Doctor, do you have a moment? National Hand Hygiene Initiative compliance in Australian hospitals

Syed Azim and Mary-Louise McLaws
Med J Aust 2014; 200 (9): 534-537. || doi: 10.5694/mja13.11203


Objectives: To examine hand hygiene compliance rates for medical and nursing staff, compliance with hand hygiene before touching a patient (Moment 1 of the Five moments for hand hygiene), and the effect of differential sampling of staff on the average national rate. Also, to establish whether hand hygiene rates impact Staphylococcus aureus bloodstream infections (SABSI).

Design and setting: Analysis of data from three different cross-sectional datasets — Hand Hygiene Australia data for 246 665 hand hygiene opportunities during the first quarter (1 January to 31 March) of 2013 from 82 public hospitals representing eight Australian states and territories, and hand hygiene rates and SABSI rates from the MyHospitals website reported for 1 July 2011 to 30 June 2012.

Main outcome measures: Compliance by medical and nursing staff for each hospital size (> 400 beds, 301–400 beds, 201–300 beds, and 101–200 beds); the proportion of hospitals with hand hygiene compliance rates for before touching a patient at or above, or below the national threshold of 70%; the impact of hand hygiene on SABSI.

Results: Medical staff consistently performed below the national threshold for hand hygiene compliance regardless of hospital size. Nurses' compliance was consistently above the threshold, and this inflated the total average national rate. A third of the patient interaction hand hygiene opportunities recorded involved before touching a patient, for which compliance was below the national threshold in 68% of hospitals. Hand hygiene has little impact on the rate of SABSI (incidence rate ratio, 0.97; P < 0.01).

Conclusions: Posting a national unadjusted average hand hygiene compliance rate on a public website conceals the fact that most hospitals and medical staff are performing below the national hand hygiene compliance threshold. Given the poor compliance after 4 years of auditing to capture non-compliance, we must shift our focus to providing medical staff with immediate feedback and move to improving a single hand hygiene indication at a time, starting with before touching a patient.

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  • Syed Azim
  • Mary-Louise McLaws

  • School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW.


Competing interests:

Mary-Louise McLaws was epidemiology advisor to the World Health Organization First Patient Safety Challenge — Clean Care is Safer Care between 2005 and 2013. She is honorary advisor to the Clinical Excellence Commission for health care-associated infections and hand hygiene activities. She is currently testing the validity of an automated hand hygiene auditing system.

  • 1. Edelstein L. The Hippocratic oath: text, translation and interpretation. Baltimore: Johns Hopkins Press, 1943.
  • 2. Grayson ML, Russo P, Cruikshank M, et al. Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative. Med J Aust 2011; 195: 615-619. <MJA full text>
  • 3. World Health Organization. WHO guidelines on hand hygiene in health care. First global patient safety challenge: clean care is safer care. Geneva: WHO, 2009. (accessed Feb 2014).
  • 4. National Health Performance Authority of Australia. Safety and quality. NHPA, 2014. (accessed Feb 2014).
  • 5. Whitby M, Pessoa-Silva CL, McLaws ML, et al. Behavioural considerations for hand hygiene practices: the basic building blocks. J Hosp Infect 2006; 65: 1-8.
  • 6. Whitby M, McLaws ML, Ross MW. Why healthcare workers don't wash their hands: a behavioural explanation. Infect Control HospEpidemiol 2006; 27: 484-492.
  • 7. McLaws ML, Maharlouie N, Yousefi F, Askarian M. Predicting hand hygiene among Iranian health care workers using the theory of planned behavior. Am J Infect Control 2012; 40: 336-339.
  • 8. Allegranzi B, Gayet-Ageron A, Damani N, et al. Successful implementation of the WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis 2013; 13: 843-851.
  • 9. Playford EG, McDougall D, McLaws ML. Problematic linkage of publicly disclosed hand hygiene compliance and health care-associated Staphylococcus aureus bacteraemia rates [letter]. Med J Aust 2012; 197: 214. <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>


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