Program Schedule

Expected vs Actual WHO Five Moments Compliance among Paramedic Emergency Responders

Session: Poster Abstract Session: Hand Hygiene
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC


Background: WHO Five Moments (5M) is the gold-standard for the performance and measurement of Hand Hygiene (HH) compliance in hospital settings. Emergency responders practice in atypical environments where length patient transport time is often critical to clinical outcomes.  To date however, there are no studies demonstrating the expected vs actual time spent on complying with WHO 5M performance indicators in the paramedic population.  

Methods: HandyAudit® was used to collect HH compliance opportunities according to 5M among Paramedics at an urban, level-one trauma center in the USA Rocky Mountain Region. A total of 220 hours of direct HH observations were analyzed over two seasons (2012-2014) of the Respiratory Protection Effectiveness Clinical Trial (ResPECT). WHO 5M compliance was measured in time (hand washing= 50 sec; alcohol rub=25 sec) according to expected and actual.

Results:  A total of 106 paramedic-patient care transports were observed. Actual time spent on HH compliance was significantly lower than expected compliance.  Expected compliance increases total time per patient 5.5-11 minutes depending on HH method implemented (See Table 1). Twenty-one HH observations occurred (12 Alcohol Rubs, 9 Hand Washing) in the external, non-patient care environment (i.e. staff break rooms), thus immeasurable in the context of WHO 5M due to HH performance location.

Table 1.

Conclusion: Paramedic WHO 5M compliance is suboptimal and education on WHO 5M performance indicators is needed.  An emphasis that HH performance is to occur within the context of the patient environment is suggested in order to further increase WHO 5M compliance. Additionally, future HH research in the paramedic population for consideration is a paradigm shift model to account for unique workflow and access to HH issues.


Amy Irwin, DNP, RN1, Sean O'malley, MPH2, Kaitlin Gorman, BS1, Mary Bessesen, MD3, Cynthia Gibert, MD, MSc4, Ann-Christine Nyquist, MD, MSPH5, Trish M. Perl, MD, MSc, FIDSA, FSHEA6, Lewis J. Radonovich, MD7, Maria C. Rodriguez-Barradas, MD8, Michael S. Simberkoff, MD9 and Connie Price, MD10, (1)Medicine, Denver Health Medical Center, Denver, CO, (2)Denver Health, Denver, CO, (3)VA Eastern Colorado Healthcare System, Denver, CO, (4)Washington, DC, VAMC, Washington, DC, (5)Children’s Hospital Colorado, Aurora, CO, (6)Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, (7)VA NY Harbor Healthcare System, New York, NY, (8)Infectious Diseases and Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, (9)VA New York Harbor Healthcare System, New York, NY, (10)Infectious Diseases, Denver Health Medical Center, Denver, CO


A. Irwin, None

S. O'malley, None

K. Gorman, None

M. Bessesen, None

C. Gibert, None

A. C. Nyquist, None

T. M. Perl, None

L. J. Radonovich, None

M. C. Rodriguez-Barradas, None

M. S. Simberkoff, None

C. Price, None

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