Hand hygiene is the single most effective way to prevent infections caused by health care. The World Health Organization estimates that out of every 100 patients in acute-care hospitals, 7 in high-income countries and 15 in low- and middle-income countries will acquire at least one healthcare-associated infection during their stay. Clean hands also protect nurses and their families.
The 5 moments
| Moment | When | Examples |
|---|---|---|
| 1. Before touching a patient | Before you approach and touch the patient | Shaking hands, helping them move, taking a pulse |
| 2. Before a clean or aseptic procedure | Immediately before, even if you will wear gloves | Inserting a cannula, giving an injection, wound care, catheter care, mouth care |
| 3. After body fluid exposure risk | Immediately after, and after removing gloves | Taking blood, emptying a catheter bag, handling waste, suctioning |
| 4. After touching a patient | When you leave the patient | After an examination, helping them wash or eat |
| 5. After touching patient surroundings | When you leave, even if you did not touch the patient | Touching the bed rails, bedside table, monitor or call bell |
Rub or wash?
| Method | Time | Use it when |
|---|---|---|
| Alcohol-based hand rub | 20–30 seconds, until dry | Most situations, when hands are not visibly dirty |
| Soap and water | 40–60 seconds | Hands are visibly dirty or contaminated with body fluids; after using the toilet; and when spore-forming organisms such as Clostridioides difficile are suspected, as alcohol does not kill spores |
The technique
Cover every surface: palms, backs of hands, between the fingers, backs of the fingers, thumbs, fingertips and nails, and wrists. The areas most often missed are the thumbs, fingertips and between the fingers.
Common mistakes
- Thinking gloves replace hand hygiene. Gloves have tiny holes, and hands get contaminated when you take gloves off. Clean your hands before putting them on and after taking them off.
- Wearing the same gloves between tasks or patients.
- Forgetting moment 5 after touching only the bed or equipment.
- Not letting alcohol rub dry before touching the patient.
- Long or artificial nails, nail polish, rings and wrist watches, which hold germs; many hospitals require staff to be “bare below the elbows”.
- Skipping hand care. Use the moisturiser provided; cracked skin harbours bacteria and makes nurses avoid hand hygiene.
Leading by example
Patients and families notice what nurses do. Invite them to remind staff to clean their hands, and remind colleagues kindly when they forget. Simple audits with feedback improve compliance on a ward.
Related: World AMR Awareness Week 2026 · Norovirus: why hand gel is not enough
Sources: World Health Organization, Guidelines on hand hygiene in health care and My 5 Moments for Hand Hygiene; WHO Global report on infection prevention and control (2022).
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