Why Are There Exactly Five Moments of Hand Hygiene and Not Six?
Ask a group of healthcare workers to name the 5 moments of hand hygiene, and most will get to two before they stall. That isn't our guess. Dr. Hugo Sax, who helped create the framework, reported it in 2011.
So why did the World Health Organization (WHO) stop at five, when a longer list might seem safer? We're parents first and scientists second, and when we dug into that question, the answer turned out to be surprisingly elegant.
Nobody pulled the number out of a hat. The team behind it mapped each moment of how germs actually travel on hands during care. Every moment marks a point where hands can carry germs somewhere new, and together the five cover the whole sequence.
Below, you'll find the logic behind the number, the sixth moment that never made the list, the proper hand hygiene technique for each moment, and what all of it means for families who are nowhere near a hospital, or even a sink.
TL;DR Quick Answers
5 Moments of Hand Hygiene
The 5 moments of hand hygiene are the five points during care when the WHO says hands must be cleaned. They come straight from the WHO's Your 5 Moments for Hand Hygiene poster:
Before touching a patient
Before a clean or aseptic procedure
After a body fluid exposure risk
After touching a patient
After touching a patient's surroundings
Why five? The WHO splits care into two zones. The patient zone holds the patient and their immediate surroundings, and the healthcare zone holds everything else.
Each moment marks a point where hands cross between zones, or approach or leave a vulnerable body site.
Moments 1 and 2 protect the patient.
Moments 3, 4, and 5 protect the caregiver and the care environment.
Any sixth moment would repeat one the list already covers.
Top Takeaways
One logic sits behind all five moments. Each maps to a real point where germs travel on hands.
Two zones set the number. Hands enter the patient zone, work inside it, and leave it, and those movements create five checkpoints.
The split is two and three. The before-contact moments guard the patient, while the after-contact moments guard caregivers and the care environment.
Gloves don't count as a sixth moment. They never replace hand hygiene, so clean hands before gloves go on and after they come off.
The moments tell you when, and technique tells you how. A proper handwashing procedure takes 40–60 seconds, and a hand rub takes 20–30 seconds.
Where the 5 Moments of Hand Hygiene Came From
Dr. Hugo Sax and his colleagues at the University of Geneva Hospitals in Switzerland introduced the five moments in their 2007 paper, "My Five Moments for Hand Hygiene": A User-Centred Design Approach. Dr. Didier Pittet, one of hand hygiene's best-known researchers, co-authored it. They developed the concept alongside the WHO's "Clean Care is Safer Care" patient safety challenge, and the WHO built it into its 2009 Guidelines on Hand Hygiene in Health Care.
Their starting point was a model of how germs move during care:
Germs live on a patient's skin and on nearby surfaces.
Hands pick them up through touch.
If nobody removes them, they survive on those hands.
The hands then carry them to the next patient, surface, or vulnerable body site.
Each of the five moments breaks that chain at a different point. That's why the framework has held up for nearly 20 years. It follows how transmission actually works instead of handing people a list of rules.
Why Exactly Five? The Logic of Two Zones
Geography explains the number. Picture an invisible bubble around each patient. That's the patient zone, and everything outside it is the healthcare zone. The five moments cover every meaningful way hands can move across that bubble or within it.
Crossing Into the Patient Zone (Moment 1)
Before touching a patient. Hands coming from the healthcare zone can carry germs from other patients and surfaces. When caregivers clean their hands at the boundary, they keep those germs out of the patient's space.
Approaching and Leaving Critical Sites (Moments 2 and 3)
Inside the patient zone, some body sites are more vulnerable than others. Think wounds, mucous membranes, and catheter sites.
Before a clean or aseptic procedure (Moment 2). Even the patient's own germs can cause harm if they reach one of these sites.
After a body fluid exposure risk (Moment 3). If hands may have touched body fluids, caregivers clean them right away to protect themselves and the environment.
Crossing Back Out (Moments 4 and 5)
After touching a patient (Moment 4). Hands leaving the patient zone carry that patient's germs with them.
After touching a patient's surroundings (Moment 5). Bed rails, monitors, and bedside tables pick up the patient's germs too, so this moment applies even when a caregiver never touches the patient directly.
One way in, two checkpoints at critical sites, and two ways out. That adds up to five, and it covers the full care sequence.
Why Not Six? What Didn't Make the Cut
People suggest a sixth moment all the time, and we understand the instinct. Here's why the WHO didn't add one.
Gloves aren't a moment. "Before putting on gloves" and "after taking off gloves" sound like new moments, but both already fall inside existing ones. Gloves add a layer on top of hand hygiene. They never replace it.
Moments overlap. When a caregiver moves from one patient to the next, Moment 4 (after touching the first patient) and Moment 1 (before touching the next) happen at the same time. A single hand hygiene action covers both, so a new moment would only create double counting.
Short lists stick. The WHO designed the framework to be easy to remember under pressure, and even so, many healthcare workers can recall only two of the five. Add a sixth and recall gets worse.
To be fair, the five moments have limits. A 2022 critique, The Problem With "My Five Moments for Hand Hygiene", points out that some hand hygiene opportunities, such as handling equipment in a utility room, happen outside the patient zone, and the framework doesn't capture them. Good infection control programs cover those separately. Within patient care, though, five is the complete set.
Hand Hygiene Steps: The Proper Technique Behind Every Moment
The five moments tell you when to clean your hands. Proper hand hygiene technique tells you how.
The WHO Hand Washing Procedure (40–60 Seconds)
Use soap and water whenever hands are visibly soiled.
Wet your hands with water.
Apply enough soap to cover every hand surface.
Rub your palms together.
Rub the back of each hand with the opposite palm, fingers interlaced.
Rub palm to palm with your fingers interlaced.
Rub the backs of your fingers against the opposite palm, fingers interlocked.
Rotate each thumb inside the opposite clasped palm.
Rub your fingertips in a circular motion against the opposite palm.
Rinse your hands with water.
Dry them thoroughly with a single-use towel.
Use the towel to turn off the faucet.
The Hand Rub Technique (20–30 Seconds)
A hand rub uses the same rubbing motions (steps 3–8) without rinsing or drying. Keep rubbing until your hands feel dry.
What Are the 7 Steps of Hand Hygiene?
The "7 steps of hand hygiene" is a popular way to teach the same hand washing technique. It starts with the six core rubbing motions that Professor Graham Ayliffe first described in 1978 to test hand hygiene products, which the WHO later adopted as its recommended 6-step technique. The teaching version then adds a seventh step for the wrists. Whether you teach six, seven, or 11 numbered steps, the goal stays the same: reach every surface of the hand.
What the 5 Moments Mean for Families Outside the Hospital
The WHO built the five moments for healthcare settings. The logic behind them- cleaning hands at the points where germs travel- works just as well at home. For the broader story of handwashing in everyday life, including the key times public health groups recommend, that overview is a good place to start.
Every family has its own everyday moments:
Before eating or handling snacks
After the playground, park, or trail
After touching pets
After using the bathroom or changing diapers
After blowing noses, coughing, or sneezing
Household Chores Count as Moments, Too
Some of the grimiest moments at home have nothing to do with a patient zone. Emptying traps or cleaning up after critters is one of them, and a solid pest control plan means you'll face that job less often. Dusty projects count as well. If you're figuring out the fastest way to get air duct cleaning booked before the cold months, plan on clean hands after you've moved furniture and wiped down vent covers. Lint is another culprit. Your dryer vents really do need to be cleaned on a schedule, and pulling out that lint leaves fingers gray and fuzzy.
Caring for Cuts, Scrapes, and Sore Feet
Moments 2 and 3 have a home version. Clean your hands before you tend a scraped knee, and clean them again once the bandage is on. For more on the care itself, parents can turn to wound care basics and everyday wound relief tips. If you want to go a step further, practical wound know-how covers the details. Feet deserve attention too. Blisters and ingrown toenails are common in active families, and a podiatry resource can help you decide when a foot problem needs a professional.
When the Sink Is Out of Reach
The hard part is that a sink isn't always nearby. On a hiking trail, in the car, or on a field trip, soap and running water can be tough to find.
We created NOWATA Soap for exactly that gap. It's a plant-based, rinse-free soap for everyday hand cleansing when water isn't available. To be clear, we made NOWATA for everyday moments. It isn't a substitute for the hand hygiene protocols that healthcare facilities require.
Parents ask us all the time whether rinse-free soap can replace handwashing at home. We answer that it fills the gaps and leaves the sink for the moments that need it. Caregivers looking after a family member at home have their own questions, and we walk through the best way to use rinse-free soap for a bed bath. For trail days and road trips, some families also want to know whether rinse-free soap can work as body wash on the go.
"As a dentist and a biomedical engineer, we've both worked in settings where hand hygiene is never optional, and we've learned that the best system is the one people can actually remember on a busy day. The five moments work because they follow how germs move instead of asking people to memorize rules, and we brought that same thinking to creating NOWATA for families."
— Dr. Ruslan Maidans and Dr. Yalda Shahriari, NOWATA Co-Founders
Essential Resources on "5 Moments of Hand Hygiene": 7 Trusted Guides to Go Deeper
When you're ready to learn more, these are the resources we'd hand any student, educator, or parent.
1. Read the Original WHO Guidelines Behind the Five Moments
The WHO's 2009 Guidelines on Hand Hygiene in Health Care are where the five moments, the patient zone, and the recommended technique all come from. It runs long, but everything else on this list builds on it.
Source: APIC – WHO Guidelines on Hand Hygiene in Health Care (2009)
2. Learn What Eight Leading Hospitals Discovered About Real-World Hand Hygiene
Eight U.S. hospitals set out to fix hand hygiene and found their true compliance sat far below what they believed. The report shares the practical fixes they tried, like marking the patient zone at doorways and inviting families to help.
3. See How U.S. Hospitals Are Improving Hand Hygiene Today
This national report tracks hospital performance against a demanding hand hygiene standard adapted from WHO guidance. It shows what progress looks like across roughly 2,100 hospitals.
Source: The Leapfrog Group – 2024 Hand Hygiene Report
4. Get Ready-to-Use Tools for Hand Hygiene Training
This toolkit puts the WHO's "5 Moments" and "How to Handwash" posters, a knowledge questionnaire, monitoring forms, and glove use guidance in one place. Start here if you're building a hand hygiene PPT or staff training.
Source: ASC Quality Collaboration – Hand Hygiene Toolkit
5. Teach Kids Proper Hand Washing Technique at Home
Written for real households, this parent-friendly guide covers how to wash hands correctly, when it matters most, and how to turn it into a family habit.
Source: Nemours KidsHealth – Hand Washing: Why It's So Important
6. Follow a Simple Five-Step Hand Washing Routine
This county public health page walks through how to wash your hands in five steps and lists the times it matters most. Keep it handy as an everyday reference.
Source: Maricopa County Department of Public Health – Handwashing
7. Discover the National Campaign That Made Clean Hands Count
In 2016, the CDC Foundation and the CDC launched a hand hygiene campaign that reached providers, patients, and caregivers with brochures, fact sheets, and posters. Their story shows how education can change behavior.
Source: CDC Foundation – Clean Hands Count: A Story of Success
Supporting Statistics
Knowing the moments is the easy part. Remembering and practicing them is where things fall apart, and the numbers show it.
1. Less Than Half: How Often Providers Actually Clean Their Hands
On average, healthcare providers clean their hands less than half of the times they should.
Depending on patient load, they may need to clean them as many as 100 times in a 12-hour shift.
Our take: With up to 100 moments in one shift, it makes sense that the WHO grouped them into five categories. Nobody can hold 100 separate rules in their head.
2. About Three Times Higher When Someone Is Watching
One study found hand hygiene rates were about three times higher when an auditor was present than at hallway dispensers no observer could see.
Our take: Hand hygiene has to become a habit rather than a performance. That only happens when the "when" is simple enough to do on autopilot.
3. Two Out of Five: The Memory Problem Behind the Moments
In informal surveys, healthcare workers correctly recalled only two of the five hand hygiene moments when asked.
Our take: This is the strongest argument against a sixth moment. If five is already hard to remember, six would be harder still.
Final Thoughts and Opinion
We think the five moments of hand hygiene are a small masterpiece of design.
They're grounded in science and complete. Each moment ties to a real point where germs travel on hands, and together, one way in, two critical-site checkpoints, and two ways out cover the entire care sequence.
They're simple on purpose. Even five is hard to remember under pressure, so a sixth would work against the whole goal.
Our opinion: The lesson here reaches well beyond hospitals. As parents, we've learned that the hygiene habits that stick are simple, tied to real moments, and easy to do anywhere. Nobody remembers a 20-item rulebook while wrangling a toddler at the playground. And if you've ever wondered whether it's okay to vent online about the nightly standoff at the bathroom sink, plenty of parents have been right there with you.
Every family can borrow the WHO's thinking:
Name a short list of moments you'll actually follow. Before snacks, after the playground, and after pets is a great start, and a few moments you keep beat a long list you forget.
Remove the barriers. The WHO found that access matters. For families, that means having a way to clean hands even with no sink in sight.
Clean hands, clean conscience. It all starts with knowing when.
Frequently Asked Questions
Q: What Are the 5 Moments of Hand Hygiene?
A: They're the five points during care when the WHO says hands must be cleaned:
Before touching a patient
Before a clean or aseptic procedure
After a body fluid exposure risk
After touching a patient
After touching a patient's surroundings
Q: Who Created the 5 Moments of Hand Hygiene?
A: Dr. Hugo Sax and his colleagues at the University of Geneva Hospitals introduced the concept in 2007. The WHO added it to its 2009 Guidelines on Hand Hygiene in Health Care.
Q: Why Are There Five Moments of Hand Hygiene and Not Six?
A: Together, the five moments cover every point where hands move into, within, or out of the patient zone, so a sixth would overlap with one that already exists. A short list is also easier to remember. Even five is hard to recall under pressure.
Q: Is Wearing Gloves a Moment of Hand Hygiene?
A: No. Gloves never replace hand hygiene.
Clean your hands before putting gloves on when a moment calls for it.
Clean them again after you take the gloves off.
Q: What Are the 7 Steps of Hand Hygiene?
A: It's a popular teaching version of the WHO handwashing technique:
Palm to palm
Back of each hand, fingers interlaced
Palm to palm, fingers interlaced
Backs of fingers against the opposite palm
Each thumb rotated in the opposite palm
Fingertips rubbed in the opposite palm
Wrists
Q: How Long Should a Proper Hand Washing Procedure Take?
A: Plan on 40–60 seconds for a full wash with soap and water. A hand rub takes 20–30 seconds.
Q: What's the Right Way to Build a Hand Hygiene PPT for Training?
A: Follow the WHO's logic and keep it simple:
One slide on the two zones
One slide per moment, each with a real-world example
One slide on gloves
One slide on proper hand hygiene technique
A quick recall quiz at the end, since remembering the moments is the hardest part.
Q: Do the 5 Moments of Hand Hygiene Apply at Home?
A: The official moments are written for healthcare settings, but the logic works anywhere. Clean hands at the points where germs travel, like before eating, after the playground, and after touching pets. When there's no sink nearby, here's how rinse-free soap works without water.
Make Every Moment Count
Now you know why five is the right number, and that clean hands matter most when germs are on the move. For all the everyday moments with no sink in sight, explore NOWATA Soap and take rinse-free, plant-based clean wherever your family goes.
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