The five moments
Answer all nine, then press Check my calls.
1Before touching a patient. Protects the patient.
2Before a clean or aseptic procedure. Protects the patient — and this is the moment most often missed, with the shortest path to harm.
3After body-fluid exposure risk. Protects you and everyone else.
4After touching a patient. Protects you and the environment.
5After touching patient surroundings — even if you never touched the patient.
Soap and water is required, and alcohol is inadequate, in five situations: visibly soiled hands or contamination with blood or body fluids; after caring for a patient with Clostridioides difficile; during outbreaks of norovirus; after known or suspected exposure to Bacillus anthracis; and before eating and after using the restroom. The reason is chemistry, not tradition — alcohol does not kill bacterial spores, and non-enveloped viruses such as norovirus are far less susceptible to it. Only the mechanical friction and rinsing of handwashing physically removes spores from the skin.
Technique is the mechanism. Alcohol-based hand rub contains 60 to 95 percent alcohol: apply a full palmful and rub every surface for about 20 to 30 seconds until the hands are completely dry. Do not wave, blow or wipe them dry — the contact time is the kill. To wash: warm (not hot) water, soap, vigorous lather over all surfaces for at least 20 seconds, rinse with fingertips pointing downward so water runs clean to dirty, dry with a paper towel and use that towel to turn off the faucet. The whole procedure takes 40 to 60 seconds. The surfaces people miss are the thumbs, fingertips, nail beds and web spaces — so start there deliberately.
Nails, rings and skin. Keep natural nail tips shorter than a quarter inch (about 0.6 cm). No artificial nails, extenders, wraps or chipped polish for direct care of high-risk patients — artificial nails harbour gram-negative bacilli and yeast and have been traced to fatal neonatal intensive-care outbreaks. Rings raise the microbial load and spoil glove fit. If your hands crack, use the facility-approved lotion: damaged skin sheds far more organisms, and petroleum-based products degrade latex gloves.
Why the order is the order
Place all five steps, then press Check the sequence.
Two memory hooks that hold under pressure. Donning moves head-to-toe in size order and ends with gloves: gown, mask, goggles, gloves — after hand hygiene. Doffing removes the dirtiest item first and the mask last: gloves, goggles, gown, mask. The gown always comes off before the mask, hand hygiene belongs between steps and at the end, and the respirator is the only item ever removed outside the room. Some facilities teach a combined gown-and-glove removal in one motion — acceptable when you have been trained in it, and the order of everything else is unchanged.
Sharps discipline
Tick the safe practices and press Check.
After the exposure
Tick the first-five-minute actions and press Check the response.
Why the urgency is real. The average risk of transmission from a percutaneous exposure to infected blood is roughly 0.3 percent for HIV, about 1.8 percent for hepatitis C, and up to 30 percent for hepatitis B in an unvaccinated worker — which is precisely why the hepatitis B vaccine series is required before clinical rotations. HIV post-exposure prophylaxis is most effective started within hours and should begin no later than 72 hours after exposure. Reporting at the end of the shift can put you past the window.
Standard precautions apply to everyone, always. Treat the blood, all body fluids except sweat, non-intact skin and mucous membranes of every patient as potentially infectious, regardless of diagnosis or known status — you never need a positive test to justify protecting yourself. The components: hand hygiene; PPE selected by anticipated exposure; respiratory hygiene and cough etiquette, including a mask for the coughing patient and at least three feet of separation in waiting areas; safe injection practices — one needle, one syringe, one time, and never re-enter a single-dose vial; safe handling of contaminated equipment and linen; environmental cleaning; and sharps safety.