Hand Hygiene in Nursing: WHO 5 Moments and Steps | NPrep

Hand hygiene in nursing follows the WHO's 5 Moments: before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching the patient's surroundings. Use an alcohol-based handrub for 20 to 30 seconds, or soap and water for 40 to 60 seconds when hands are visibly soiled.

Updated 10 November 2026. Steps, timings and indications are from the WHO Guidelines on Hand Hygiene in Health Care and WHO's "My 5 Moments for Hand Hygiene". Exam notes are NPrep's.

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Hand hygiene at a glance

Item	WHO standard
When	The 5 Moments for Hand Hygiene
First choice	Alcohol-based handrub
Handrub time	20 to 30 seconds, until hands are dry
Handwash time	40 to 60 seconds
Soap and water instead of rub	Hands visibly dirty or soiled with body fluids, after using the toilet, suspected spore-forming organisms such as Clostridioides difficile
Gloves	Do not replace hand hygiene; clean hands before and after
Surgical scrub with antimicrobial soap	Usually 2 to 5 minutes, as the product directs

What are the 5 Moments of hand hygiene?

Moment	When	Example
1. Before touching a patient	Before any contact with the patient	Taking a pulse, helping a patient sit up
2. Before a clean or aseptic procedure	Immediately before the procedure, even after Moment 1	Inserting a catheter, giving an injection, dressing a wound
3. After body fluid exposure risk	Immediately after, and after removing gloves	Drawing blood, emptying a urine bag, suctioning
4. After touching a patient	When you leave the patient	After a bed bath or examination
5. After touching patient surroundings	Even if you did not touch the patient	Touching the bed rail, monitor or bedside table

Moments 1 and 2 protect the patient. Moments 3, 4 and 5 protect you and the hospital environment.

What are the steps of handrub and handwashing?

WHO's handrub technique takes 20 to 30 seconds:

1. Apply a palmful of rub to cover all surfaces of the hands.
2. Rub palm to palm.
3. Right palm over the back of the left hand with fingers interlaced, and the other way round.
4. Palm to palm with fingers interlaced.
5. Backs of the fingers against the opposite palm, with fingers interlocked.
6. Rotational rubbing of each thumb clasped in the opposite palm.
7. Rotational rubbing of the clasped fingertips in the opposite palm, backwards and forwards.
8. Let the hands dry. Do not wipe them.

Handwashing with soap and water takes 40 to 60 seconds. Wet your hands, apply enough soap to cover all surfaces, follow the same rubbing steps, rinse, and dry thoroughly with a single-use towel. Use the towel to turn off the tap.

When should I wash hands instead of using a handrub?

A handrub is faster and kills most organisms, so WHO makes it the routine choice. Wash with soap and water instead:

• When hands are visibly dirty or soiled with blood or body fluids.
• After using the toilet.
• When exposure to spore-forming organisms, such as during a C. difficile outbreak, is strongly suspected, because alcohol does not kill spores.

What are the common hand hygiene mistakes?

• Treating gloves as hand hygiene. Gloves can have tiny holes and hands get contaminated as gloves come off. Clean hands before putting gloves on and after removing them.
• Rushing. A few seconds of rub misses the thumbs, fingertips and backs of the hands.
• Long or artificial nails, rings and watches. They hold organisms and stop thorough cleaning.
• Wiping off the rub before it dries. The alcohol needs to dry to work.
• Skipping Moment 5. Touching the bed rail or monitor counts, even without touching the patient.

How is hand hygiene asked in nursing exams?

It appears in Fundamentals of Nursing in B.Sc and GNM papers, and in NORCET and other Nursing Officer exams. These are NPrep practice questions, not questions from a past paper.

A nurse has just removed gloves after emptying a patient's urinary drainage bag. Which WHO moment of hand hygiene applies?

A. Before touching a patient B. Before a clean or aseptic procedure C. After body fluid exposure risk D. After touching patient surroundings

Answer: C. Emptying a drainage bag carries a risk of body fluid exposure, and hand hygiene is still needed after removing gloves.

Which situation needs soap and water rather than an alcohol-based handrub?

A. Before taking a patient's pulse B. Hands visibly soiled with blood C. After touching the bed rail D. Before giving an oral medicine

Answer: B. Visibly soiled hands need washing. In the other cases a handrub is the WHO's first choice.

For more infection control, see Fundamentals of Nursing for NORCET and the microbiology of how infections spread in Anatomy, Physiology, Microbiology for NORCET.

FAQs

What are the 5 moments of hand hygiene?

Before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. They come from the WHO's "My 5 Moments for Hand Hygiene".

How long should handwashing take?

40 to 60 seconds with soap and water. An alcohol-based handrub takes 20 to 30 seconds, until the hands are dry.

How many steps are there in handwashing?

WHO's technique has rubbing steps that cover the palms, backs of the hands, between the fingers, the backs of the fingers, the thumbs and the fingertips, plus wetting, rinsing and drying for a handwash.

Is a handrub better than handwashing?

For routine care, WHO prefers an alcohol-based handrub because it is faster and effective against most organisms. Use soap and water when hands are visibly soiled, after the toilet, or when spore-forming organisms are suspected.

Do gloves replace hand hygiene?

No. Clean your hands before putting gloves on and after taking them off, because hands can be contaminated through tiny holes or while removing gloves.

How long is a surgical hand scrub?

With an antimicrobial soap, usually 2 to 5 minutes, as the product directs. WHO says longer scrubs, such as 10 minutes, are not necessary.

What to read next

• Up: Fundamentals of Nursing for NORCET
• Across: Anatomy, Physiology, Microbiology for NORCET and Medical-Surgical Nursing for NORCET
• Practice: free NORCET mock test

Source: WHO Guidelines on Hand Hygiene in Health Care.