Hand hygiene for clinicians
The WHO 5 Moments, when to rub and when to wash, and the small rules that make a big difference, in one place.
The WHO 5 Moments
- 1Before touching a patient
- 2Before a clean or aseptic procedure
- 3After a body fluid exposure risk
- 4After touching a patient
- 5After touching a patient’s surroundings
Rub or wash?
| Situation | Alcohol rub | Soap & water |
|---|---|---|
| Before and after touching a patient | Yes | |
| Before gloves on, after gloves off | Yes | |
| Moving from a dirty body site to a clean one | Yes | |
| Hands visibly soiled | Yes | |
| Caring for patients with C. diff or norovirus | Yes | |
| Before eating, after the restroom | Yes |
The small rules
Short natural nails
The space under the nails carries the most germs on the hand. CDC says natural nails shouldn’t extend past the fingertip.
No artificial nails
CDC and WHO advise against artificial nails for staff caring for high-risk patients. Germs survive under them even after hand rub.
Minimal jewelry
Skin under rings carries more germs, and rings make hands harder to clean. Follow your facility’s policy.
Gloves aren’t a substitute
Clean hands before gloving and after removing gloves, never reuse gloves, and change them between patients.
Look after your skin
Sore, cracked skin makes hand hygiene painful, and it gets skipped. Use facility-approved lotion.
The compliance gap
- 40%
Median compliance among hospital staff across 96 studies.
Erasmus et al., 2010 - 38% → 63%
Compliance in one study after alcohol-based rub was introduced.
Cited by CDC - 70%
Of healthcare-associated infections preventable with strong infection prevention programs.
WHO, 2022
Quick questions
How long should I rub with alcohol hand rub?
About 20 seconds, covering every surface, until your hands are dry.
How long should I wash with soap and water?
CDC’s minimum for healthcare workers is 15 seconds of scrubbing. WHO’s full procedure, from wetting to drying, takes 40 to 60 seconds.
Do gloves replace hand hygiene?
No. Hands can get contaminated through tiny tears and when gloves come off. Clean your hands before putting gloves on and after removing them.
What makes compliance go up?
Making alcohol rub easy to reach is one of the clearest wins: in one study cited by CDC, compliance rose from 38% to 63% after it was introduced. Education and caring for staff skin help too.
- WHO. Guidelines on Hand Hygiene in Health Care. 2009.
- CDC. Clinical Safety: Hand Hygiene for Healthcare Workers.
- Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings. MMWR. 2002;51(RR-16).
- Erasmus V, et al. Compliance with hand hygiene guidelines in hospital care: a systematic review. Infect Control Hosp Epidemiol. 2010;31(3):283-294.
- Pittet D, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet. 2000;356:1307-1312.
- WHO. First global report on infection prevention and control. May 6, 2022.