Visualizing the WHO "My Five Moments for Hand Hygiene," framework: A virtual reality training program for improving hand hygiene adherence among nurses.

IntroductionHand hygiene is an important measure in infection prevention to decrease transmission of microbial pathogens. Especially in these last two years, COVID-19 pandemic brought focus on the importance of a correct and frequent hand hygiene. Currently, direct observation is considered the gold standard for hand hygiene surveillance. The purpose of this observational study is to assess healthcare professionals hand hygiene compliance during the World Health Organization's ‘Five Moments for hand hygiene'.MethodsIn this study we examined perceptions, compliance, techniques, and contextual issues of hand hygiene practices among healthcare workers, in three different hospitals. Twelve different wards were observed, including ICU, surgical wards and medical wards. At least 200 hand hygiene opportunities (based on the WHO's ‘Five Moments') were recorded for each ward, using a mobile application called SpeedyAudit™.ResultsThe results showed highly variable levels of adherence to the hygiene practices, with compliance rates ranging from 20% to 84%. There was also a wide variability of compliance between the different moments, with compliance rates ranging from 75% after touching patient surroundings to 59% before touching a patient. Overall, physicians had the worst score among the healthcare workers, resulting in 55% of compliance, while social health operators performed best with 70%.ConclusionsThere is still a huge variability in hand hygiene among healthcare workers. Despite the conceivable Hawthorne Effect influence, general compliance was not optimal. Overall hand hygiene adherence and knowledge should be achieved by implementing hand sanitizer distribution, offering further education and raising awareness on the importance of a correct hand hygiene, for the sake of both patients and healthcare workers.Key messages Hand hygiene adherence and knowledge should be achieved by implementing hand sanitizer distribution, offering further education and raising awareness on the importance of a correct hand hygiene.There is still a huge variability in hand hygiene among healthcare workers.

Hand hygiene in hospitals is vital to limit the spread of infections. This study aimed to identify key beliefs underlying hospital nurses' hand-hygiene decisions to consolidate strategies that encourage compliance. Informed by a theory of planned behaviour belief framework, nurses from 50 Australian hospitals (n=797) responded to how likely behavioural beliefs (advantages and disadvantages), normative beliefs (important referents) and control beliefs (barriers) impacted on their hand-hygiene decisions following the introduction of a national '5 moments for hand hygiene' initiative. Two weeks after completing the survey, they reported their hand-hygiene adherence. Stepwise regression analyses identified key beliefs that determined nurses' hand-hygiene behaviour. Reducing the chance of infection for co-workers influenced nurses' hygiene behaviour, with lack of time and forgetfulness identified as barriers. Future efforts to improve hand hygiene should highlight the potential impact on colleagues and consider strategies to combat time constraints, as well as implementing workplace reminders to prompt greater hand-hygiene compliance. SO WHAT?: Rather than emphasising the health of self and patients in efforts to encourage hand-hygiene practices, a focus on peer protection should be adopted and more effective workplace reminders should be implemented to combat forgetting.

Hand-hygiene compliance: The importance of WHO's “moment 1” in prevention of healthcare-associated infections

BackgroundElectronic hand hygiene (HH) monitoring systems have many potential advantages but there are limited data on wide-scale implementation of these systems.TableHand Hygiene Observations, Improvement in Adherence Rates and SIR Trends by HospitalMethodsWe deployed an electronic HH monitoring system in over 2,100 acute and critical care rooms across 9 hospitals in an academic health system. Badges with a Bluetooth beacon were issued to over 7,000 healthcare workers. Deployment began in early 2020 and was interrupted by the pandemic. The rollout of interventions to improve HH adherence was managed at the hospital level. Healthcare-associated infections (HAIs) were determined by the infection prevention team using standard CDC definitions. Hospital-level HH adherence rates were compared to a composite SIR including SIRs for CLABSI, CAUTI, hospital-onset MRSA bloodstream infections and hospital-onset Clostridiodes difficile infections.ResultsBetween January 2020 and April 2022, there were over 36 million hand hygiene opportunities with an average of 19 observations per staffed room per day. Overall HH adherence improved from 46% to 60%, with significant variation by hospital (4 improving by >25% and 3 by < 5%). Hospitals whose implementation was most delayed showed the least improvement. Preliminary analysis found no relationship between hand hygiene improvement and the SIR composite aggregated by calendar year.ConclusionDespite the challenges of large-scale implementation of an electronic HH system during a pandemic, we demonstrated an overall improvement in HH adherence. The wide variation in improvement among hospitals was due to timing of implementation, variation in the dedicated hospital-specific project management resources and leadership engagement. In addition to technology, successful implementation of electronic HH systems requires dedicated resources and culture change. Pandemic-related staffing challenges, disruption of standard HAI prevention efforts and intensive device utilization confounded our ability to show a relationship between HH adherence and HAI rates.DisclosuresAll Authors: No reported disclosures.

BACKGROUND: Improper hand hygiene (HH) practices are responsible for nearly 40% of health care-associated infections (HCAIs). Good HH measures are the most cost-effective means of reducing its incidence. Health-care workers (HCWs) play an important role in reducing HCAI by adhering to HH and intensive care unit protocols. OBJECTIVES: The objectives of the study are to assess the knowledge regarding HH among nurses using a questionnaire and to assess compliance to the WHO's “My five moments of hand hygiene” among nurses using a mobile application (App). MATERIALS AND METHODS: This was an observational cross-sectional study in a tertiary care center conducted among 100 nurses willing to participate. Their knowledge on hand hygiene was assessed using the WHO questionnaire, and compliance to the WHO's “My five moments of hand hygiene” was assessed by direct observation and documentation using a mobile App (Speedy Audit™, freely downloadable, developed by Handy Metrics Corporation). The data on compliance were entered into the mobile App which saves it as a MS Excel sheet. The knowledge and compliance rate were then calculated using proportions. RESULTS: Of 100 nurses who participated in the study, 72% had good knowledge about HH practices. Overall compliance to “My five moments of hand hygiene” was 73.6%, with 100% compliance for “after body fluid exposure” and “after touching a patient” and 50% for “after contact with patient surroundings.” CONCLUSIONS: Our study has shown that nurses not only have good knowledge about HH practices but have also implemented it. Periodic awareness programs on HH and the provision of adequate hand washing facilities can facilitate better practices.

Background Hand hygiene compliance was incorporated in the Global Patient Safety Challenge initiative by WHO with the goal of reducing the burden of Health care Associated Infections (HAIs), however, compliance rates among healthcare workers remain low. Methods All possible opportunities for Hand Hygiene were recorded for 15 days in a cross sectional study among healthcare workers in a 10-bedded Pediatric Oncology Ward. The observations were noted for all five moments of Hand hygiene by WHO. Each moment was counted as one opportunity. Results Hand Hygiene compliance rates of 53.4%, 42.5% and 32.6% were observed for nurses, doctors and other HCWs respectively. 100% and 26.4% compliance rates were observed for moments 3 and 5 respectively. Nurses had the best compliance in all five moments of hand hygiene. Conclusions Infection trends can vary with hand hygiene indicators. Hand hygiene monitoring is the key intervention in prevention of spread of multi-drug resistant organisms in health care settings.

Background:Hand hygiene is one of the key ways of preventing healthcare-associated infections (HCAI), especially in patients with cancer. The aim of this study was to determine nurses' compliance with hand hygiene guidelines in caring for patients with cancer in a selected center in Isfahan, Iran, in 2016.Materials and Methods:The present observational study was conducted on nurses in a cancer center in Isfahan in 2016. The participants were selected via convenience sampling method. Nurses serving at bedsides and willing to participate were entered into the study. Data were collected through the direct observation of nurses during delivering routine care, using the standard checklist for direct observation of the “five moments for hand hygiene” approach.Results:In the present study, 94 nurses were studied at 500 clinical moments. The overall hand hygiene compliance rate was 12.80%. The highest hand hygiene compliance rate was observed in the after body fluid exposure moment (72.70%). In addition, hand hygiene compliance rate in preprocedure indications (before patient contact and before aseptic procedure) and postprocedure indications (after patient contact, after body fluid exposure, and after patient surrounding contact) were 3.40 and 21%, respectively, which had a significant correlation (p = 0.001).Conclusions:The findings indicate that the hand hygiene compliance rate among nurses was low. Further research in this regard is recommended in order to find the causes of low compliance with hand hygiene and design interventions for improvement in hand hygiene compliance rate among nurses.

Hand hygiene has been empirically proven to prevent cross-transmission of infection, which has led to the development of global guidelines such as the World Health Organization's 'My 5 Moments for Hand Hygiene.' Because of the relatively recent launch of these guidelines (2009) technology designed to assist in measuring hand hygiene compliance appears not to fully acknowledge the influence of the WHO 5 Moments for hand hygiene Consequently, they may not be fit for purpose (FFP). This paper uses a review of the literature on current hand hygiene technology to assess the extent to which these are FFP based on these global guidelines. The results show that there are a variety of technologies available to assist with the monitoring and measurement of hand hygiene levels. However, none appear to explicitly achieve detection of all WHO 5 Moments for hand hygiene, limiting their effectiveness. The authors conclude that a systems approach offers a potential aid for developers aspiring to meet domain specific FFP requirements. Human factors may help guide such developments to meet user and context specific needs.

Improved hand hygiene technique and compliance in healthcare workers using gaming technology

Introduction: Health-care Providers hands become progressively colonized by germs and potential pathogen during patient care. Absence of hand hygiene practices by health care providers possesses high risk to patient’s safety. Hand hygiene practices either by Hand rub by disinfectant or hand washing by Soap & Water is very important for preventing Health Care Associated Infections (HCAIs). Objective: Assessment of Knowledge, Attitude & Perceived Barriers among doctors towards practice of Hand Hygiene during patient care. Materials and Methods: Cross sectional observation study carried among 36 doctors working in 8 indoor departments of a Govt. Tertiary care Hospital. Semi Structured Questionnaires was used for data collection. Data Entry was done in MS excel and was analysed in SPSS software. Categorical Variables was expressed in frequency and Percentage. Result was extrapolated on Graph and Table. Result: 53% Doctors do not have knowledge about “5 moments of hand hygiene”. 92% Doctors realised the importance of practice of Hand hygiene as in prevention of transmission of infection. 61% Doctors realised that forgetfulness’ leads to omission of practice of hand hygiene. Perceived Barriers to practice Hand Hygiene identified were increased workload, lack of water, sinks, hand rubs and antiseptic solutions in the practice area. Conclusion: The study identifies the knowledge gap still exist among Doctors regarding Hand hygiene and although Doctors have good attitude towards hand hygiene, Perceived barriers which are rectifiable prevents them from practicing hand hygiene everywhere and all the time. Keywords: Hand hygiene, Doctors, Knowledge, Attitude, Perceived barriers, Health Care Associated Infections.

Background and Objective: Nosocomial infections from inconsistent hand hygiene (HH) significantly increase morbidity, mortality, and healthcare costs globally. To address this, the World Health Organization (WHO) introduced the “Five Moments for Hand Hygiene” in 2009, emphasizing critical points for HH to prevent healthcare-associated infections. Despite its importance, compliance among healthcare workers (HCWs), particularly in resource-limited settings like Tanzania, remains challenging. This study assessed awareness and compliance with the “Five Moments” in Misungwi District Council. Methods: This was a cross-sectional study design to assess HH compliance among HCWs in Misungwi District. A mixed-methods approach combined quantitative observations of compliance and qualitative surveys exploring barriers and enhancers. A multistage random sampling technique selected 154 participants from Comprehensive Emergency Obstetric Care (CEmOC) facilities. Data collection involved questionnaires and checklists. The Statistical Package for the Social Sciences was used to analyze sociodemographic and compliance data. Results: The study revealed that a total of 154 participated, whereby the response rate was 33%, and most participants were female. The mean and mode age for participants were 39.05 and 34.5 years, respectively, but the age of 30–39 had the highest frequency. Furthermore, the study result showed that 95 (61.7%) had working experience between 5 and 10 years. HH awareness was low, with 53.9% answering fewer than three questions correctly. Compliance averaged 37.87%, with the highest adherence after touching body fluids (93.6%) and the lowest before touching patients (14.8%). Key barriers included lack of awareness (88.7%) and irregular water supply (84.8%), while guidelines (82.5%) and a suitable environment (77.5%) were key enhancers. Conclusion and Implications for Translation: Based on the Five Moments HH awareness, compliance is low in Misungwi District CEmOC facilities, requiring targeted education, adequate resources, and barrier mitigation. Promoting a culture of HH can enhance compliance, reduce infections, and improve patient safety. A collaborative approach involving healthcare leaders, staff, and stakeholders is essential for sustainable improvements.

Background: Appropriate hand hygiene is one of the most important ways to reduce the transmission of pathogens and prevent healthcare-associated infections (HCAIs), but the rate of compliance among doctors remains low. The purpose of this study is to evaluate the impact of the COVID-19 pandemic on the rate of hand hygiene compliance among doctors during outpatient consultations. Method: This study was conducted on doctors providing outpatient care at Mie University Hospital (Japan) from January 2019 to December 2023. The electronic counting device, Hand Hygiene Monitoring System Compleo-IO, was used, which automatically tallies the amount of alcohol-based hand sanitizer used by installing a wireless device under the hand sanitizer dispenser. The hand hygiene compliance rate was calculated by dividing the number of times hand disinfection was performed by the number of patients receiving outpatient care. We measured the hand hygiene compliance rate of each department and each doctor every month, and evaluated the changes in the impact of the pandemic on the hand hygiene compliance rate. In addition, we categorized the compliance rate into poor (0% to < 25%), average (25% to < 50%), and good (50% or more) categories, and visually evaluated the transition of the categories over the years. Result: The hand hygiene compliance rate in 27 departments was 24.8% on average before the pandemic (2019), but rose to 35.2-39.4% in the early stages of the pandemic (2021-2022). However, in the late stages of the pandemic (2022-2023), it had returned to baseline values of 25.4-27.2%(figure1, 2). The hand hygiene compliance rate among individual doctors (based on 97 doctors for whom data could be measured continuously over a five-year period) was similarly 26.9% on average before the pandemic, but rose to 32.1% - 37.7% in the early stages of the pandemic. However, in the late stages of the pandemic, it had returned to baseline values of 26.0-26.6%(figure 3,4). Conclusion: During the unprecedented COVID-19 pandemic, hand hygiene compliance rates increased in the early stages of the pandemic, but eventually returned to pre-pandemic levels. We hope to use this experience to help us improve compliance rates on an ongoing basis.

Background: Adherence to the five moments of hand hygiene in hospital settings plays a crucial role in preventing healthcare-associated infections (HAIs). Despite the widespread dissemination and acceptance of these guidelines, nurses’ compliance rates remain suboptimal in many healthcare institutions. Numerous factors have been identified as influencing nurses’ adherence to the five moments of hand hygiene. Purpose: To identify factors associated with nurses' compliance with the five moments of hand hygiene in reducing healthcare-associated infections. Method: This study employed a quantitative, non-participatory observational design using a cross-sectional correlational approach. A total of 334 nurses from Prof. Dr. I.G.N.G. Ngoerah General Hospital were recruited as participants. Data were collected through structured questionnaires and analyzed using univariate, bivariate, and multivariate statistical methods. Results: Overall, the compliance rate of nurses with the five moments of hand hygiene was 62.0%. The main factors significantly associated with compliance included the type of treatment room (p = 0.007; AOR = 2.116; 95% CI: 1.225–3.656), belief (p = 0.001; AOR = 16.596; 95% CI: 4.726–58.279), and glove use (p = 0.001; AOR = 5.957; 95% CI: 3.430–10.340). Conclusion: The key determinants affecting compliance with the five moments of hand hygiene include nurses’ beliefs, the use of gloves, and the type of treatment room. Beyond the variables examined in this study, additional predictors such as patient conditions, stress levels, workload, and socio-cultural influences may also contribute to variations in nurses’ adherence to the five moments of hand hygiene.

Background: Wearing of gloves by health-care workers (HCWs) reduces the transmission of pathogens between patient contacts. However, it is not a substitute for hand washing. The present study aimed to observe the gloving behavior versus its indications and hand hygiene (HH) compliance with and without gloves. Materials and Methods: HCWs working in intensive care units (ICUs) and acute care setup of a tertiary care hospital were observed for the use of gloves and HH practices as laid down by the World Health Organization (WHO). Results: Of a total 4301 opportunities, HH actions were performed in 2312 (53.74%) opportunities. In ICU, of 2053 opportunities, HH actions were performed in 1169 (56.94%) opportunities, which was better than other acute care settings where HH was performed in only 50.8% occasions. Out of 1989 missed opportunities where HH was not performed, in 525 occasions (26.39%) the gloves were worn. Conclusion: The rate of HH compliance was higher in ICU than other acute wards. At the same time, HH rate was lower when gloves are worn. Sensitizing HCWs about the WHO five moments of HH and glove pyramid can improve HH practices and gloving practices.

Objective To assess hand hygiene compliance in selected primary hospitals in Ghana. Design A cross-sectional health facility-based observational study was conducted in primary health care facilities in five regions in Ghana. A total of 546 healthcare workers including doctors, nurses, midwives and laboratory personnel from 106 health facilities participated in the study. Main outcome measures The main outcome measures included availability of hand hygiene materials and alcohol job aids; compliance with moments of hand hygiene; and compliance with steps in hygienic hand washing. These were assessed using descriptive statistics. Results The mean availability of hand hygiene material and alcohol job aids was 75% and 71% respectively. This was described as moderately high, but less desirable. The mean hand hygiene compliance with moments of hand hygiene was 51%, which was also described asmoderately high, but less desirable. It was observed that, generally, hand hygiene was performed after procedures than before. However, the mean compliance with steps in hygienic hand washing was 86%, which was described as high and desirable. Conclusion Healthcare workers are generally competent in performance of hygienic hand washing. However, this does not seem to influence compliance with moments of hand hygiene. Efforts must therefore be made to translate the competence of healthcare workers in hygienic hand washing into willingness to comply with moments of hand hygiene, especially contact with patients.