Why clean your hands again? The 5 Moments

Yes: Moment 5, after touching their surroundings, even without touching the patient.

You cleaned your hands at the door. Two minutes later you're about to change a dressing, so why clean them again? Because hand hygiene isn't just about how often, it's about when.

Australia's National Infection Control Guidelines call effective hand hygiene the single most important strategy for preventing healthcare-associated infections. And they don't just say do it, they say when.

Picture the patient zone. The patient and the things around them, like the bed, the rails, the table and the call bell. Outside it is the wider healthcare environment.

Your hands are the bridge between the two, and they can carry microbes both ways. In an example shown in the Australian guidelines, a healthcare worker did a routine abdominal exam on a patient with no history of MRSA infection, who routine screening showed was carrying MRSA.

A print of the worker's ungloved hand grew MRSA. Another print, taken after the worker used alcohol-based hand rub, was negative. So timing comes down to direction.

Clean hands before contact protect the patient, both from your microbes and from their own microbes getting into their body during a procedure. Clean hands after contact protect you and the healthcare environment from the patient's microbes.

The World Health Organization's Five Moments turn this into a habit, and they're used in Australia too. Moments one and two come before. One, immediately before you touch a patient, even just to take a pulse or help them move.

Two, immediately before a procedure, like a wound dressing or a blood glucose check. And once your hands are clean, touch nothing else around the patient before you start.

Moments three, four and five come after. Three, straight after a procedure or any body fluid exposure risk, such as handling a used bedpan or a used specimen jar.

Four, after touching the patient. Five, after touching anything in their surroundings when you haven't touched the patient. And always clean your hands before you leave the room.

Gloves don't replace any of this. Microbes get through tiny defects you won't notice, and your hands can pick them up as the gloves come off. So clean your hands before you put gloves on.

And again, after you take them off. Which product? If your hands look clean, use alcohol-based hand rub. Cover every surface, especially the fingertips, the thumbs and between the fingers, and keep rubbing until your hands are dry.

If your hands are visibly dirty, wash with soap and water instead. Clean your hands right before you touch the patient or start a procedure. And clean them straight after a procedure or body fluid exposure risk, after touching the patient, and after touching their surroundings.

When isn't routine enough? If C. diff or a virus like norovirus is suspected or known, and you weren't wearing gloves, your gloves were breached, or your hands are visibly contaminated, Australian guidelines suggest soap and water, then dry your hands thoroughly with a single-use towel.

Washing physically removes spores. Hand rub doesn't work on C. diff spores and may not work on viruses like norovirus. If you wore gloves and none of that happened, hand rub is still the product of choice.

If hand hygiene products are irritating your skin, review your technique first. If the irritation persists or you react to a particular product, contact the person responsible for infection control or occupational health where you work.

Damaged skin makes infection transmission more likely. And if hand rub isn't readily accessible at key points of care, consider approaching management. So, back to that dressing.

After you cleaned your hands at the door, they may have touched the bed rails, the trolley or the patient. A wound is a way into the body. So changing a dressing is Moment 2: clean your hands again, right before you start.

This is general education, not a replacement for your facility's policy. The sources are in the description.