WHO 5 Moments for Hand Hygiene Explained with Examples

The WHO 5 Moments for Hand Hygiene are the five points in patient care when health workers must clean their hands: before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. The model comes from the WHO Guidelines on Hand Hygiene in Health Care (2009).

Health workers' hands are a major route for spreading microorganisms, including multidrug-resistant organisms, between patients and the environment. The 5 Moments turn a vague instruction into specific actions that can be taught, audited and improved.

The patient zone and the health-care area

The model rests on two spaces. The patient zone is the patient plus their immediate surroundings: bed, rails, bedside table, linen, monitors and other equipment dedicated to that patient. The health-care area is everything outside it, including other patients and the wider ward environment.

One hand hygiene action can satisfy two moments at once, for example Moment 4 for one patient and Moment 1 for the next, provided nothing else is touched in between.

The 5 Moments explained

Hand rub or soap and water?

WHO recommends alcohol-based hand rub as the preferred method for routine hand hygiene when hands are not visibly soiled, because it is faster, more effective against most microorganisms and available at the point of care. A full hand rub takes about 20-30 seconds, covering palms, backs of hands, between fingers, thumbs and fingertips until the hands are dry.

Handwashing with soap and water takes about 40-60 seconds, followed by thorough drying with a single-use towel. Use soap and water:

• When hands are visibly dirty or soiled with blood or other body fluids
• After using the toilet
• When exposure to spore-forming organisms such as Clostridioides difficile is suspected or confirmed, because alcohol does not kill spores
• During norovirus outbreaks, where many infection prevention policies prefer soap and water; follow your facility's policy

Gloves do not replace hand hygiene

Gloves can have tiny defects, and hands are often contaminated during removal. Perform hand hygiene before putting on gloves whenever a moment applies, and always after removing them.

• Change gloves between patients and never wash or rub gloved hands to reuse them
• Change gloves when moving from a contaminated body site to a clean site on the same patient
• Use gloves only when indicated by standard and transmission-based precautions, not as a habit

Nails, jewellery and skin care

• Keep natural nails short; WHO advises nail tips less than 0.5 cm long
• Do not wear artificial nails or extensions if you have direct patient contact
• Remove rings, bracelets and wrist watches before clinical care, following your facility's policy on plain bands
• Use the hand cream your facility provides to prevent dermatitis, and report damaged skin to occupational health

Auditing compliance and giving feedback

WHO's multimodal improvement strategy combines system change (hand rub at the point of care), training, monitoring and feedback, workplace reminders and an institutional safety climate.

Direct observation by trained observers is the reference method. Observers record each opportunity, meaning a moment when hand hygiene is indicated, and whether an action took place. Compliance is the number of actions divided by the number of opportunities, multiplied by 100. Because people improve when watched, add indicators such as hand rub consumption and share results quickly with ward teams.

Worked example: a medication round on a Dubai ward

A staff nurse on a medical ward in a Dubai hospital starts her morning round in a four-bed bay. Her trolley carries hand rub, and each bed has a dispenser.

1. At the trolley: she rubs her hands before preparing an intravenous antibiotic (Moment 2)
2. Bed 1: she rubs hands before checking the patient's wristband and giving oral tablets (Moment 1); after disinfecting the hub and administering the IV dose she rubs again on leaving the bed (Moment 4)
3. Bed 2: the patient is asleep; she silences the infusion pump alarm and adjusts the over-bed table, then rubs hands on leaving (Moment 5)
4. Bed 3: she wears gloves to empty a urinary catheter bag, removes them and rubs immediately (Moment 3), then rubs before giving the patient tablets (Moment 1)
5. Moving to Bed 4: a single action after leaving Bed 3 covers Moment 4 for that patient and Moment 1 for the next

During the month's audit, the infection prevention nurse observed one missed opportunity: the nurse picked up a dropped pen from the floor and went straight to Bed 4. Feedback was immediate, and the ward added pocket-sized hand rub bottles for use at the exact point of care.

Hand hygiene in food handling

In kitchens and food plants, norovirus, hepatitis A, Staphylococcus aureus and Salmonella also spread on hands. Food handlers should wash with soap and water before starting work and handling ready-to-eat food, after using the toilet, after handling raw meat, poultry or eggs, after touching hair, face or phone, and after handling waste or chemicals.

In food businesses, hand sanitiser supplements handwashing but does not replace it. Requirements are set by authorities such as Dubai Municipality, ADAFSA and FSSAI, so confirm the rules that apply to your premises.

Common mistakes

• Using gloves as a substitute for hand hygiene
• Rubbing for a few seconds instead of until hands are dry
• Forgetting Moment 5 after touching only the bed, chart or equipment
• Relying on hand rub when hands are visibly soiled
• Wearing rings, watches or artificial nails during clinical care
• Placing dispensers far from the point of care
• Auditing without sharing results with the team

Key takeaway: Clean your hands at each of the 5 Moments, using hand rub for 20-30 seconds unless soap and water is needed. Gloves never replace hand hygiene, and compliance improves only when audits lead to clear, timely feedback and practical changes at the point of care.

Frequently Asked Questions

What are the WHO 5 Moments for Hand Hygiene?

They are the five times health workers should clean their hands: before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. The model was set out in the WHO Guidelines on Hand Hygiene in Health Care (2009).

When should I use soap and water instead of hand rub?

Use soap and water when hands are visibly dirty or soiled with blood or body fluids, after using the toilet, and when exposure to spore-forming organisms such as Clostridioides difficile is suspected or confirmed. Many facilities also prefer soap and water during norovirus outbreaks. In all other situations, alcohol-based hand rub is the preferred method in health care.

Do I still need hand hygiene if I wore gloves?

Yes. Gloves can have small defects, and hands are easily contaminated when gloves are removed. Clean your hands before putting gloves on whenever a moment applies, and always immediately after taking them off. Never wash or rub gloved hands to reuse them.

How is hand hygiene compliance measured?

The reference method is direct observation by trained observers using a standard observation form. Each moment when hand hygiene is indicated counts as an opportunity, and compliance is the percentage of opportunities where an action was performed. Hospitals often add indirect indicators, such as hand rub consumption, and feed results back to staff.

Next steps

To build practical infection prevention skills, explore Infection Prevention & Control Essentials, which Innoryx offers online to learners in India and the GCC.

Laboratory staff can continue with Laboratory biosafety vs biosecurity, and food sector readers with Food safety culture: what managers can do. Need advice on the right course? Speak to a counsellor.