Admitted patient safety and quality

The quality of care provided to patients admitted to hospitals can be measured in several ways. One way is to use data from hospitals to measure rates of:

  • Staphylococcus aureus (‘golden staph’) bloodstream infections (SABSI)
  • Hand hygiene compliance
  • Unplanned readmissions
  • Hospital-acquired complications and adverse events
  • Potentially preventable hospitalisations (PPHs).

Another way is to survey people about their experiences as hospital patients. Information gathered through hospital data and patient surveys does not cover all aspects of hospital safety and quality. Certain aspects of safety and quality—continuity of care and responsiveness of hospital services—are difficult to measure and are not included here.

Media release: Golden staph bloodstream infections continue to fall in Australian public hospitals​

The COVID-19 pandemic affected many areas of people’s lives, including their use of health services such as hospitals. It also highlighted the importance of good hand hygiene to prevent the spread of disease. In response to COVID-19, the Australian Commission on Safety and Quality in Health Care promoted greater emphasis on using audit data to inform local quality improvement activities, and made Audit 2 (1 April to 30 June), 2020 voluntary for data submission. Audit 1 (1 November to 31 March) and Audit 3 (1 July to 31 October) remained mandatory for 2020.

Why is hand hygiene important?

In hospitals, patients are at greater risk of getting an infection because they may be undergoing invasive procedures, have weakened immune systems or may have a pre-existing infection. In addition to reducing the likelihood of transmitting viruses such as COVID-19 or influenza, good hand hygiene is a key first line defence to prevent or reduce hospital-acquired infections, including Staphylococcus aureus (‘golden staph’) bloodstream infections (SAB). 

How is hand hygiene measured in hospitals?

Hand hygiene in hospitals generally refers to the washing of hands or use of alcohol-based rubs by healthcare workers. The World Health Organization (WHO) has developed the following posters on performing hand hygiene:

Hand hygiene rates are calculated by dividing the number of correct observed hand hygiene moments by the number of observed moments by auditors in a specified audit period. In a hospital, good hand hygiene is important and there are particular occasions when the risk of transmitting disease is increased. These are:

  • before touching a patient
  • before a procedure
  • after a procedure or body fluid exposure risk
  • after touching a patient
  • after touching a patient’s surroundings.

These are known as hand hygiene opportunities or ‘moments’. Moments are defined in the World Health Organization (WHO) Guidelines on Hand Hygiene. In Australia, these moments have been modified slightly to reflect our healthcare conditions. See the Australian Commission on Safety and Quality in Healthcare’s website for more information on hand hygiene moments.

To measure how often healthcare workers in hospitals perform hand hygiene at these important moments, audits are continuously undertaken and reported three times a year.

The National Hand Hygiene Initiative (NHHI) aims to educate and promote correct hand hygiene practice in all Australian hospitals, and includes auditing and reporting processes for hospitals to measure how they are performing against the benchmark determined by the Australian Health Ministers Advisory Council. This benchmark has been progressively increasing and is now set at 80%. The performance of all participating hospitals has also been increasing across the country.

The Australian Commission on Safety and Quality in Health Care (ACSQHC) coordinates the NHHI and has a range of resources available to support the continuing implementation of improved hand hygiene and the NHHI. The AIHW reports on hand hygiene rates for individual hospitals on the MyHospitals website. This can be explored below.

Explore the data

In the data visualisation below you can explore information on hand hygiene rates by hospital between 2010–2020.

Factors to consider when interpreting these data

  • Since they are based on a sample of moments, hand hygiene rates should be interpreted alongside their confidence interval. For more information on confidence intervals see the 'More information about the data' section at the bottom of this page.
  • There are a number of factors contributing to hospital hand hygiene compliance rates. These factors include the type of clinical care provided; product placement and availability; and staff awareness of and compliance with infection prevention and control strategies.
  • While hand hygiene was actively supported during COVID-19, submission of data to Audit period 2 2020 was not mandatory for organisations, in order to reduce administrative burden. Comparisons with this audit period should be made with caution.
  • When comparing hospitals over time, it is important to consider the results in the context of the national benchmark at that time:
    • data from before 2016 should be compared to the benchmark of 70%
    • data from 2016 should be compared to the benchmark of 75%
    • data from 2017 onwards should be compared to the benchmark of 80%.

Hand hygiene

All data in these visualisations are available for download in the Data & downloads section of the MyHospitals website.

Hospitals and LHNs

This figure shows hand hygiene rates and observed hand hygiene moments for period 1 (end of March 2020) and period 2 (end of June 2020). Data is presented by measure (hand hygiene rate and observed hand hygiene moments and public/private. Hospital and national data is available.

Time series

This figure shows hand hygiene compliance between 2012 and 2020. Data is presented by audit period and hospital.