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Hand hygiene ‘moments’
Hand hygiene is a key intervention to prevent or reduce Hospital Acquired Infections (HAIs), including S. aureus bloodstream (SAB) infections. Hand hygiene in hospitals generally refers to the washing and/or use of alcohol-based rubs by healthcare workers to clean their hands. Hand hygiene rates are calculated using the number of observed correct hand hygiene ‘moments’, or opportunities, in a specified audit period. ‘Moments’ of hand hygiene indicate when there is a perceived or actual risk of pathogen transmission from one surface to another via a person’s hands, and are defined in the World Health Organization (WHO) Guidelines on Hand Hygiene.
The National Hand Hygiene Initiative (NHHI) aims to educate and promote standardised hand hygiene practice in all Australian hospitals, and includes auditing and reporting processes for hospitals to measure how they are performing. The NHHI measures correct hand hygiene in the 5 critical moments determined by the WHO (modified slightly to reflect Australian health care conditions):
As of 1 November 2019, the NHHI coordination and support role is provided by the Australian Commission for Safety and Quality in Health Care (ACSQHC). The AIHW is currently working with the ACSQHC to review and establish new processes for publication of hand hygiene data from both public and private hospitals.
Hand hygiene data on MyHospitals currently reflects NHHI historical information to 2015. These will be updated when the current review process is complete and new arrangements are in place for reporting.
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 opportunities, ‘moments’, that are conducted up to three times per year under the National Hand Hygiene Initiative.
Hospitals that provide information on hand hygiene report:
The estimated rate is compared to the national benchmark and is reported as:
Calculation of hand hygiene rates
The estimated hand hygiene rate for a hospital is a measure of how often (as a percentage) hand hygiene is correctly performed. It is calculated by dividing the number of observed hand hygiene ‘moments’ where proper hand hygiene was practised in a specified Audit Period, by the total number of observed hand hygiene ‘moments’ in the same Audit Period, and multiplying by 100. The rate is rounded to one decimal place.
Hand hygiene rate estimates and confidence intervals
Since the hand hygiene rates are based on audits from a sample of hand hygiene ‘moments’, in a sample of hospital wards the calculation is only an estimate of the true rate for that hospital, and is associated with a 95% confidence interval.
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, the confidence interval is larger, meaning we are less sure of the true rate. When a large number of ‘moments’ are audited, the confidence interval is smaller, meaning we are more sure of the true rate.
Interim national benchmark
An interim benchmark (compliance rate) of 70% for hand hygiene reporting was initially advised by the Australian Commission on Safety and Quality in Health Care. This benchmark was increased to 75% in 2016, and increased again to 80% in 2017.
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