National Hand Hygiene Initiative
The National Hand Hygiene Initiative (NHHI) has been in operation for ten years, supported by the Australian Commission on Safety and Quality in Health Care, and since 1 November 2019, the Commission has coordinated and supported all aspects of the NHHI. Hand hygiene is a key element of a comprehensive suite of initiatives to prevent and reduce healthcare-associated infections in Australian healthcare settings.
The NHHI is implemented by states, territories and private health service organisations, and includes auditing of hand hygiene practice as well as educational and promotional activities.
Hand hygiene data are provided by state and territory health authorities for public hospitals and by individual private hospitals. The data are derived from audits of hand hygiene moments that are conducted continuously over three reporting periods each year. These audit periods are:
- Audit period 1: 1 November to 31 March
- Audit period 2: 1 April to 30 June
- Audit period 3: 1 July to 31 October.
Hospitals provide information on hand hygiene by providing the total number of moments observed and the total numbers of correct moments observed. The rate is then generated from these validated data.
Further information on the data collection process is described in the NHHI Manual.
Calculation of hand hygiene rates
Hand hygiene (HH) is a general term applying to the use of soap/solution (non-antimicrobial or antimicrobial) and water, or a waterless antimicrobial agent (e.g. alcohol-based handrub) to the surface of the hands (HHA, 2019).
Hand hygiene compliance is defined when HH is performed when considered necessary and is classified according to one of the “5 Moments”. If the action is performed outside of these Moments, then it is not included in the compliance audit.
The number of Moments observed constitutes the denominator for assessing HH compliance. The actual HH actions undertaken are compared to the number of Moments observed to calculate the rate of HH compliance (HHA, 2019). The rate is rounded to one decimal place.
HH non-compliance is defined when there is an indication for HH (i.e. a “Moment”) and yet no HH was undertaken.
Hand hygiene rate estimates and confidence intervals
Hand hygiene compliance rates are based on audits from a sample of hand hygiene moments, and 95% confidence intervals are provided for all breakdowns.
A ‘confidence interval’ is a statistical term describing the range (‘interval’) within which we can be sure (‘confident’) the true rate falls. Confidence intervals indicate the reliability of the estimated rate and are calculated using data provided by hospitals.
When only a small number of moments are audited (for example, those associated with particular healthcare worker types), the confidence interval will be wider, indicating there is less certainty regarding the true compliance rate. When a large number of moments are audited, the confidence interval will be narrower, indicating there is more certainty regarding the true rate.
Confidence intervals are used to assess whether or not the compliance rate for the sample of moments meets the benchmark. If the confidence interval includes the value of the benchmark 80%, then that figure is considered to have met the benchmark.
In 2015, the Australian Health Ministers’ Advisory Council agreed to:
- An increase for the national hand hygiene benchmark to 75% in 2016, followed by an increase to 80% in 2017
- Reporting against a benchmark for 75% in 2016, and 80% in 2017, for all professional groups
- Reporting against a benchmark for 75% in 2016, and 80% in 2017, for each of the five moments.
Hand Hygiene Australia 2019. Glossary of Terms. Melbourne: HHA