The
5
Moments Model
1 2 3 4 5
Before touching a patient
Before a clean / aseptic procedure
After body fluid exposure risk
After touching a patient
After touching patient surroundings
In my view , the WHO ’ s My Five
Moments sets the bar unhelpfully high , but once it was set thus , it is very difficult to move away from it without appearing as if one is watering it down .” — Jacob McKnight , PhD
support for this regime of hand hygiene as a means of reducing healthcare-associated infections ,” and cautioned further , “ Consensus-based guidelines based on weak scientific foundations should be assessed carefully to prevent shifting the clinical focus from more important issues and to direct limited resources more effectively . We recommend caution in the universal adoption of the WHO ’ s Five Moments of Hand Hygiene ’ … and emphasize the need for evidence-based principles when adopting hospital guidelines aimed at promoting excellence in clinical practice .”
In the years since , the Five Moments framework has prevailed but recently , some experts have come to question the absolute reign of this framework . As Gould and Purssell , et al . ( 2022 ) observe , “ The Five Moments are the dominant paradigm used to organize practice , policy and research in relation to hand hygiene ,” but they identify five “ inconvenient truths ” limiting the Five Moments and beg the question of whether the development of a more effective paradigm is possible .
The WHO ’ s Five Moments framework has been the dominant hand hygiene paradigm — with the Centers for Disease Control and Prevention ( CDC )’ s recommendations and the Compendium recommendations from the Society for Healthcare Epidemiology of America ( SHEA ) followed in the U . S . – but is it a blind loyalty ? In healthcare , practitioners are often advised to consider the local as well as the global when identifying and implementing the best clinical strategies for improving patient outcomes , but the WHO ’ s paradigm seems to eclipse other approaches .
“ I believe it ’ s due to a common logical fallacy associated with the idea that the best logic must be the most rigorous one ,” says Jacob McKnight , PhD , of the Health Systems Collaborative , Nuffield Department of Clinical Medicine , Oxford , UK . “ In my view , the WHO ’ s My Five Moments sets the bar unhelpfully high , but once it was set thus , it is very difficult to move away from it without appearing as if one is watering it down .”
McKnight , who was a co-author on the Gould and Purssell , et al . ( 2022 ) paper , continues , “ I ’ m also interested in the mindset of those who designed the approach . You can hardly fault the research – they were very thorough in their approach , and the
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Identifying the Critical Gaps in Hand Hygiene Science
By Kelly M . Pyrek
Addressing notable gaps in hand hygiene science , the International Conference on Prevention and Infection Control ( ICPIC ) ABHR Taskforce recently provided a synthesis of evidence and formulate a research agenda on four critical areas for the implementation of effective hand hygiene practices : ABHR formulations and handrubbing techniques ; low-resource settings and local production of ABHR ; hand hygiene monitoring and technological innovations ; and hand hygiene standards and guidelines .
Tartari , et al . ( 2024 ) report on the findings from the September 2023 meeting of the ICPIC ABHR Taskforce where 42 experts in infection prevention and control ( IPC ) convened to identify some notable gaps in hand hygiene science , specifically redefining hand hygiene-related actions in terms of technique , volume , and duration .
Regarding hand hygiene technique , the taskforce emphasizes that efforts aimed at improving hand hygiene have “ primarily targeted increasing compliance rates with hand hygiene opportunities . However , the quality and technique of hand hygiene action , or the “ How to Handrub ” method , which is essential to assure complete coverage of hands with ABHR , has been overlooked .”
Additionally , the taskforce points to a scarcity of studies evaluating hand hygiene techniques in clinical settings coupled with the absence of a standardized monitoring tool for assessing adherence to the technique , as critical gaps in current hand hygiene practices .
For example , an observational study in Switzerland reported a contrast between hand hygiene performed in 93.2 percent of all opportunities and low adherence to the World Health Organization ( WHO ) six-step hand hygiene technique at only 8.5 percent , indicating the need for more studies to assess hand hygiene techniques in clinical settings and guide healthcare workers ’ attention to the most contaminated parts of their hands .
There are two primary hand hygiene techniques used in the healthcare setting : The “ 6 steps ” method recommended by the 2009 WHO Hand Hygiene Guidelines ( 2009 ) and the “ 3 steps ” technique created by the Centers for Disease Control and Prevention ( CDC ). As the ICPIC taskforce explains , “ Both techniques have been shown to be equally effective in reducing the microbial load on the hands , but the ‘ 3 steps ’ technique is easier to remember and promote . However , a systematic review found insufficient evidence to determine the most effective and feasible hand hygiene technique in a real clinical setting and called for further robust research on the reproducibility of these findings in clinical settings .”
In that review , Price , et al . ( 2022 ) found four significant studies to help inform about the effectiveness of the two techniques :
● Chow , et al . found no difference in the effectiveness of the WHO 6-step technique compared to the CDC 3-step technique
● Reilly , et al . found the WHO 6-step technique to be more effective .
● Tschudin-Sutter , et al . reported that an adapted 3-step technique that focused on the fingertips and thumbs was more effective than the WHO 6-step technique when tested in laboratory settings ; however , when the authors compared the two techniques in clinical settings , no difference was found .
● Pires , et al . provided evidence on the superiority of the modified 6-step technique (“ Fingertips First ” approach ”) over the standard WHO 6-step technique in reducing bacterial
14 • www . healthcarehygienemagazine . com • may 2024