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Hand hygiene only protects patients if it happens at the right moments on every shift, and an audit is how a team finds out whether it does. This free hand hygiene audit checklist is for IPC teams, link practitioners and ward, clinic and practice managers who audit one area at a time. One run is one observation audit of one ward, clinic or practice. It plans the period, the sessions and the staff groups, checks basins, soap, paper towels, handrub at the point of care and posters, then records every opportunity against WHO’s five moments, with bare below the elbows and glove use checked alongside. It works out the compliance rate overall, by staff group and by moment, gives feedback to staff, and ends with a report, an action plan and the IPC lead’s sign-off. An improvement and re-audit phase appears when compliance falls below your organisation’s own target.
NHS England’s National Infection Prevention and Control Manual (NIPCM) says hand hygiene is considered one of the most important ways to reduce the spread of the infectious agents that cause healthcare associated infections. WHO’s Hand Hygiene Technical Reference Manual sets out how to measure it: a trained observer watches routine care, counts every opportunity for hand hygiene against the “My 5 Moments for Hand Hygiene”, and records whether hand hygiene was done. Compliance is the actions performed divided by the opportunities. WHO calls direct observation the method that gives the most accurate data on compliance, while noting that being watched can change what staff do.
A hand hygiene audit is narrower and deeper than an infection control audit. The Infection Control Audit Checklist checks all ten standard infection control precautions in an area, with hand hygiene as one of them. This checklist is the focused observation audit that sits under it: enough sessions and opportunities to give a rate by staff group and by moment that you can track over time. Both feed the evidence a regulator looks for, which the CQC Inspection Readiness Checklist gathers.
Asks: do staff clean their hands at each moment it is needed, and are the basins, soap and handrub there for them?
When: on the cycle your organisation sets, at least once a year under WHO’s strategy, and again after a poor result.
Output: a compliance rate overall, by staff group and by moment, with feedback, an action plan and the IPC lead’s sign-off.
Asks: are placement, hand hygiene, PPE, equipment, the environment, linen, spills, waste and sharps safety all in place today?
When: on your IPC programme’s rolling cycle.
Output: a score for each element, findings and an action plan.
Asks: can we show the regulator that our systems work, including how we manage infection risk?
When: continuously, ahead of an inspection or survey.
Output: evidence organised by the regulator’s questions or standards, with your audits among it.
Seven phases take one audit from planning to sign-off. Phases 2 to 4 happen in the area: a facilities walk-round, then observation sessions that record every opportunity against the five moments, with bare below the elbows and glove checks alongside. Phase 7 appears only when compliance falls below the target your organisation sets.
Decide what this audit measures, and how, before anyone is watched. WHO’s method gives results you can compare only when the scope, the staff groups and the sessions are set in advance and kept the same next time.
The first component of WHO’s hand hygiene improvement strategy is system change: water, soap and towels, and alcohol-based handrub at the point of care. Walk round the area before the first session, because staff cannot comply where the means are missing.
Watch routine care and record what you see. WHO’s rule is that the observer records only actions they can clearly see that match an indication, and never assumes that hand hygiene took place.
Hand hygiene works best on bare forearms and short, natural nails, and gloves do not replace it. Make these checks during the same sessions. The rules quoted are the NIPCM’s for England; elsewhere, check against your own dress code and glove policy.
WHO’s formula is the number of hand hygiene actions performed divided by the number of opportunities, multiplied by 100. Work it out the same way at every audit so the results can be compared.
WHO’s manual says final results should go to the staff concerned, and to management or the infection control committee, as soon as possible after the data are collected. The IPC lead signs off the report first, and nothing after the sign-off can be completed until they do.
Shown only when compliance falls below the target your organisation sets. Work through the actions, then observe the same area again with the same method.
WHO’s “My 5 Moments for Hand Hygiene” is the reference approach for doing, teaching and observing hand hygiene. Two moments come before contact and protect the patient; three come after contact and protect the health-care worker and the wider care area. An observer counts an opportunity whenever one or more moments arise, and records the action against it: handrub, handwash or missed.
| Moment | When it applies | Examples from WHO’s manual |
|---|---|---|
| 1. Before touching a patient | When approaching the patient, before touching their intact skin or clothing. | Shaking hands, helping a patient move, wash, eat or dress, taking a pulse or blood pressure. |
| 2. Before a clean or aseptic procedure | Immediately before contact with a mucous membrane, non-intact skin or an invasive medical device. If gloves are used, hand hygiene comes before putting them on. | Brushing a patient’s teeth, giving eye drops, dressing a wound, inserting a catheter or tube, preparing medicines or food. |
| 3. After body fluid exposure risk | As soon as a task with a risk of exposure to blood or body fluids ends, and after removing gloves. | After an injection or puncture, removing an invasive device, handling a sample, clearing excreta or soiled bed linen. |
| 4. After touching a patient | When leaving the patient’s side after touching them. If surroundings are touched after the patient, it is still moment 4. | After taking a pulse or blood pressure, helping a patient back into bed, giving physiotherapy. |
| 5. After touching patient surroundings | When leaving the patient zone after touching objects or furniture there, without touching the patient. Never combined with moment 4. | After changing an empty bed, holding a bed rail, clearing a bedside table, adjusting an infusion rate. |
Working out compliance. Compliance (%) is the number of hand hygiene actions performed divided by the number of opportunities, multiplied by 100. One action can cover two moments that arise together, such as after touching one patient and before touching the next. An action with no matching moment is not counted, and the observer never assumes an action they did not see. WHO’s manual says compliance by moment is a guide rather than an exact measure, so report the rate by staff group and overall, and use the moments to target training.
Setting a target. The WHO manual and the NIPCM’s hand hygiene section do not set a compliance target. Agree one in your own IPC policy, record it on the first task, and observe and calculate the same way at every audit. In England, the NIPCM lists the same five moments for direct patient care and adds hand hygiene before putting on and after removing gloves.
A recurring schedule starts each area’s audit on the cycle you choose, assigned to its observer. The due dates count from the audit start date, so the walk-round, the sessions, the calculation and the sign-off land in order, and a result below your target adds the re-audit phase to that run.
The IPC lead is chosen on the first task. The sign-off is assigned to them alone, and nothing after the approval step can be completed until they record a decision. Their decision, any conditions and the report itself stay on the checklist with the date.
Every run keeps its session log, totals by staff group and by moment, and the action plan with names and dates. The Reports Grid lists every area’s audit with the answers given, including the overall compliance rate, and Analytics shows overdue and late tasks by person and step.
CheckFlow does not decide whether an opportunity was met. That judgement is the observer’s, recorded on the form and in the totals. It runs the audit around it: who does what, by when, with what evidence, and who signed it off. CheckFlow’s healthcare checklist software shows how the same approach handles other clinical processes.
Hand hygiene is one of ten precautions the Infection Control Audit Checklist checks in each area. Audit results feed the CQC Inspection Readiness Checklist and the Joint Commission Survey Readiness Checklist, instrument loads are recorded with the Medical Equipment Sterilization Checklist, and new staff learn the five moments through the New Nurse Onboarding Checklist.
Infection Control Audit Checklist
CQC Inspection Readiness Checklist (England)
Medical Equipment Sterilization Checklist
Joint Commission Survey Readiness Checklist
New Nurse Onboarding Checklist
Describe the process in a sentence and the AI checklist generator drafts the phases and tasks for you.
A hand hygiene audit measures how often staff clean their hands when they should. A trained observer watches routine care in one area, counts each opportunity for hand hygiene against WHO’s five moments, and records whether handrub or handwashing was done or the moment was missed. Most audits also check the facilities, such as basins, soap, paper towels and handrub at the point of care, and whether staff are bare below the elbows. The result is a compliance rate overall and by staff group, feedback to staff, an action plan and a date to audit again.
Divide the number of hand hygiene actions performed by the number of opportunities observed, then multiply by 100. That is WHO’s formula. An opportunity is counted whenever one or more of the five moments arises, and each opportunity needs one action, so two moments that coincide count once. Actions with no matching moment are left out, and the observer never assumes an action they did not see. Work the rate out overall and for each staff group. WHO’s manual says a breakdown by moment is a useful guide but not an exact measure.
They are the five times WHO says hand hygiene is needed during care: before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching a patient’s surroundings. The first two protect the patient; the last three protect the health-care worker and the wider care area. WHO proposes the five moments as the reference approach for doing, teaching and observing hand hygiene, which is why audits record opportunities against them. NHS England’s National IPC Manual lists the same five moments for direct patient care.
WHO’s manual says there is no clear evidence on the ideal sample size, but that estimates indicate 200 opportunities per observation period, per ward, department or staff group, are needed to compare results reliably. It breaks observation into sessions of about 20 minutes, up to 10 minutes longer or shorter, run at different times and with different staff, and advises watching no more than three health-care workers at once. Fewer opportunities still give a rate, but a rise or fall from the last audit may then be down to chance.
WHO’s manual and the NIPCM’s hand hygiene section do not set a target, so agree one in your own infection prevention and control policy. Record it on the first task of this checklist, and observe and calculate the same way at every audit so the rates can be compared over time. A rate is only as good as the sample behind it: report the number of opportunities with every result, and look at staff groups and moments as well as the overall figure, because a high overall rate can hide one group or one moment that is often missed.
A trained observer who knows the five moments well enough to identify, tell apart and explain them. WHO’s manual says observers should have broad experience of patient care, and its implementation guide says they should be validated by testing before they collect data. Observers introduce themselves, stand near the point of care without interrupting care, and record only what they clearly see. They also set an example: no wristwatch on the wrist, no jewellery and short, unvarnished nails. The IPC lead signs off the results.
WHO’s implementation guide says observations should be repeated regularly, at least once a year, to monitor sustained improvement and find areas that need more work, with the frequency set by the hand hygiene programme’s coordinator. You may want to observe high-risk areas more often, and to audit again sooner after a poor result or a change such as new dispensers. Set the cycle in your IPC programme and run it as a recurring schedule, so each area’s audit starts on time and no area is missed.
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