In the patient zone: healthcare staff's perceptions of the 5th moment

Valerie Ness, Lesley Price, Lisa Margaret Ritchie, Jacqui Reilly, Jackie McIntyre, Jon Godwin, D. Bunyan

Research output: Contribution to conferencePaperpeer-review


Introduction: Hand hygiene is one of the most effective measures in preventing healthcare associated infection. The 5 moments for hand hygiene provides guidance on when hand hygiene should be performed. Compliance with the 5 moments is lowest for the 5th moment. The research aimed to evaluate healthcare staff’s perceptions of moment 5 for hand hygiene relative to compliance with this moment.
Methods: A mixed methods study was conducted using focus groups, non-participant observation and survey with focus groups informing the design of the questionnaire. The population was healthcare staff observed during three National Hand Hygiene Audits in three Scottish Health Boards. The purposive sample was staff observed who had an opportunity to perform hand hygiene in accordance with the 5th moment. Of the 484 participants observed 410 returned a questionnaire; a response rate of 85%.
Results: Results showed that hand hygiene compliance following the 5th moment was high with 93% of staff performing hand hygiene. Compliance varied with Health Board (¿²3 (2)=10.3, 1p=0.006) but not professional group (¿²3=5.3, 1p=0.2). Staffs’ perception of the 5th moment were positive with over 65% indicating 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 compliance and the perception that the 5th moment was widely known (Mann-Whitney U, 2p <0.001).
Discussion: Although staff were generally positive about the 5th moment hand hygiene compliance was not optimum. Lack of understanding of the guidelines regarding the implementation of the 5th moment may be contributing to staffs’ perception that it is repetitive. There provides an opportunity to improve compliance by focusing education to raise awareness of the 5th moment and how it should be implemented in practice.
Original languageEnglish
Publication statusUnpublished - 2014


  • hand hygiene
  • mixed methods study
  • Health care staff
  • spread of infection


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