Hand Hygiene

Empathy as an important factor for hand hygiene compliance


In order to avoid healthcare-associated infections, hand hygiene according to the “5 moments” defined by the World Health Organization WHO [1] is one of the most important elements. Hand hygiene compliance (HHC), however, varies between the different moments and seems to be generally lower with “BEFORE” than with “AFTER” moments. At the same time, "BEFORE” moments are particularly relevant to patient safety, while "AFTER” moments focus mainly on one's own health. A recently published study taking place between March 2017 and March 2018 at three German tertiary care centers investigated the extent of the influence of empathy [2]. The publication is available online.

Empathy and HHC collected both individually and at the ward level

The study aimed to examine the relationship between moment-specific HHC rates and healthcare workers’ (HCW’s) empathy at both the individual and the ward level. In addition to the observation by trained infection prevention & control professionals, two questionnaires were used: one recorded the self-reported HHC, one the emotional empathy of the HCW. Ward-level emotional empathy was calculated using the mean scores of HCWs. Overall, data from 329 HCWs, 20 wards (incl. 275 HCWs), and 4,328 hand hygiene opportunities were included in the analysis [2].

Greater empathy was associated with better HHC at "BEFORE” moments

Except for moments 2 (“BEFORE aseptic procedures”) and 3 (“AFTER body fluid exposure risk”), objectively observed and self-reported HHC rates were in good agreement. For these two moments, the self-reported HHC was significantly higher than that observed at the ward level (moment 2: 59.7% observed vs. 86.2% self-reported HHC; moment 3: 80.5% observed vs. 93.5% self-reported HHC). With regard to the impact of empathy, significant correlations were found between empathy level and HHC for both “BEFORE” moments. Wards and HCWs with higher levels of empathy achieved the highest HHC, while wards and HCWs with lower empathy showed the lowest. Particularly for moment 2, very low HHC rates of less than 40% were sometimes observed; and precisely for this moment, empathy correlated most strongly with HHC. In contrast, HHC did not differ substantially between different levels of empathy for “AFTER” moments [2].


HCW empathy may play a different role in HHC compliance at “BEFORE” and “AFTER” moments. Interventions that specifically target the “BEFORE” moments and promote empathic behavior could thus improve HHC. However, the two motivations – patient protection and self-protection – should not be seen as opposing poles, but as complementary motivational processes.


  1. World Health Organization (2009) WHO guidelines on hand hygiene in health care: First global patient safety challenge. Clean care is safer care. WHO, Geneva. http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf (accessed on August 9, 2022)
  2. Diefenbacher S et al. (2022). Differences in observed and self-reported compliance with the 5 moments for hand hygiene as a function of healthcare workers' empathy. J Hosp Infect: S0195-6701(22)00223-7. https://doi.org/10.1016/j.jhin.2022.07.008

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