title: Toward improving the World Health Organization fifth moment for hand hygiene in the prevention of cross-infection.
abstract: The World Health Organization describes that there are 5 moments during a health care encounter when hand hygiene should be performed. This research explores a number of explanatory hypotheses to inform future intervention development with regard to improving compliance with the fifth moment.
  
  
  
  A sequential, mixed-methods study was conducted using nonparticipant observation and a survey with focus groups informing the development of the questionnaire. A total of 484 participants were observed and 410 returned a postobservation questionnaire; a response rate of 85%. Analysis explored the role of organizational culture, professional culture/practice, and individual-level variables in explaining compliance with the fifth moment.
  
  
  
  Ninety-three percent of participants performed hand hygiene following the fifth moment. Compliance varied between regions, but not by professional group. More than 65% indicated that the fifth moment was clearly defined, achievable, valuable, encouraged, and widely known. However, 60% suggested that it was repetitive. There was a positive relationship between the performance of hand hygiene following the fifth moment and the perception that it was widely known.
  
  
  
  Interventions to improve compliance with the fifth moment should focus on promoting awareness of the fifth moment and how it should be implemented in practice. Mechanisms for raising awareness should include education and role modeling.
authors: Glasgow Caledonian University, Glasgow, United Kingdom. Electronic address: L.Price@gcu.ac.uk.
authors: Lesley
authors: L
authors: Price
authors: Glasgow Caledonian University, Glasgow, United Kingdom.
authors: Karen
authors: K
authors: Roome
authors: Health Protection Scotland, Glasgow, United Kingdom.
authors: Ritchie
authors: R
authors: Lisa
authors: Glasgow Caledonian University, Glasgow, United Kingdom.
authors: Jacqui
authors: J
authors: Reilly
authors: Health Protection Scotland, Glasgow, United Kingdom.
authors: Jackie
authors: J
authors: McIntyre
authors: Glasgow Caledonian University, Glasgow, United Kingdom.
authors: Jon
authors: J
authors: Godwin
authors: Health Protection Scotland, Glasgow, United Kingdom.
authors: Donald
authors: D
authors: Bunyan
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D063373:Hand Hygiene / Q000379:methods*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D014944:World Health Organization
keywords: Health care staff; Observation; Perceptions; Questionnaire