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

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
196 Downloads (Pure)


Background The World Health Organization describes that there are 5 moments during a health care encounter when hand hygiene should be performed. This research explores a number of explanatory hypotheses to inform future intervention development with regard to improving compliance with the fifth moment. Methods A sequential, mixed-methods study was conducted using nonparticipant observation and a survey with focus groups informing the development of the questionnaire. A total of 484 participants were observed and 410 returned a postobservation questionnaire; a response rate of 85%. Analysis explored the role of organizational culture, professional culture/practice, and individual-level variables in explaining compliance with the fifth moment. Results Ninety-three percent of participants performed hand hygiene following the fifth moment. Compliance varied between regions, but not by professional group. More than 65% indicated that the fifth 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 fifth moment and the perception that it was widely known. Conclusions Interventions to improve compliance with the fifth moment should focus on promoting awareness of the fifth moment and how it should be implemented in practice. Mechanisms for raising awareness should include education and role modeling.
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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