Evaluation of compliance to the World Health Organization's five moments of hand hygiene: Cross-sectional observation of healthcare professionals

Background: Human hands are home to thousands of microorganisms, which may be transmitted to surfaces that the hands come into contact with. When in contact with people who are ailing or have weakened immune systems, some of these microorganisms can cause infections and disease. Correct hand hygiene goes a long way in eradicating these potentially infective microorganisms and forms the cornerstone of infection prevention and control (IPC) within healthcare facilities and beyond. The healthcare industry is constantly challenged by healthcare-associated infections (HAIs) and their negative effects on patient safety and clinical outcomes. Hospitals in Pretoria are facing similar challenges posed by HAIs and there is no report available on compliance of healthcare professionals (HCPs) to the World Health Organization's (WHO) 'five moments of hand hygiene'. Healthcare professional's compliance to all of the five moments of hand hygiene, particularly within the patient zone, is crucial in mitigating and reducing the spread of contact-based infections in the healthcare setting. Methods: A quantitative longitudinal design was used in a covert direct observation of HCP compliance to the WHO's five moments of hand hygiene. The observations were conducted over 4 weeks in three hospitals, covering 25 wards, inclusive of four adult critical care units using the WHO's 'five moments of hand hygiene' observation form. Results: A total of 1906 hand hygiene opportunities were directly observed in three hospitals. Hand hygiene compliance was 17.26% (n = 329). Allied health professionals had higher compliance (23.02%) than medical (19.26%) and nursing professionals (15.76%). The moment before patient contact had the lowest compliance (8.21%) as compared with all other moments. Conclusions: In general, HCPs had low compliance to the five moments of hand hygiene within the patient zone. Allied health professionals had higher compliance than medical and nursing professionals. Compliance in public hospitals was lower than in private hospitals. Critical care units had higher compliance compared to general wards. Healthcare professionals better complied to the moments meant for their safety as compared to those indicated for patient safety.