It’s no secret that antibiotic resistant microorganisms are prevalent around the world, and to the chagrin of both healthcare workers and patients alike, they seem to be here to stay. The U.S. Centers for Disease Control (CDC) estimates that in the United States approximately one in 20 hospital patients gets an infection, while the World Health Organization (WHO) says that healthcare associated infections are affecting hundreds of millions of people around the globe, causing a great deal of illness, death and financial losses for healthcare systems. The good news is the first line of defense against the spread of infection is as simple as hand hygiene.

My Five Moments for Hand Hygiene

World Health Organization (WHO)
My 5 Moments for Hand Hygiene

Even though an ASC may not have the resources and infrastructure that inpatient hospitals have at their disposal, it is no less important to follow the same infection prevention measures. The CDC recommends all healthcare workers make it a priority to implement the WHO’s evidence-based program for hand hygiene called “My 5 Moments for Hand Hygiene.” This easy to learn approach specifies the strategic times when healthcare workers need to carry out hand hygiene to prevent the transmission of microbes to patients, and it has become the standard around the world.

The WHO’s key moments are as follows:

  • Moment 1: Before touching a patient
  • Moment 2: Before clean/aseptic procedures
  • Moment 3: After body fluid exposure/risk
  • Moment 4: After touching a patient
  • Moment 5: After touching a patient’s surroundings

Implementation Strategies

The ASC Quality Collaboration has made it easy to find helpful resources to promote a hand hygiene campaign. Their online “Hand Hygiene Toolkit” consists of links to various resources for training, implementation aids, assessment and monitoring tools, workplace reminders, and guidelines from the CDC, WHO, and other leading authorities. This kit is definitely the go-to resource for any ASC.

Risk Factors for Noncompliance

Moment 1 is probably the most important moment, since hand washing at this point protects the patient from potent microorganisms carried on the worker’s hands from the previous patients they touched, as well as from contamination on their hands due to touching cell phones, computers and other equipment. Unfortunately for patients, a global survey revealed that hand hygiene before care happens less than after care.

Also, research has shown that nurses and women have a greater compliance rate for hand hygiene than doctors and men. It also seems that lack of conveniently located or automated sinks and lack of supplies affect compliance negatively, as well as times when healthcare workers are exceptionally busy. Skin irritation and dryness, forgetfulness and lack of buy-in with the hand hygiene program are other factors that compromise compliance.

Often healthcare workers neglect hand washing when they use gloves. The WHO guidelines specify that hands should be cleansed before gloves are put on and after they are taken off, and that gloves should be changed between each patient.

Strategies to Improve Compliance

When all stakeholders, policy makers and physicians agree to create a climate of patient and workplace safety, and when they give full commitment to support the WHO’s strategy, the ASC can greatly improve upon its hand hygiene protocol.

Healthcare worker education and training, along with visual workplace reminders, convenient sink locations and worker access to an alcohol-based hand rub at the point of patient care are all necessary for good compliance rates.

The best way to assess how well the program is working is by direct observation. Good feedback is vital, and many facilities use rewards and penalties to boost compliance. Another desired outcome of a hand hygiene initiative is improved understanding of microbial transmission and the best hand hygiene practices by all of the staff, which can be measured by the use of questionnaires. In addition, keeping good compliance records, especially in the beginning of implementation, can give the infection control team direction as to where corrective action is needed.

Positive Return on Investment

The effort and investment that a surgery center puts into employing the “My 5 Moments for Hand Hygiene” will limit the transference of infection-causing microorganisms. The result is a positive return not just in safety for the patients but also for the safety of all the healthcare workers. Once the program is in place and resources and focus is diverted, the real challenge for the ASC becomes keeping the hand hygiene momentum going so that compliance rates remain high.

Written by Donna Pleis

Bio: Donna Pleis graduated from the University of Pittsburgh’s dental hygiene program and worked 18 years as a dental hygienist. After receiving a business administration degree, she worked in management within the medical/dental insurance industry.



abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.

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