, or two, to discuss and feed back on how they world over come them Session 8 05:00 Quiz See group activity 2 in the group work document in your resource pack A chance to assess the delegate s ability to apply the Five Moments to clinical workflow in their work setting 05:30 and evaluation Page 75

76 ward for Your Five Moments training This section contains some activities to stimulate discussion and assist learning during your Five Moments training session. The activities can be extracted to use separately. Alternatively you can take the ideas and design your own group work resources. The activities can be used within your own training programme or as part of the full training day suggested in your Five Moments for hand hygiene resource pack. Activity 1 : The patient zone and healthcare zone Activity one is aimed at ensuring the Five Moments approach, specifically in relation to the patient zone and healthcare zone is understood. The materials for this activity are images of care environments. These are taken from the DVD My Five Moments for hand hygiene. To help delegates understand the patient zone, and healthcare zone, each group should be encouraged to discuss an image and decide where the boundary of the patient zone is. This can be drawn on the image if you intend to print new copies for each training session. Each group should then feed back and discussion encouraged with other groups. This activity can be supported by use of the DVD My Five Moments for hand hygiene. This activity can be customised by using images of care settings from within your own organisation. Page 76

77 ward for Your Five Moments training Activity 2 : Moments and indicators Activity two is aimed at ensuring the terminology in relation to the Five Moments approach is understood, specifically as it translates to actual tasks. In this activity delegates are encouraged to bridge the gap between a task orientated approach to clinical work and the non task orientate Five Moments approach to hand hygiene. The aim is to apply the Five Moments approach successfully to clinical workflow. Lists of indicators are provided. Delegates are encouraged to consider these indicators and place them in the appropriate moment group. This activity can be supported by use of the DVD My Five Moments for hand hygiene. Page 77

78 ward for Your Five Moments training Activity 3 : Question time This is a group activity which helps delegates to identify what difficult questions may arise when they attempt to apply the Five Moments approach to hand hygiene in practice. It is hoped this activity will help delegates prepare for debate, discussion and advocacy of the Five Moments approach to hand hygiene when they return to their workplace. For this session no material is needed other than some writing materials. In small groups, e.g. five people, each member of the group should take the opportunity to ask a question. This should be a question which they feel will be asked of them and may be difficult to answer. The group should try and agree an answer for each question which is asked within their group. Examples of some questions may be; I work in a mental health outpatients department, we don t do procedures so why do we need all of the moments in our materials? On our ward we have one nurse per bed, so how do I teach the Five Moments when the nurse will not be leaving the patient zone? I m a GP we perform hand hygiene before and after seeing patients, isn t this enough? Page 78

79 ward for Your Five Moments training Activity 4 : Discussion board This activity is an opportunity for delegates to highlight positive and negative points in relation to the implementation of the Five Moments approach. These points can be addresses in the closing session by the training facilitator. This activity requires a communal board, divided in two with the headings What I like about the approach and what I don t like about the approach Delegates can post items by writing them on a whiteboard, flipchart or using post-it notes, depending on what facilities are available locally Page 79

80 ward Image for group activity 1, Five Moments approach to hand hygiene Look at the images below. Having heard the presentation and seen the DVD My Five Moments for hand hygiene consider where you think the patient zone is in the image. What items are included and which are not? Page 80

81 Image for group activity 1, Five Moments approach to hand hygiene ward Page 81

82 Image for group activity 1, Five Moments approach to hand hygiene ward Page 82

83 Image for group activity 1, Five Moments approach to hand hygiene ward Page 83

84 Image for group activity 1, Five Moments approach to hand hygiene ward Page 84

85 Image for group activity 1, Five Moments approach to hand hygiene ward Page 85

86 Image for group activity 1, Five Moments approach to hand hygiene ward Page 86

87 Image for group activity 1, Five Moments approach to hand hygiene ward Page 87

88 Image for group activity 1, Five Moments approach to hand hygiene ward Page 88

89 Image for group activity 1, Five Moments approach to hand hygiene ward Page 89

90 ward for Your Five Moments training Lists of indicators for group activity 2, Five Moments approach to hand hygiene For each of the tasks, and groups of tasks listed below apply the Five Moments approach to hand hygiene to 1. Decide how many times hand hygiene should be performed 2. Decide what moments the episodes of hand hygiene comply with 3. Note any questions which you ask yourself when trying to decide which moments occur These are and you are encouraged to develop your own organisation specific material for use in this activity Hospital non ward care, Hospital in-patient care Nurse needs to enter a patient s bed space to help the patient sit up in bed, nurse stays with patient to assist them to eat Nurse needs to enter a bed space to administer a subcutaneous injection then leaves Doctor enters a patients bed space, examines patient chest, removes wound dressing to examine chest wound, writes a prescription in the notes, shakes patients hand, leaves Midwife enters a bed space and lifts baby from cot, places baby with mother to feed, changes linen on cot, leaves Page 90

91 ward for Your Five Moments training Pre-hospital based care, Community based care Paramedics alight from vehicle, enter patients home, patient is helped to an ambulance chair within the vehicle by both paramedics. One paramedic remains with patients, the other paramedic return to the cab of the vehicle GP welcomes patient into consultation room, after discussion examines patient s abdomen, Patient is given a prescription and leaves CPN visits a patients home to discuss how they are. Speaks with patient at length, leaves the patient home without having touched them Dentist welcomes patient and shows them to chair, discusses treatment, prepares and administers anesthetic, ask patient to wait outside again Page 91

92 ward Key source documents Sax H, Allegranzi B, Uçkay I, Larson E, Boyce J, Pittet D (2007) My five moments for hand hygiene : a user-centred design approach to understand, train, monitor and report hand hygiene. Journal of Hospital Infection vol./is. 67/1(9-21), This article explains the development of the five moments approach and outlines the scientific rationale. WHO (2009) WHO Guidelines on Hand Hygiene in Health Care. WHO, Geneva, Switzerland This document is the most comprehensive examination of hand hygiene related evidence published to date. The document cites over one thousand pieces of research relating to hand hygiene. The guidance recommends the five moments approach to hand hygiene. This final version of this document, due in 2009, will form the key publication from which the cleanyourhands campaign develops it s clinical strategy. Ftika, L, Czarniak, E (2008) Geneva Infection Control Project Delivered by the Infection Control Team, Chesterfield Royal Hospital. This case study from the Infection Control Team at Chesterfield Royal Hospital examines potential transmission dynamics in the inpatient setting. Page 92

93 ward For a more general reference/evidence list for the cleanyourhands campaign please visit our website at: On our website you will also find support, materials and a secure area for campaign coordinators If you cannot find the support or information you need in this resource pack or online please us at: handhygiene@npsa.nhs.uk Page 93