Hand hygiene shortcuts: knowing why they happen can improve everyone’s practice

It's all too easy to push hand-washing protocols aside when you’re under pressure – so recognising when this happens can help keep patients safe

It's all too easy to push hand-washing protocols aside when you're under pressure – so recognising when this happens can help keep patients safe 

Picture: Jim Varney

We know compliance with hand hygiene protocols has a significant effect on the prevention of healthcare-acquired infections (HAIs). Yet compliance with best practice standards is patchy to say the least.

In recent years, there has been an improvement in hand hygiene practice, much of it related to the WHO campaign SAVE LIVES: Clean your hands. This campaign introduced the ‘five moments’ principle identifying the five occasions in clinical care where hand hygiene is mandatory.

However, the expectation that nurses and other health professionals practise effective hand hygiene at every one of the ‘five moments’ is a long way from being met. If we are to improve, we need to understand why compliance is low.

Five moments of hand hygiene

  • Before touching a patient
  • Before clean/aseptic procedures
  • After body fluid exposure/risk
  • After touching a patient
  • After touching patient surroundings

Source: World Health Organization


Different factors have been investigated, including comparing different professions’ compliance with hand hygiene. Generally, doctors are less compliant than nurses. Higher workloads are more commonly associated with lower compliance, while positive role modelling and a culture that encourages hand hygiene is related to higher compliance.

My investigation of compliance with the ‘five moments’ showed that the highest level of compliance with hand hygiene requirements is following patient care and exposure to body fluids; the lowest compliance is after touching patients’ immediate environment and before an aseptic task.

We’re human – and liable to make mistakes

Humans are able to multitask, problem-solve and undertake extremely complicated activities, but we have limited cognitive processing capacity and in busy stressful situations with multiple interruptions are liable to forget elements of a task or make a mistake. People choose to depart from specified procedures because of perceived lack of time, resources, knowledge or, because shortcuts have become routine in their workplace. There is no intention to do harm, rather it is about weighing up the potential risk.

A nurse may choose to omit hand hygiene at one of the ‘five moments’ when constrained by time and workload and because they believe there is low risk of infection. If an infection does occur, it will seem distant in time from the lapse in protocol, and it is rarely possible directly to link it to a single act of omission.

How you can improve compliance 

The following strategies are ones you can use to ensure you contribute to effective hand hygiene protocols and therefore preventing infections:

  • Be mindful and conscious that when you are busy and short staffed, with multiple interruptions you are more likely to forget to complete hand hygiene protocols.
  • Work with others in your team to develop cues to remind each other discretely if you observe one another omitting hand hygiene requirements.
  • Empower your patients and families to remind you if they note you forgetting one of the ‘five moments’. Remember though that patients and families will feel vulnerable reminding you to wash your hands and will need plenty of encouragement.
  • Become a hand hygiene champion and role model to other health professionals. Use the current literature, posters and your healthcare hand hygiene audits to support your declarations.

Big changes happen when ordinary people commit.

Further reading

Read about the WHO’s SAVE LIFES: Clean your hands campaign

 Heather Gluyas is associate professor and honorary research fellow, Murdoch University, Western Australia


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