In the JournalsPerspective

National program improves hand hygiene, infection control in Australia

A national initiative implemented 8 years ago in Australia has significantly improved hand hygiene compliance among health care workers and led to a decline in the incidence of health care-associated Staphylococcus aureus bacteremia, according to newly published findings from a longitudinal study.

Researchers said it could be a “template” for other countries.

“In 2011, we reported 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 methicillin-resistant Staphylococcus aureus bacteremia,” M. Lindsay Grayson, MD, MSc, FRACP, FAFPHM, FRCP, FIDSA, director of the department of infectious diseases and microbiology at Austin Health, director of Hand Hygiene Australia and professor of infectious diseases at the University of Melbourne, and colleagues wrote.

“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.”

According to Grayson and colleagues, the NHHI — which cost just 6 cents per inpatient admission in 2016 — is based on WHO’s My 5 Moments for Hand Hygiene approach, which defines the five key moments when health care workers should wash their hands.

In their study, Grayson and colleagues assessed the impact of the program as it related to hospital participation, hand hygiene compliance, educational engagement, cost and the incidence of health care-associated S. aureus between Jan. 1, 2009, and June 30, 2017. They observed an increase in participation among health care facilities from 105 participating hospitals in 2009, including 103 public facilities, to 937 in 2017, including 598 public and 339 private institutions.

Overall hand hygiene compliance — measured as the simple percentage of observed “Moments” — increased from 63.6% (95% CI, 63.2-63.9) in 2009 to 84.3% (95% CI, 84.2-84.4) in 2017 (P = .0001). Additionally, Grayson and colleagues observed an increase for each “Moment” type, as well as for each health care worker occupational group. Compliance to hand hygiene “Moments” among medical staff in 2009 was 50.5% (95% CI, 49.4-51.5) compared with 71.7% (95% CI, 71.4-72) in 2017 (P = .0001), according to the study.

Moreover, for every 10% increase in hand hygiene compliance at 132 of Australia’s major public hospitals, Grayson and colleagues reported that the incidence of health care-associated S. aureus bacteria declined 15% — an incidence rate ratio of 0.85 (95% CI, 0.79-0.93; P .0001).

“We believe the Australian NHHI is the largest, most comprehensive and effective national hand hygiene program 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 [health care-associate S. aureus bacteria],” they wrote.

“The NHHI appears to have been highly successful in sustainably improving hand hygiene compliance among Australian health care workers nationally and to have effectively raised awareness about the importance of infection control among the Australian population, such that the NHHI might be a template for other national culture-change initiatives in health care.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

A national initiative implemented 8 years ago in Australia has significantly improved hand hygiene compliance among health care workers and led to a decline in the incidence of health care-associated Staphylococcus aureus bacteremia, according to newly published findings from a longitudinal study.

Researchers said it could be a “template” for other countries.

“In 2011, we reported 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 methicillin-resistant Staphylococcus aureus bacteremia,” M. Lindsay Grayson, MD, MSc, FRACP, FAFPHM, FRCP, FIDSA, director of the department of infectious diseases and microbiology at Austin Health, director of Hand Hygiene Australia and professor of infectious diseases at the University of Melbourne, and colleagues wrote.

“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.”

According to Grayson and colleagues, the NHHI — which cost just 6 cents per inpatient admission in 2016 — is based on WHO’s My 5 Moments for Hand Hygiene approach, which defines the five key moments when health care workers should wash their hands.

In their study, Grayson and colleagues assessed the impact of the program as it related to hospital participation, hand hygiene compliance, educational engagement, cost and the incidence of health care-associated S. aureus between Jan. 1, 2009, and June 30, 2017. They observed an increase in participation among health care facilities from 105 participating hospitals in 2009, including 103 public facilities, to 937 in 2017, including 598 public and 339 private institutions.

Overall hand hygiene compliance — measured as the simple percentage of observed “Moments” — increased from 63.6% (95% CI, 63.2-63.9) in 2009 to 84.3% (95% CI, 84.2-84.4) in 2017 (P = .0001). Additionally, Grayson and colleagues observed an increase for each “Moment” type, as well as for each health care worker occupational group. Compliance to hand hygiene “Moments” among medical staff in 2009 was 50.5% (95% CI, 49.4-51.5) compared with 71.7% (95% CI, 71.4-72) in 2017 (P = .0001), according to the study.

Moreover, for every 10% increase in hand hygiene compliance at 132 of Australia’s major public hospitals, Grayson and colleagues reported that the incidence of health care-associated S. aureus bacteria declined 15% — an incidence rate ratio of 0.85 (95% CI, 0.79-0.93; P .0001).

“We believe the Australian NHHI is the largest, most comprehensive and effective national hand hygiene program 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 [health care-associate S. aureus bacteria],” they wrote.

“The NHHI appears to have been highly successful in sustainably improving hand hygiene compliance among Australian health care workers nationally and to have effectively raised awareness about the importance of infection control among the Australian population, such that the NHHI might be a template for other national culture-change initiatives in health care.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

    Perspective

    Photo of Keith Kaye

    National campaigns regarding hand hygiene can be effective. We typically do not think about national approaches when we think about hand hygiene programs. The degree of improvement (increase of an absolute percent of approximately 20%) is impressive, as is the high rate of compliance at the endpoint — greater than 80%. Also, the large number of hospitals in the study was impressive. The CDC has undertaken several initiatives around infection prevention, notably around device-associated infections, resistant pathogens and antimicrobial stewardship. These are analogous programs to the Australian one. What is unique about the Australian program is that it focused on hand hygiene specifically and was very effective.

    Keith S. Kaye, MD, MPH

    Infectious Disease News Editorial Board member
    President, Society for Healthcare Epidemiology of America
    Professor of internal medicine and director of clinical research
    Division of infectious diseases
    University of Michigan Medical School

    Disclosure: Kaye reports no relevant financial disclosures.