Chart — Fundamentals
Hand Hygiene Checklist
WHO 5 Moments of Hand Hygiene checklist with triggers, rationale, clinical examples, and method selection for each moment. Hand hygiene is the single most effective infection prevention measure in healthcare.
Educational use only. Follow CDC/WHO guidelines and your facility's infection prevention protocols. This checklist is for nursing education and NCLEX preparation. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
NCLEX Tip: Hand hygiene is the first action in nearly every infection prevention scenario. C. difficile and norovirus require soap and water — ABHR is insufficient. Moment 5 (after patient surroundings) is commonly tested — hand hygiene is required even if the patient was not directly touched.
WHO 5 Moments Checklist
Before Patient Contact
Entering the room or approaching the patient for any care activity
Protect the patient from organisms carried on the nurse's hands from the environment or previous patient
- Before entering a room to perform assessment
- Before taking vital signs
- Before helping with meals or oral hygiene
- Before any physical examination
ABHR (preferred) or soap and water if hands visibly soiled
NCLEX: Moment 1 is always before any patient contact — even if you do not think you will touch anything. It protects the patient.
Before Aseptic Task
Immediately before performing any procedure requiring aseptic technique
Prevent organism introduction into a sterile field, invasive device, or open wound
- Before IV line insertion or access
- Before urinary catheter insertion or care
- Before wound dressing change
- Before medication preparation
- Before any injection
ABHR (preferred); must be immediately before the task — not 10 minutes prior
NCLEX: Moment 2 is critical for invasive procedures — HAIs like CAUTI and CLABSI are directly linked to lapses in this moment.
After Body Fluid Exposure Risk
Immediately after any activity involving potential contact with blood, body fluids, or mucous membranes
Protect the healthcare worker from acquiring infection and prevent environmental contamination
- After handling a specimen (blood, urine, stool, sputum)
- After emptying a urinary drainage bag
- After wound care or dressing change
- After oral suctioning
- After glove removal following a potentially contaminated task
ABHR for most; soap and water required after C. diff / norovirus exposure
NCLEX: Gloves must still be followed by hand hygiene — gloves do not replace hand hygiene at Moment 3.
After Patient Contact
After any direct contact with the patient, even if gloves were worn
Protect the healthcare worker and the environment from the patient's organisms
- After completing a physical assessment
- After assisting with ADLs (bathing, positioning, ambulation)
- After therapeutic touch or therapeutic communication
- After handling patient's belongings that have been in contact with the patient
ABHR (preferred) or soap and water
NCLEX: Moment 4 is after direct patient contact — even if the patient appeared clean and healthy. Standard precautions apply to all patients.
After Contact with Patient Surroundings
After touching any object or surface in the patient's immediate environment — even without touching the patient
Prevent cross-contamination from the patient's environment (high-touch surfaces harbor organisms)
- After touching the bed rails or headboard
- After adjusting the IV pump
- After touching the call light or remote control
- After handling the bedside table or food tray
- After charting at the bedside computer
ABHR (preferred) or soap and water
NCLEX: Moment 5 is frequently tested on NCLEX — hand hygiene is required after touching patient surroundings even if the patient was never directly touched.
Special Situations — Method Selection
| Situation | Required Method | Reason |
|---|---|---|
| C. difficile exposure | Soap and water ONLY | ABHR does not destroy C. diff spores — mechanical removal with soap and water is required |
| Norovirus exposure | Soap and water ONLY | Alcohol ineffective against norovirus — soap and water mechanically removes virus particles |
| Visibly soiled hands | Soap and water ONLY | Visible contamination must be mechanically removed before ABHR is effective |
| Before eating / after restroom | Soap and water preferred | Standard hygienic practice; mechanical removal preferred |
| Before donning gloves | ABHR or soap and water | Reduces bioburden before a sterile or clean task |
| After removing gloves | ABHR or soap and water | Hands become contaminated during glove removal — hand hygiene is always required after doffing |
Technique Quick Reference
Alcohol-Based Hand Rub (ABHR)
- Apply product to palm of one hand
- Rub hands together, palm to palm
- Interlace fingers — rub between and around fingers
- Rub backs of both hands
- Rub thumbs in clasped position
- Rub fingertips into opposite palm
- Continue until hands are dry (~20 seconds)
Minimum 60% alcohol; rub until completely dry
Soap and Water
- Wet hands with clean, running water
- Apply soap
- Lather and scrub all surfaces — backs, between fingers, under nails — for ≥20 seconds
- Rinse thoroughly under running water
- Dry with a single-use paper towel
- Use paper towel to turn off faucet
20 seconds = singing "Happy Birthday" twice
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Nurses Association (ANA) Standards of Practice · The Joint Commission. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →