References
The ‘5 Moments for Hand Hygiene’: casting a critical eye on the implications for practice

Abstract
The ‘5 Moments’ approach is a time–space framework that delineates when hand hygiene should be performed and provides a resource for educators and auditors. It has become the dominant paradigm for organisations, practice, policy, and research in relation to hand hygiene. It is a concept that adopts the ‘precautionary principle’ that if the relative risk of a specific care task is unknown, a safe system must be to treat them on an equal level. However, a literal interpretation will frequently result in an extraordinary, implausible number of hand-hygiene opportunities and if this then becomes the standard to audit practice, within a policy document that espouses zero tolerance, it is likely to generate inauthentic data. If used effectively the 5 Moments concept provides an opportunity to enhance practice and reduce healthcare-associated infections but the healthcare provider organisation must embody a ‘just culture’ and collect the data in a climate of openness, transparency, and learning.
A healthcare-associated infection (HCAI) is defined as a problem that develops as a direct result of healthcare interventions, for example, medical or surgical treatment, or because of direct contact with a healthcare setting (NICE Clinical Knowledge Summaries, 2024). It is the most common adverse incident experienced by people in hospital and is something that pervades all healthcare systems regardless of the resources available. In a modelling exercise Guest et al (2020) estimated that in any given year there are approximately 834 000 HCAIs in the NHS in England with 28 500 deaths. This translates to 7.1 million occupied bed days, equivalent to 21% of the annual number of bed days across all NHS hospitals. The financial cost of HCAI is thought to exceed £2.7 billion. In addition, it is responsible for 79 700 days of absenteeism among frontline health professionals (Guest et al, 2020). The causes of HCAI are multifactorial, but many of the pathogens responsible are spread through the contaminated hands of healthcare workers (HCWs) (Loveday et al, 2014).
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