Hand Hygiene Compliance Systems

The WHO 5 Moments

The WHO 5 Moments for Hand Hygiene define when a hand-hygiene event should occur: before patient contact, before an aseptic task, after body-fluid exposure risk, after patient contact, and after contact with the patient's surroundings. Every electronic system tries to measure the ratio of events to opportunities; the hard problem is counting opportunities.

Categories of electronic monitoring

1. Dispenser counters — RFID or mechanical counters on soap and gel dispensers. Cheapest, but only measure the numerator.
2. Badge-based systems — RTLS-tagged badges log entry/exit and pair with dispenser activation.
3. Group / unit-level anonymised — count dispenser events per patient day; used for benchmarking, not individual feedback.
4. Computer vision — camera-based detection of hand contact at entry/exit. Emerging, and subject to the privacy considerations in the [privacy of clinical video](/guides/privacy-basics) guide.

Common failure modes

• Hawthorne inflation — direct observation raises compliance 2–3× vs. covert measurement.
• Denominator drift — a doorway sensor placed 1 m inside the room misses brief entries.
• Feedback latency — dashboards updated monthly do not change behaviour; near-real-time nudges do.