It probably has not escaped your attention that it’s World Hand Hygiene Day tomorrow, on the 5^th of May. This year, it’s a double-header focussing on hand hygiene and sepsis, under the theme: “Sepsis – it’s in your hands.” But, which is the ‘Cinderella’ Moment for Hand Hygiene? Moment 5, of course: following contact with the patient environment.

Of the WHO’s 5 Moments for Hand Hygiene, Moment 5 (following contact with the patient environment) consistently scores the lowest compliance level in audits. For example, in one study, compliance with Moment 5 was 50% compared with 80% after direct patient contact. Why is this the case? We don’t know for sure, but I suspect it has to do with perceived risk. You would think that contact with a patient carries a greater risk of picking up contamination with an MDRO than contact with a patient’s environment. And yet, somewhat counter intuitively, contact with a patient’s environment carries approximately the same risk of picking up contamination with an MDRO as direct contact with the patient themselves (see the Figure below).

Figure: The under-rated risk of picking up MDRO contamination following contact with a patient’s environment.

Could it be, then, that hand contamination acquired through contact with the patient’s environment is relatively more important than contamination acquired from direct patient contact because you’re less likely to perform hand hygiene following contact with the environment (the Cinderella Moment)? An opportunity for an interesting modelling study here!

I’m not saying that the Cinderella Moment is more important than the others, only that Moment 5 is just as important as Moments 1-4; they all need to go to the ball! The more I think about it, the more I see a staff or patient hand as just another highly mobile surface in the healthcare setting that is rarely disinfectant when it should be (despite our best efforts!) and carries a risk of MDRO transmission.