Study: Only 23.2% Compliance Rate With WHO's 5 Moments of Hand Hygiene

Compliance to the World Health Organization's "five moments" of hand hygiene was only 23.2 percent in a Thai hospital, according to a study in Infection Control and Hospital Epidemiology.

Researchers studied compliance to the WHO's five moments of hand hygiene in a hospital in Thailand. WHO recommends healthcare workers perform hand hygiene in five situations:


1. Before touching a patient.
2. Before a clean or aseptic procedure.
3. After body fluid exposure risk.
4. After touching a patient.
5. After touching the patient surroundings.

A researcher observed 123 healthcare workers' hand hygiene practices during these five moments from January to December 2012. Healthcare workers also answered questions about their self- reported compliance rates and questions related to behavioral theories in an interview.

The average compliance rate for all five moments of hand hygiene was 23.2 percent by direct observation, compared with 82.4 percent by self report. Observed compliance was higher for moments four and five, at 38.8 percent and 21.9 percent, respectively, than for moments one, two and three, at 17.9 percent, 16.3 percent and 19.2 percent, respectively.

Factors associated with hand hygiene compliance include the following:

•    Critical care unit encounters
•    Medicine unit encounters
•    Immunocompromised patient encounters
•    Healthcare worker prioritized patient advocacy
•    Action or maintenance stages in the transtheoretical model of behavioral change. In the action stage, the healthcare worker agrees with the five moments of hand hygiene, and in the maintenance stage, the worker continues to commit to this model.
•    Total score on theory of planned behavior questions. This theory includes attitude toward hand hygiene behavior, subjective norm (the perceived expectations of others relative to the behavior) and perceived behavioral control of hand hygiene practice. Healthcare workers with more positive attitudes and higher perceived behavioral control had higher compliance rates.

The authors noted several limitations of the study, including the inclusion of only one direct observation for the five moments for each healthcare worker.

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More Articles on Hand Hygiene:

WHO's 5-Part Hand Hygiene Strategy Improved Compliance in 5 Countries
5 Factors Associated With High Hand Hygiene Compliance

How to Maintain More Than 85% Hand Hygiene Compliance

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