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WHOMoments

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¤Need for clear,robust and simple conceptual framework

¤User-centred designapproach

¤Incorporating strategies of²humanfactorsengineering,

²cognitive behaviour science

²elements ofsocial marketing,

¤Tested within the targetpopulation

Saxetal.JHosp Infect2007;67:9-21

¤ Universally/globallyapplicable

¤ Includesallpossiblecontacts(holistic)

¤ Mostpeoplehave5fingers

² 5fingers(perhand)thattransmit

² Easytoremember

² Hand-logothathasnoothermeaning

Don’t likeHH

Peace – evenifyou don’t wash

Cornuto

Thumb needsnocleaning

Lessmoments Moremoments

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¤ Myfirsttrytodefinemoments¤ 30+yearsago¤ 20+GermanInfectionControlpeople¤ 2daysofformulatingmoments¤ Theresult

² afewhundredcategorizedindicationsforHH² publicationofaverylonglist

Perfectresultusedforguidelinesand…absolutelyun-implementable

plus2momentenenenkelevoorbeelden… dus5momentennognietvoldoende

¤ Between40-50 momentsperpatient/dayonamixedsurgicalunit(measuredon3continents)

¤ Assumingthat² 70%ofallcontactsarebynurses² 80%ofallcontactsareoverthetwodayshifts(40%pershift)² Onenurseseeing4patientsduring8hourshift² à 56HHmoments/shift/nurseor

à 7HHmomentsperhourofwork

Isthis too much to ask?

*observations based on5Moments

One momentlessby combining

moment4and 5

While 4instead of5moments,it doesn’t changeathing

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combined

deleted

¤ 5momentsistoomuch!¤ 4momentsalaWHOLTCF(combined4=5)isnorealhelp¤ 3momentsalaOPDCWZissomethingHCWslike,butisnot

offeredforhealth-carewithinthehospital

Two questions: What doHCW’s want?What isthe main problem?

We don’t know, but less

¤ Safetyroundlookingatpreparationofmedicationwithinmyhospitalincludeshandhygiene.HHComplianceduringstandardsafetyround:75%

¤ Under-cover,blindobservationsshowedasignificantcompliancereductionformanyoftheobservedtasks.HHComplianceduringunder-coversafetyround:5%

70%ofHCWs know what isneeded butchoose not to doit !(nextto the 25%who don’t know and don’t doit,orjust don’t care)

Mypersonalbias:

“Many HCWs only know and wantone moment*namely when they think that it isneeded”

* Idohavea(slightlydifferent)onefingergesturethatwouldexpressmythinkingaboutthiskindofbehavior

¤ Socialcontacts needstobeexcludedasitpresentlyincludesmoment1(before)andmoment4(after)

¤ Myquestions(notanswers)²Whatissocialcontact?² Socialcontactswithwhichkindofpatients?

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Internal Medicinetaking puls

Surgeonexaminesforearm

Neurologistcheckingbiceps

Orthopedicsurgeoncheckingrotatorcuff

Internal Medicinetaking puls

Surgeonexaminesforearm

Neurologistcheckingbiceps

Orthopedicsurgeoncheckingrotatorcuff

AlternativeScenario

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¤ Highest transferofbacteria:hand-shake

¤ Lowest transferofbacteria:fist bump

(highfivewasinthemiddle)

¤ Explanation:handshakes havethegreatestsurface areaincontact,for alonger time

Mela etal.AmJInfectControl2014;42:916-7

¤ Themicrobes can’tdifferentiate betweencareand social contact…

A B

Whichoneissocialcontactskin?SomeDutchtoldmethatIshouldnotcolonize“that”skin

¤ Theproblemaboutthat(risk)approachisthatnon-complianceasweknowit,alreadyistheconsequenceofHCWsusingtheirownrisk-estimate.(Theonemomenttheory)

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• The emotions of people whohave no other plan

• Some thinking still needed• Social contact

(if you believe in it)• People don’t like to be told

when to do what

• Simple and clear• Universally applicable• Everything included• Best for most settings• Was adjusted for some

settings• Not seen a better plan

Foraslongasyouhavenobetter,universallyapplicableandeasytomemorizeplan…