| Inconvenient truth 1: hand hygiene guidelines need updating. |
Rewrite the guidelines for hand hygiene practice and audit based on newer methodologies, for example National Institute for Health and Care Excellence38 (solution 1). Consider health workers’ and patients’ preferences and opinions (solution 1).
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| Inconvenient truth 2: it is not always possible to implement the Five Moments for all patients all the time. |
Implement hand hygiene dispensers at hospital, clinics and ward entrances and throughout wards with prompts, monitoring at all locations, publicity and national signage (solution 2).
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| Inconvenient truth 3: the concept of the patient zone is oversimplified. |
Place hand hygiene dispensers at hospital, clinic and ward entrances with prompts, monitoring and publicity (solution 2). Introduce a stochastic approach to hand hygiene programmes and audit at agreed ‘set points’ (solution 3). Refresh hand hygiene training to reflect hand hygiene at the agreed ‘set points’ (solution 3). Introduce non-touch technology (eg, automatic doors) (solution 2).
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| Inconvenient truth 4: barriers that can reduce hand hygiene adherence are overlooked. |
Introduce self-disinfecting surfaces and equipment (solution 4). Increase frequency of cleaning in clinical and non-clinical areas, especially high-contact areas (solution 4). Introduce chlorhexidine gluconate into the formulations of handrubs used in clinical areas (solution 4).
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| Inconvenient truth 5: adherence to the Five Moments cannot prevent all risks of transmission. |
Implement hand hygiene dispensers at hospital, clinic and ward entrances with prompts, monitoring and national signage (solution 2). Introduce a stochastic approach to hand hygiene programmes and audit at agreed ‘set points’ (solution 3). Refresh hand hygiene training to reflect the stochastic approach (solution 3). Introduce self-disinfecting surfaces and equipment. Introduce chlorhexidine gluconate into handrubs used in clinical areas (solution 4). Increase frequency of cleaning in clinical and non-clinical areas, especially high-contact areas (solution 4).
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