Some IPC activities such as Microbiological cross transmission studies : Studies using fluorescent markers and microbiological sampling demonstrate that microbes spread through indirect contact.
Hands that have not directly touched the patient can still carry pathogens if they contact contaminated objects.

halla and colleagues studied patients with skin colonization by S. aureus (including MRSA) and found that the organism was frequently transferred to the hands of HCWs who touched both the skin of patients and surrounding environmental surfaces.96 Hayden and colleagues found that HCWs seldom enter patient rooms without touching the environment, and that 52% of HCWs whose hands were free of VRE upon entering rooms contaminated their hands or gloves with VRE after touching the environment without touching the patient.114 Laboratory-based studies have shown that touching contaminated surfaces can transfer S. aureus or Gram-negative bacilli to the fingers.132 Unfortunately, none of the studies dealing with HCW hand contamination was designed to determine if the contamination resulted in the transmission of pathogens to susceptible patients.

Many other studies have reported contamination of HCWs’ hands with potential pathogens, but did not relate their findings to the specific type of preceding patient contact.78,79,94,132–142 For example, in studies conducted before glove use was common among HCWs, Ayliffe and colleagues137 found that 15% of nurses working in an isolation unit carried a median of 1× 104 CFU of S. aureus on their hands; 29% of nurses working in a general hospital had S. aureus on their hands (median count, 3.8 × 103 CFU), while 78% of those working in a hospital for dermatology patients had the organism on their hands (median count, 14.3 × 106 CFU). The same survey revealed that 17–30% of nurses carried Gram-negative bacilli on their hands (median counts ranged from 3.4 × 103 CFU to 38 × 103 CFU). Daschner135 found that S. aureus could be recovered from the hands of 21% of ICU caregivers and that 21% of doctors and 5% of nurse carriers had >103 CFU of the organism on their hands. Maki80 found lower levels of colonization on the hands of HCWs working in a neurosurgery unit, with an average of 3 CFU of S. aureus and 11 CFU of Gram-negative bacilli. Serial cultures revealed that 100% of HCWs carried Gram-negative bacilli at least once, and 64% carried S. aureus at least once. A study conducted in two neonatal ICUs revealed that Gram-negative bacilli were recovered from the hands of 38% of nurses.138

You’re absolutely right — we need to break the culture of bias around hand hygiene. The WHO’s 5 Moments are not just a checklist; they’re a mindset shift. An active IPC presence is key to maintaining high standards of care, and reinforcing these messages through management engagement, real-time hand hygiene/PPE audits, and visible accountability can drive genuine behavioural change. It’s about embedding the principle of “clean in, clean out” into everyday practice, so that even unplanned contact with the patient’s environment is met with the same commitment to hand hygiene.

The 5 Moments make hand hygiene unnecessarily complicated for staff. We should just say
wash your hands before any contact with the patient or their environment, and after any contact with the
patient or their environment. I think it would achieve better results

I was wondering would it be worth wile
To invest in fluorescent markers and do checks every so often to demonstrate the importance of handwashing? Also does anyone have problems with staff wearing nail varnish despite being told not to and passing information onto management?

I suspect it isnt just medical staff. I think it would be great fun to put some fluorescent marker onto something like the unit door or something, and then demonstrate its movement throughout the unit. Markers dont lie. I wonder if anyone has experience of how to explain this to patients, and how to manage them in the (inevitable) event of spread being demonstrated?