Hand hygiene: the five moments and the technique
- Safe practice
Cleaning your hands at the right moment and in the right way is the simplest measure to prevent infections linked to health care.
What it is
Health workers' hands are the most common route by which germs pass between patients. WHO sets out five moments when hand hygiene is required and a technique that covers every surface of the hands. Rubbing with an alcohol-based product is the preferred method when hands are not visibly dirty: it takes about 20 to 30 seconds, until the skin is dry. Washing with soap and water takes about 40 to 60 seconds and is used when hands are visibly dirty or contaminated with body fluids, and per protocol for certain organisms such as Clostridioides difficile during outbreaks.
What it requires
- Alcohol-based product available at the point of care, close to the bed.
- Natural nails no longer than the fingertips; no artificial nails in high-risk areas.
- Hands and forearms free of rings, watches and bracelets, following institutional policy.
- Soap and water when hands are visibly dirty or after contact with body fluids.
- Skin care with institution-approved lotions: damaged skin holds more germs.
Components
- Moment 1, before touching the patient: protects the patient from the germs on your hands.
- Moment 2, immediately before a clean or aseptic task: keeps germs, including the patient's own, from entering their body.
- Moment 3, immediately after body fluid exposure risk (and after removing gloves): protects the professional and the surroundings.
- Moment 4, after touching the patient, when leaving their side: protects the professional and the care environment.
- Moment 5, after touching objects or furniture in the patient's immediate surroundings, even without touching the patient.
How it is applied (and why)
- Identify the moment: if you are about to do an aseptic task or have just touched the patient or their surroundings, it is time to clean your hands.
- Choose the method: alcohol if hands look clean; soap and water if they are visibly dirty or there was contact with body fluids.
- With alcohol, use enough product to cover both hands completely: if it does not reach, some areas stay unclean.
- Rub palm to palm, each palm over the back of the other hand and between interlaced fingers: these are the areas most often missed.
- Rub the backs of the fingers, rotate each thumb inside the opposite hand and rub the fingertips on the palm: thumbs and fingertips are often skipped.
- Keep rubbing until the skin is dry, about 20 to 30 seconds: alcohol works while it evaporates.
- With soap and water, wet the hands, apply soap and make the same movements; rinse and dry with a disposable towel, about 40 to 60 seconds in all.
- Turn off the tap with the same towel: that way you do not recontaminate your clean hands.
The five moments: when, and whom they protect
| Moment | When | Protects |
|---|---|---|
| 1. Before contact | When approaching the patient, before touching them | The patient |
| 2. Before an aseptic task | Just before a clean or aseptic procedure (tubes, catheters, dressings) | The patient |
| 3. After fluid exposure | Just after any risk of contact with body fluids and after removing gloves | The professional and the surroundings |
| 4. After contact | When leaving the patient after touching them | The professional and the surroundings |
| 5. After the surroundings | After touching objects or furniture near the patient, even without touching them | The professional and the surroundings |
In nursing practice
- Several moments can fall together in one episode of care; one well-done hand hygiene covers those that happen at the same time.
- Hand hygiene is the basis of standard precautions and of infection prevention bundles.
- Change gloves and clean your hands when moving from a dirty to a clean site on the same patient.
- Observing adherence and giving feedback to the team improves compliance.
Common mistakes
- Wearing gloves instead of cleaning your hands.
- Drying the alcohol with a towel or shaking the hands before it evaporates.
- Missing the thumbs, fingertips and the spaces between the fingers.
- Skipping moment 5 because the patient was not touched.
- Using only alcohol when hands are visibly dirty.
Test yourself
Think of the answer, then tap the question to see it.
What are WHO's five moments for hand hygiene?
Before touching a patient, before a clean or aseptic task, after body fluid exposure risk, after touching a patient and after touching the patient's surroundings.
Roughly how long does WHO say an alcohol hand rub takes, and how long a soap and water wash?
An alcohol rub takes about 20 to 30 seconds, until the skin is dry; a soap and water wash takes about 40 to 60 seconds.
When is soap and water preferred over an alcohol hand rub?
When hands are visibly dirty or contaminated with body fluids, and per protocol during outbreaks of organisms such as Clostridioides difficile or norovirus.
Do gloves replace hand hygiene?
No. Hands are cleaned before putting on gloves and after taking them off, because gloves can have defects and hands get contaminated when removing them.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Hand Hygiene: Why, How & When (leaflet: How to handrub, How to handwash, Your 5 Moments for Hand Hygiene) (World Health Organization (WHO), 2009); WHO guidelines on hand hygiene in health care (World Health Organization (WHO), 2009); Clinical Safety: Hand Hygiene for Healthcare Workers (Centers for Disease Control and Prevention (CDC), 2024).
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Representative model, for educational purposes only.