An evaluation of healthcare staff’s perceptions of the World Health Organisation (WHO) ‘5th moment’ for hand hygiene in the prevention of cross infection

Lesley Price, Lisa Ritchie, D. Bunyan, Jackie McIntyre, Jacqui Reilly

Research output: Book/ReportOther report


Hand hygiene is considered one of the most effective measures in reducing and preventing healthcare associated infection. The WHO’s 5 moments for hand hygiene aims to provide healthcare staff with guidance on when hand hygiene should be performed. Compliance with the 5 moments is lowest for the 5th moment; after touching a surface within the patient zone.

The research aim was to evaluate healthcare staff’s perceptions of the WHO hand hygiene moment 5 relative to compliance with this moment. A mixed methods study was conducted in cooperation with Health Board Hand Hygiene Coordinators using focus groups, non-participant observation and survey with focus groups being used to inform the design of the survey tool. The population was healthcare staff observed during the January, March & May 2013 National Hand Hygiene Audits in three Health Boards in Scotland. The purposive sample was any member of staff observed who had an opportunity to perform hand hygiene in accordance with the WHO 5th moment. Of the 484 participants who were observed 410 returned a questionnaire giving a response rate of 85%.

Results showed that overall hand hygiene compliance following the 5th moment was high with 93% of staff taking the opportunity to perform hand hygiene. Compliance with 5th moment for hand hygiene varied according to Health Board but not professional group. Generally staff’s perception of the 5th moment were positive with over 65% expressing the view that it was clearly defined, achievable, valuable, encouraged, widely known and not too time consuming. Participants were less positive about the repetitive nature of the 5th moment with 60% indicating that it was repetitive. There was a positive relationship between the performance of hand hygiene and the perception that the 5th moment was widely known.

The study has shown that although staff were generally positive about the 5th moment for hand hygiene compliance with the 5th moment in practice was less than optimum. Lack of understanding of the guidelines for the 5th moment may be contributing to staff’s perception that it is repetitive. Educational programme should focus on how the 5th moment should be implemented in practice. This along with greater awareness of the 5th moment for hand hygiene could improve compliance further
Original languageEnglish
Place of PublicationGlasgow
Publisher Scottish Infection Research Network
Publication statusUnpublished - 2014


  • healthcare staff
  • WHO
  • 5th moment
  • prevention
  • cross infection


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