ArticlesEffects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study
Introduction
Improvement of hand hygiene compliance among health-care workers is an important national patient safety strategy,1, 2, 3, 4, 5, 6, 7 but few national programmes have been sustained over many years and become successfully integrated into a national health-care structure. In 2011, we reported4 the early outcomes of the Australian National Hand Hygiene Initiative (NHHI), citing an association between significant improvements in hand hygiene compliance among health-care workers and a reduction in the incidence of meticillin-resistant Staphylococcus aureus bacteraemia. Since this preliminary report, the NHHI has progressed from the implementation phase to maintenance and establishment within the Australian health-care system, such that all public and private hospitals are mandated to participate to maintain accreditation.8 Thus, 8 years after implementation, we did a detailed analysis of NHHI outcomes, including hand hygiene compliance and potential impact on incidence of health-care-associated S aureus bacteraemia (HA-SAB), given that S aureus infections are linked to poor hand hygiene compliance,1, 2, 7 and summarised the various structural features of the NHHI that could be used as a template for other national intervention programmes.
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Organisational structure and governance
Details regarding the NHHI have been described previously4 and are available on the Hand Hygiene Australia website.9 In brief, the NHHI is based on the WHO Multimodal Hand Hygiene Improvement Strategy,1 with a focus on system change, health-care worker education, and audit and feedback. The My 5 Moments for Hand Hygiene methodology was incorporated as a standardised, evidence-based educational and auditing approach.4 The primary focus of the NHHI is to improve hand hygiene compliance among
Results
The number of health-care institutions submitting hand hygiene audit data increased from 105 (103 public and two private hospitals) in March 31, 2009, to 937 (598 public and 339 private hospitals) in June 30, 2017 (figure 1). Between Jan 1, 2016, and June 30, 2017, the number of non-hospital health facilities grew to 6% of all participating sites (n=56), although hospital-derived hand hygiene compliance data still constituted 575 360 (98·1%) of 586 559 of all hand hygiene Moments in the most
Discussion
We believe the Australian NHHI is the largest, most comprehensive and effective national hand hygiene programme in existence and that we have, for the first time, shown on a national scale the significant association between improvements in hand hygiene compliance and reductions in HA-SAB. On the basis of our analysis of the largest public hospitals, which provide about 77% of all Australian public inpatient care days (ie, 15·3 million nationally in 2016–17),15 for every 10% increase in hand
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