Hand Hygiene Compliance: Is Measurement of "In & Out" Comparable to the WHO 5-Moments and Does it Truly Reflect the Risk to Our Patients

Background: :The World Health Organization (WHO) has recommended the 5-Moments of Hand Hygiene as the preferred method of hand hygiene monitoring. Many hospitals continue to monitor hand hygiene performance of healthcare workers (HCW) entering and exiting the room, assuming that performance at these points is a surrogate for the other moments

Methods:

The aim of the study was to compare the distribution of the WHO 5-Moment patient care activities between hand hygiene opportunities (HHO) involving entry/exit of patient rooms versus HHO contained within the patient rooms. A previous report from our institution provided data on 4522 HHO captured on 24-hour surveillance video monitoring within patient rooms. For the current study, HHO were grouped as follows:

(1) Entry: Door entry and Moment 1 (before touching patient)

(2) Exit: Door exit and Moments 4 or 5 (after touching patient or patient surroundings) but not both 4 and 5 within same HHO

(3) Inside Room: No involvement of entry/exit and any of the 5 moments

Results:Of the 4522 HHO, 2940 (65%) involved entry/exit and 1582 (35%) did not. Activities involving moments 2 or 3 (before aseptic technique or after body fluid exposure --the 2 highest-risk moments), occurred more frequently “Inside Room” compared to “Entry/Exit” of room (27.5% vs 11.5%). Of the Moment 5s observed inside the room 47% involved “higher risk” touches such as bed, bed table, or IV pump. Compliance rates differed significantly (P<001) between the HHO groups and were 79.4%, 61.9%, and 72.7% for entry, exit, and inside room, respectively.

Conclusion: Sole measurement of entry/exit hand hygiene compliance misses a significant number of HHO. In addition, many of the missed “inside room” HHO appear to be “riskier” moments (2 & 3) involving greater chance of contamination. The potential knowledge gap surrounding missed moments prevents opportunities for potentially valuable HCW feedback and remediation.