What are the 5 movements of hand hygiene?

The 5 Moments of Hand Hygiene

The World Health Organization defines 5 critical moments when healthcare workers must perform hand hygiene to interrupt microbial transmission during patient care. 1

The 5 Moments Are:

1. Before touching a patient - Decontaminate hands before having direct contact with patients to protect the patient from harmful microorganisms carried on your hands 1

2. Before clean/aseptic procedures - Decontaminate hands before donning sterile gloves for procedures like inserting central lines, urinary catheters, peripheral vascular catheters, or other invasive devices to prevent introduction of pathogens into sterile body sites 1

3. After body fluid exposure risk - Decontaminate hands after contact with body fluids, excretions, mucous membranes, nonintact skin, and wound dressings to protect yourself and the healthcare environment from patient microorganisms 1

4. After touching a patient - Decontaminate hands after contact with a patient's intact skin (such as taking a pulse, blood pressure, or lifting a patient) to protect yourself and the healthcare environment from patient microorganisms 1

5. After touching patient surroundings - Decontaminate hands after contact with inanimate objects and medical equipment in the immediate vicinity of the patient to protect yourself and the healthcare environment from patient microorganisms 1

Proper Hand Hygiene Technique

For Alcohol-Based Hand Rub:

• Apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are completely dry 1
• Follow manufacturer's recommendations for volume of product 1

For Soap and Water (when hands are visibly soiled):

• Wet hands first with water 1
• Apply manufacturer-recommended amount of soap 1
• Rub hands together vigorously for at least 15 seconds, covering all surfaces of hands and fingers 1
• Rinse hands with water 1
• Dry thoroughly with disposable towel 1
• Use towel to turn off faucet 1

Critical Additional Moments

Always decontaminate hands immediately after removing gloves - gloves do not provide complete protection and hands can become contaminated during glove removal 1

Decontaminate hands when moving from a contaminated body site to a clean body site during patient care - this prevents cross-contamination on the same patient 1

Common Pitfalls

• Only 72% of healthcare workers achieve satisfactory hand coverage even immediately after training, with the dorsal and palmar aspects of hands most commonly missed 2
• Fingertips are inadequately cleaned in 3.5% of instances despite being high-risk areas for pathogen transmission 2
• Nurses perform better than other healthcare workers (77% pass rate), and women perform better than men (75% vs 62%) 2
• The concept requires clear visualization of "patient zones" versus "healthcare zones," which can be challenging in overcrowded or resource-limited settings 3