Hand-hygiene compliance: The importance of WHO's "moment 1" in prevention of healthcare-associated infections

Background: Hand hygiene is the single most effective strategy for preventing healthcare associated infections (HCAI) but compliance is usually low and effective improvement strategies are needed. We assessed hand hygiene (HH) compliance with the World Health Organization (WHO) prescribed five moments of hand hygiene among health-care workers (HCW).Methods: A retrospective analysis of one-year data on hand hygiene was done. WHO single observer direct observation technique was used and HH compliance was noted among HCWS.Results: A total of 16,552 opportunities were recorded. Overall compliance as per WHO Guidelines was 69.2%. Sanitation worker had an adherence rate of 73.1% (95% confidence interval [CI]:70.6-75.4) followed by the nurses 71.2% (95% CI: 70.4-72.1). Physicians and technicians had a compliance rate of 64.9% (95% CI: 63.1-66.6) and 64% (95% CI: 60.1-67.9) respectively. Physiotherapists had a compliance rate of 62.2 (95% CI: 50.1-73.2) and the compliance of Phlebotomists was observed to be 23.1% (95% CI: 9.0-43.6). HCW stood best for WHO moment 5 and worst for moment 1 with compliance of 79.1% (95% CI:77.4-80.7) and 55.8% (95% CI:54.5-57.1) respectively.Discussion: The moment 1 of the WHO's five moments is the most important for preventing the transmission of resistant pathogens between patients. Missed opportunities in moment 1 need to be focused on while planning new strategies to promote hand hygiene.