title: Environmental challenges of identifying a patient zone and the healthcare zone in a crowded Vietnamese hospital.
abstract: BACKGROUND
  The application of the World Health Organization (WHO) 'My five moments for hand hygiene' was designed for a healthcare environment with levels of bed spacing and occupancy normally present in developed countries. However, overcrowded healthcare facilities in Vietnam and other challenged settings require strategies to adapt 'My five moments for hand hygiene' in order to meet their situational needs.
  
  
  OBJECTIVE
  To identify the environmental challenges to compliance with the 'My five moments' indications.
  
  
  METHODS
  Overt observation using the WHO hand hygiene audit tool was conducted in two clinical departments at a large teaching hospital in Vietnam. Clinical practice movements and the 'My five moments' indications were detailed diagrammatically.
  
  
  RESULTS
  Sharing a bed is widely practised outside the intensive care unit in this country, which makes visualizing a patient zone according to the WHO instructions difficult. In addition, decreased spacing between shared beds in overcrowded conditions results in the close proximity of patients to the shared healthcare zone. These two barriers prevent attempts to apply the 'My five moments' correctly.
  
  
  CONCLUSIONS
  Undertaking hand hygiene and conducting audits in accordance with the 'My five moments for hand hygiene' assumes a separation of patients and individual healthcare zones. The barriers to applying 'My five moments' include the lack of distinct zones between patients and their shared healthcare zone, and amelioration requires resources beyond current chronic resource challenges. Until environmental resources can meet the western standards required for application of the 'Five moments' principle, healthcare workers urgently need detailed clarification of modifications that would empower them to comply.
authors.affiliation: School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Salmon
authors.affiliation: School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia. Electronic address: m.mclaws@unsw.edu.au.
authors.forename: M L
authors.initials: ML
authors.lastname: McLaws
mesh_terms: D001509:Bed Occupancy; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D004865:Equipment and Supplies, Hospital; D005069:Evaluation Studies as Topic; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods; D063373:Hand Hygiene / Q000379:methods* / Q000592:standards; D006272:Health Facility Environment / Q000458:organization & administration* / Q000592:standards; D006282:Health Personnel; D006295:Health Resources / Q000600:supply & distribution; D006761:Hospitals / Q000592:standards*; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards; D007362:Intensive Care Units / Q000458:organization & administration; D014744:Vietnam / Q000453:epidemiology
keywords: Clinician safety; Hand hygiene; Healthcare-associated infection; Overcrowding; Patient safety; Resource-limited settings