Objective: To report outcomes from the first 2 years of the National Hand Hygiene Initiative (NHHI), a hand hygiene (HH) culture-change program implemented in all Australian hospitals to improve health care workers’ HH compliance, increase use of alcohol-based hand rub and reduce the risk of health care-associated infections.
Design and setting: The HH program was based on the World Health Organization 5 Moments for Hand Hygiene program, and included standardised educational materials and a regular audit system of HH compliance. The NHHI was implemented in January 2009.
Results: In late 2010, the overall national HH compliance rate in 521 hospitals was 68.3% (168 641/246 931 moments), but HH compliance before patient contact was 10%–15% lower than after patient contact. Among sites new to the 5 Moments audit tool, HH compliance improved from 43.6% (6431/14 740) at baseline to 67.8% (106 851/157 708) (P < 0.001). HH compliance was highest among nursing staff (73.6%; 116 851/158 732) and worst among medical staff (52.3%; 17 897/34 224) after 2 years. National incidence rates of methicillin-resistant SAB were stable for the 18 months before the NHHI (July 2007–2008; P = 0.366), but declined after implementation (2009–2010; P = 0.008). Annual national rates of hospital-onset SAB per 10 000 patient-days were 1.004 and 0.995 in 2009 and 2010, respectively, of which about 75% were due to methicillin-susceptible S. aureus.
Conclusions: The NHHI was associated with widespread sustained improvements in HH compliance among Australian health care workers. Although specific linking of SAB rate changes to the NHHI was not possible, further declines in national SAB rates are expected.
- 1. Johnson PDR, Martin R, Burrell LJ, et al. Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust 2005; 183: 509-514. <MJA full text>
- 2. Grayson ML, Jarvie LJ, Martin R, et al; Hand Hygiene Study Group and Hand Hygiene Statewide Roll-out Group, Victorian Quality Council. Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out. Med J Aust 2008; 188: 633-640. <MJA full text>
- 3. Pittet D, Hugonnet S, Harbarth S, et al; Infection Control Programme. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000; 356: 1307-1312.
- 4. Grayson ML, Russo PL. The National Hand Hygiene Initiative [editorial]. Med J Aust 2009; 191: 420-421. <MJA full text>
- 5. World Health Organization. WHO guidelines on hand hygiene in health care. First Global Patient Safety Challenge: Clean Care is Safer Care. Geneva: WHO, 2009. http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf (accessed Oct 2011).
- 6. Grayson ML, Russo PL, Cruickshank M, et al. Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative: supplementary data. http://www.hha.org.au/mjasupplement.aspx (accessed Oct 2011).
- 7. Pantle AC, Fitzpatrick KR, McLaws ML, Hughes CF. A statewide approach to systematising hand hygiene behaviour in hospitals: Clean hands save lives, Part I. Med J Aust 2009; 191 (8 Suppl): S8-S12. <MJA full text>
- 8. Fitzpatrick KR, Pantle AC, McLaws ML, Hughes CF. Culture change for hand hygiene: Clean hands save lives, Part II. Med J Aust 2009; 191 (8 Suppl): S13-S17. <MJA full text>
- 9. McLaws ML, Pantle AC, Fitzpatrick KR, Hughes CF. Improvements in hand hygiene across New South Wales public hospitals: Clean hands save lives, Part III. Med J Aust 2009; 191 (8 Suppl): S18-S25. <MJA full text>
- 10. McLaws ML, Pantle AC, Fitzpatrick KR, Hughes CF. More than hand hygiene is needed to affect methicillin-resistant Staphylococcus aureus clinical indicator rates: Clean hands save lives, Part IV. Med J Aust 2009; 191 (8 Suppl): S26-S31. <MJA full text>
- 11. Collignon P, Dreimanis D, Ferguson J, et al. Bloodstream infection. In: Cruickshank M, Ferguson J, editors. Reducing harm to patients from healthcare associated infection: the role of surveillance. Sydney: Australian Commission on Safety and Quality in Health Care, 2008: 53-89. http://www.safetyandquality.gov.au/ internet/safety/publishing.nsf/Content/con-pubs-hai-report (accessed Sep 2011).
- 12. Grayson ML, Russo P, Ryan K, et al; editors. HHA manual: 5 Moments for hand hygiene. Melbourne: Hand Hygiene Australia, 2010. http://www.hha.org.au/ForHealthcareWorkers/manual.aspx (accessed Sep 2011).
- 13. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; fifteenth informational supplement. M100-S15. Wayne, Pa: CLSI, 2005.
- 14. Australian Commission on Safety and Quality in Health Care. Draft data set specification. Surveillance of healthcare associated infections: Staphylococcus aureus bacteraemia & Clostridium difficile infection. Version 3.0. Sydney: ACSQHC, Oct 2010.
- 15. Australian Institute of Health and Welfare. Australian hospital statistics 2009–10. Canberra: AIHW, 2011. (AIHW Cat. No. HSE 107; Health Services Series No. 40.) http://www.aihw.gov.au/publication-detail/?id=10737418863&tab=2 (accessed Sep 2011).
- 16. Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002; 27: 299-309.
- 17. Xuereb C. How to best sell your message. Australasia – South East Asia Hand Hygiene Collaborative Inaugural Workshop; 2010 Jun 18–19; Palm Cove, Qld.
- 18. Collignon P, Nimmo GR, Gottlieb T, Gosbell IB; Australian Group on Antimicrobial Resistance. Staphylococcus aureus bacteremia, Australia. Emerg Infect Dis 2005; 11: 554-561.
- 19. Ferguson JK, Van Gessel H. Methicillin-resistant Staphylococcus aureus in hospitals: time for a culture change [letter]. Med J Aust 2008; 188: 62. <MJA full text>
- 20. Wilson J, Guy R, Elgohari S, et al. Trends in sources of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia: data from the national mandatory surveillance of MRSA bacteraemia in England, 2006–2009. J Hosp Infect 2011; 79: 211-217. [Epub Jul 20 ahead of print.]
- 21. Pearson A, Chronias A, Murray M. Voluntary and mandatory surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) bacteraemia in England. J Antimicrob Chemother 2009; 64 Suppl 1: i11-i17.
- 22. Bureau of Health Information (NSW). NSW public hospital emergency departments by peer group. http://www.bhi.nsw.gov.au/publications/hospital_quarterly_report/PR_grp_report2 (accessed Sep 2011).
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.