Hand hygiene and sharps safety: the WHO five moments and needlestick response

Every blood draw is a potential exposure event — for the patient and for you. Blood-borne pathogens such as HIV, hepatitis B, and hepatitis C do not show on a patient's chart, so the safety routine is the same for everyone, every time. Two habits carry most of that safety: hand hygiene at the right moments, and disciplined handling of the needle from use to disposal. This guide covers both, plus what to do if a sharp gets you.

The five moments of hand hygiene

Hand hygiene is the single most effective control against healthcare-associated infection. WHO's five moments for hand hygiene name the points in a clinical encounter at which it must happen. In a single venepuncture, all five occur in a short window:

1. Before patient contact — you enter the patient's zone clean, before you touch the patient, the chair, or the bed rail.
2. Before a clean or aseptic procedure — immediately before you put on gloves and prepare the puncture site.
3. After body-fluid exposure risk — at once if blood reaches your skin, a glove fails, or you handle a soiled item.
4. After patient contact — after gloves are off and the site is dressed, before you touch the next surface.
5. After contact with patient surroundings — after touching the bed, chart, or tray, even if you never touched the patient.

Alcohol rub or soap and water?

The two methods are not interchangeable. Alcohol-based hand rub is the default whenever your hands are not visibly soiled — faster, kinder to skin, and effective against the organisms that matter on a ward. Soap-and-water washing is required when hands are visibly soiled, after any contact with blood or body fluid, and for patients with spore-forming infections such as C. difficile, against which alcohol rub is not reliable. The rub takes 20–30 seconds; the wash, 40–60.

Sharps safety: three rules

Many blood-borne exposures in healthcare happen at the sharps end of the procedure — between needle use and disposal. Three behaviours prevent most of them.

Use a safety-engineered device where your service provides one. Its sheath or retractable mechanism activates before the needle comes near your hand a second time. Activate it the instant the needle is withdrawn — not after labelling, not after tube transfer. The window between withdrawal and activation is when injuries happen.

Never recap a used needle. Two-handed recapping is a common cause of needlestick injury and is prohibited under WHO Best Practices in Phlebotomy. Where recapping is genuinely unavoidable, the only acceptable method is the one-handed scoop technique: lay the cap on a flat surface and slide the needle in using only the hand holding the device. The second hand stays away.

Dispose at the point of care. The sharps container sits within arm's reach before the draw begins, not down the corridor.

The container takes more than needles: used sharps also include lancets, used capillary tubes, blood-contacted broken glass, scalpel blades, and used safety-engineered devices even after the mechanism has fired. Plastic syringes without a needle, gauze, and wrappings are clinical waste, not sharps.

If you have a needlestick or splash

A needlestick injury or blood splash is a clinical incident with a time-limited window. The actions in the first hour set the trajectory of risk, so the response runs in two parallel tracks: manage the exposure site, and trigger the clinical pathway.

For a needlestick, let the wound bleed naturally — do not squeeze, suck, or scrub it — then wash with soap and running water (never bleach or disinfectant) and cover it. For a splash, irrigate immediately with copious running water or saline; for eye exposure, use an eyewash station and irrigate for at least ten minutes.

Then report and assess: tell your supervisor and occupational health at once, arrange source-patient and baseline serology for HIV, HBV, and HCV, and let the occupational-health clinician decide on post-exposure prophylaxis.

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This guide is a free extract from PhlebMastery's phlebotomy theory course, with content aligned to published WHO guidance. The full treatment — standard precautions, PPE, the WHO hand-hygiene technique, and the complete post-exposure protocol — is in Module 2: Infection Control & Safety Standards. New here? Start with the free Module 1, or see the whole course — full access is a one-time purchase.