Research for infection protection

WHO Moments model for geriatric and nursing homes

Due to the increasing life expectancy and demographic change the number of elder people, who require intensive support and care in residential homes, increases as well. Pathogens play a growing role in geriatric care. Clearly defined recommendations for action in terms of hand hygiene are necessary to prevent nosocomial infection and the spread of multidrug-resistant pathogens. The daily care routine in geriatric and nursing homes bears specific risks and special hand hygiene requirements. To fulfil these, together with WHO, the German “Aktion Saubere Hände” (Clean Hands Campaign) has adapted the 5 Moments model for geriatric care.

In the following passages you will read how the WHO’s Moments model can be used for the treatment and care of mobile and immobile residents.

What is a moment for hand hygiene?

A moment for hand hygiene is a situation that requires a hand disinfection. It is the moment when there is a risk of a transmission of pathogens. Hand disinfection can prevent such a transmission efficiently.

Moments for hand hygiene in case of immobile residents

Completely or almost completely immobile residents are bound to bed due to their age or disease. In a single room, the entire room is considered the direct resident surrounding. If the patient is accommodated in a shared room, the direct resident surrounding includes the bed, the bedside table, personal items, and all devices assigned to the resident.

For the care and treatment of immobile residents, WHO defines five moments that require hand disinfection:

  1. BEFORE touching a resident
  2. BEFORE aseptic procedures (e.g. connection/disconnection of an invasive device, when changing from a colonised to a non-colonised body site, dressing changes, etc.)
  3. AFTER body fluid exposure risk (e.g. with blood, vomit, secretion from a wound, nasal secretion, saliva, etc.)
  4. AFTER touching a resident
  5. AFTER touching surfaces in the immediate resident surroundings

What is a resident contact?

A resident contact is a medical or caregiving interaction, in which the skin is touched directly and intensively and the resident’s privacy is not preserved: Examples are repositioning of the resident or body care.

Moments for hand hygiene in case of mobile residents

Mobile residents are not bound to bed and move through the facility almost freely and independently. The respective areas are partly used by several residents – direct resident surroundings cannot be defined here.

In this case, the fifth WHO moment is dropped. Hence, the following four moments are relevant for the care of mobile residents:

  1. BEFORE touching a resident
  2. BEFORE aseptic procedures (e.g. connection/disconnection of an invasive device, when changing from a colonised to a non-colonised body site, dressing changes, etc.)
  3. AFTER body fluid exposure risk (e.g. with blood, vomit, secretion from a wound, nasal secretion, saliva, etc.)
  4. AFTER touching a resident


Risks of infection in geriatric care


According to studies, the prevalence of nosocomial infection is six to ten per cent in nursing homes (1, 2). Every single resident on average acquires one to three infections per year. These commonly are urinary tract infection or pneumonia. In addition, infections are the most common cause for nursing home residents to stay in hospital: 26 to 50 % of all transfers to hospitals stem from nosocomial infections (1, 2, 3). In many cases, multidrug-resistant pathogens – mostly strains of Enterobacteriaceae or C. difficile – are the cause.

In nursing homes, there is a particular risk of nosocomial infection. There are many reasons for this:

  • Lack of infection control practitioners and hygiene plans
  • Staff shortage
  • High staff turnover
  • Inadequate antibiotic therapy
  • Irregular medical examinations
  • High frequency of social contacts (promotes cross contamination)

Additionally, there are health-related risk factors that may favour bacterial infection:

  • Malnutrition
  • Immunosuppressed status
  • Permanent bladder catheter
  • Stomach tube
  • Chronical immobility

Hence, in geriatric and nursing homes, highest requirements for hand hygiene compliance are very important for the safety and health of the residents.


Sources:    
Hand Hygiene in Outpatient and Home-based Care and Long-term Care Facilities. A Guide to the Application of the WHO Multimodal Hand Hygiene Improvement Strategy and the “My Five Moments for Hand Hygiene” Approach, 2012, World Health Organisation

Terminologie und Konzept der "5 Indikationen zur Händedesinfektion“, 2016, „Aktion Saubere Hände“

1) Strausbaugh LJ. Emerging health care-associated infections in the geriatric population. Emerging Infectious Diseases, 2001, 7:268-271. 12.
2) Schulz M, Mielke M, Wischnewski N. Clusters of infectious diseases in German nursing homes: observations from a prospective infection surveillance study, October 2008 to August 2009. Euro Surveillance, 2011, 16:pii 19881.
3) Gavazzi G, Krause KH. Ageing and infection. Lancet Infectious Diseases, 2002, 2:659-666.