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SAVE LIVES: Clean Your Hands

May 04, 2014

WHO SAVE LivesThis year the WHO SAVE LIVES: Clean Your Hands campaign on May 5th focuses on:


“No action today; no cure tomorrow – make the WHO 5 Moments for Hand Hygiene part of protecting your patients from resistant germs”.



Together, we are urged to highlight, explain and promote the way in which the WHO 5 Moments for Hand Hygiene can act as a barrier to stop the spread of resistant organisms.

 As part of the campaign two global surveys have been created, looking at (i) Global Prevalence Survey on Multidrug-Resistant Organisms (MDROs) and (ii) Point Prevalence Global Survey on use of Surgical Antibiotic Prophylaxis (SAP).


This focus on data collection is an ideal opportunity to remind ourselves of principle aims of the WHO 5 Moments approach: the ability to monitor hand hygiene performance AND ensure that such monitoring results in the reporting of meaningful data.


Hand hygiene and Antimicrobial Resistance (AMR)


The link between hand hygiene and AMR is nicely summarised in this blog by Jason Tetro. The cyclical relationship between hand hygiene and AMR further promotes the need for widespread implementation and understanding of the WHO 5 Moments. It is the understanding aspect that I am particularly keen on discussing. Often!


When discussing understanding the WHO 5 Moments, I always find it best to go back to the start…. 

WHO 5 Moments – A User-Centred Approach


WHO 5 MomentsOriginally discussed by Sax et al. (2007) these global guidelines were designed around a user-centred concept. This allowed an evidence based hand-transmission model to be translated into a recognisable, practical healthcare setting.


This translation, from evidence-base to practical use, underpins the training potential of the WHO 5 Moments approach. When discussing hand hygiene, the take home message from Sax et al. (2007) is surely this: make sure it is about the WHY one performs hand hygiene, not only the WHEN.  For this reason education is a large part of the approach too.


We should all make sure that measurement/assessment of hand hygiene training and education is not just focussed on recall. Likelihood of hand hygiene has been seen to differ depending on clinical activity, linked to an instinctive drive for self-protection (Dawson, 2013a, b).  Therefore, simply being able to name the WHO 5 Moments is unlikely to lead to behaviour change.  We need to ensure that healthcare professionals understand WHY hand hygiene is important at all WHO 5 Moments, regardless of their instinctive reaction.


With apathy towards hand hygiene recognised as a challenge, it is vital that the evidence behind required hand hygiene is communicated.


Is Meaning getting lost in Measurement?


Whilst education has been a vital part of the WHO 5 Moments from its inception, I worry that sometimes the link between the WHY and the WHEN gets lost.


Think about how you measure hand hygiene in your setting. 


Hopefully you have been able to incorporate the WHO 5 Moments in some way, with direct observation (the gold standard) likely to feature.  Perhaps you have begun to trial electronic monitoring too. 


But what happens to your findings? 

  • How are they communicated back to your healthcare professionals –individuals working in critical Patient safety scenarios on a daily, hourly basis?
  • Do they know what (if any) behaviours they need to change?  

Think of it this way.  


If you walk into work on a Monday morning and see the latest hand hygiene compliance score for your area is 62%…what does that mean in terms of how you are going to behave differently today?  

  • WHEN do you need more aware about hand hygiene, and WHY?

  • Is your current monitoring system providing you with this information?

To underline this message, let’s use a quote from Sax et al. (2007) to sum up:

“…reporting details on risk-specific hand hygiene performance may increase the impact of any feedback and make it possible to monitor progress in a meaningful way that fully corresponds to training and promotional material.” (p. 17)


About Carolyn Dawson, BSc, MA


Carolyn DawsonCarolyn Dawson is a doctoral researcher at Warwick University exploring healthcare hand hygiene, the potential role of technology and influences of human behavior. Her research explores the challenges faced by healthcare staff in performing hand hygiene and the potential role of technology according to the WHO 5 Moments.  You can gain more insights into Carolyn's doctoral research by visiting her "Exploring Hand Hygiene" blog or following @CHD05 on Twitter. 

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