Toward improving the World Health Organization fifth moment for hand hygiene in the prevention of cross-infection

Lesley Price, Karen Roome, Lisa Ritchie, Jacqui Reilly, Jackie McIntyre, Jon Godwin, Donald Bunyan

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Background: The World Health Organization recommend 5 moments for when hand hygiene should be performed. This research explores a number of explanatory hypotheses in order to inform future intervention development with regard to improving compliance with the 5th moment.
Methods: A sequential mixed methods study was conducted using non-participant observation and survey with focus groups informing the development of the questionnaire. A total of 484 participants were observed and 410 returned a post-observation questionnaire giving a response rate of 85%. Analysis explored the role of organisational culture, professional culture/practice and individual-level variables in explaining compliance with the 5th moment.
Results: 93% of participants performed hand hygiene following the 5th moment. Compliance varied between regions, but not professional group. Over 65% indicated that the 5th moment was clearly defined, achievable, valuable, encouraged and widely known. However, 60% suggested that it was repetitive. There was a positive relationship between the performance of hand hygiene following the 5th moment and the perception that it was widely known.
Conclusion: Interventions to improve compliance with the 5th moment should focus on promoting awareness of the 5th moment and how it should be implemented in practice. Mechanisms for raising awareness should include education and role modelling.
Original languageEnglish
Pages (from-to)631-635
Number of pages5
JournalAmerican Journal of Infection Control
Issue number6
Early online date5 Feb 2016
Publication statusPublished - 1 Jun 2016


  • perceptions
  • health care staff
  • observations
  • questionnaire
  • hand hygiene
  • 5th moment


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