Admitted patients safety and quality

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:

• How to Hand Wash
• How to Hand Rub

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%.

Unplanned readmissions are hospitalisations for which an unplanned readmission to the same public hospital occurred within 28 days following surgery (for selected surgical procedures), and the cause of the hospitalisation (the principal diagnosis) was an adverse event. Where a patient is readmitted more than once within 28 days of the procedure, only the first readmission is included.

‘Unplanned or unexpected readmissions after surgery’ is a National Health Agreement performance indicator in the outcome area of Australians receive appropriate high quality and affordable hospital and hospital-related care. It is also a measure of continuity of care under the Australian Health Performance Framework.

This measure is regarded as an indicator of the safety of admitted patient care in hospitals. This indicator does not currently include information on all unplanned or unexpected readmissions, or readmission to another hospital. Therefore, the information presented here may differ from rates reported by states and territories.

Highlights

In 2018–19:

• of the selected surgeries, rates of unplanned readmissions in public hospitals were highest for Tonsillectomy (39.4 per 1,000 separations), Hysterectomy (30.1 per 1,000 separations) and Prostatectomy (29.0 per 1,000 separations)
• of the selected surgeries, rates of unplanned readmissions were lowest for Cataract extractions (2.8 per 1,000 separations).

The Australian Commission on Safety and Quality in Health Care (ACSQHC) lists 16 hospital-acquired complications for which clinical risk mitigation strategies may reduce the risk of occurrence. These hospital-acquired complications (HACs) include pressure injuries, healthcare-associated infections, delirium, malnutrition and neonatal birth trauma.

National trends

In 2019–20:

• one or more ACSQHC hospital-acquired complications was reported for 150,300 separations from a total of 9.1 million hospitalisations that were in scope for analysis
• the most common hospital-acquired complication was Healthcare-associated infections acquired in hospital affecting 80,500 hospitalisations
• other hospital-acquired complications included Cardiac complications, Delirium and Medication complications
• the 20 most common hospital-acquired complications accounted for 87% of all hospitalisations where one or more hospital-acquired complications was reported
• the rate of hospital-acquired complications was 2.1 for public hospitalisations and 1.0 for private hospitalisations.

Average length of stay for hospitalisations with at least one hospital-acquired complication

In 2019–20:

• the average length of stay (ALOS) for overnight hospitalisations with at least one hospital-acquired complication was 9.8 days in public hospitals and 9.4 days in private hospitals, longer than the ALOS for all overnight hospitalisations (5.5 days and 5.4 days, respectively).

Patients with longer lengths of stay in hospital may already have a higher risk of acquiring a complication during the episode, and the occurrence of a hospital-acquired complication may further extend the hospital stay.

Conditions that arise during a hospital stay include conditions which may have been preventable, as well as other conditions which may not have been preventable.

Condition onset flags (COF) are used to help to identify conditions that arose during the hospital stay (that is, conditions which were not present on admission).

In 2019–20:

• 786,300 separations (19.7%) of all separations for which COF data were provided) recorded a condition that arose during the episode of care
• separations with conditions that arose during the episode of care accounted for 9.6% of public hospital separations and 5.2% of private hospital separations
• for both same-day and overnight separations, in public and private hospitals, the highest proportion of separations with a condition that arose during the episode was in the Childbirth category—reflecting conditions arising after admission that impact on obstetric care (for conditions that affect the mother).

Emergency admissions involving surgery had relatively high rates of conditions that arose during the episode:

• for public hospitals, 1.5% of same-day and 28.1% of overnight emergency admissions involving surgery included a condition that arose during the episode
• for private hospitals, 0.6% of same-day and 25.5% of overnight emergency admissions involving surgery included a condition that arose during the episode.

Potentially preventable hospitalisations (PPHs) are conditions where hospitalisation could have potentially been prevented through the use of appropriate and individualised preventative health interventions and early disease management.  

The rate of PPHs is a National Healthcare Agreement (NHA) performance indicator, relating to the outcome Australians receive appropriate high quality and affordable primary and community health services. Selected potentially preventable hospitalisations is also an indicator of the health system’s effectiveness under the Australian Health Performance Framework.

For more information about PPHs, refer to the more information about the data section below.

Highlights

In 2019–20:

• 712,000 separations in public and private hospitals were classified as PPHs
• PPHs accounted for 6.4% of all hospital separations—8.3% of public hospital separations and 3.5% of private hospital separations
• more than three-quarters of PPHs (78%) were reported for public hospitals
• the majority of PPH separations were for Chronic conditions (47%) or Acute conditions (45%) and a small proportion were for Vaccine preventable conditions (20%). A separation can be affected by multiple PPHs
• Diabetes complications affected 17% of separations that were classified as Chronic condition PPHs.

Variation in PPH across population groups

In 2019–20:

• for Indigenous Australians, the overall age standardised rate of PPHs per 1,000 population was 72.2, this is almost 3 times the rate for other Australians (24.3 per 1,000 population)
• the overall age standardised rate of PPHs was highest for residents of Remote and Very remote areas (41.7 and 62.8 per 1,000 population, respectively) and lowest for residents of Major cities (23.7 per 1,000 population)
• the age standardised rate of PPHs generally fell with increasing levels of socioeconomic advantage, ranging from 19.7 per 1,000 population for residents of areas classified as being in the highest SES group (least disadvantaged) to 29.5 per 1,000 population for residents of areas classified as being in the lowest (most disadvantaged) SES group.

Changes over time

From 2018–19 and 2019–20:

• age standardised rates of PPHs decreased from 27.3 per 1,000 population to 25.5 per 1,000 population
• This decrease in the number of PPH separations was the greatest for Acute conditions (7.4%) and Chronic conditions (excluding diabetes) (7.4%).

Between 2014–15 and 2018–19:

• overall, age standardised rates of PPHs increased from 25.2 per 1,000 population to 27.3 per 1,000. 

The Australian Bureau of Statistics’ (ABS) conducts an annual survey, Patient Experiences in Australia. The survey includes information on patient experience in various health-care situations, including hospital admissions and emergency department visits.

This section highlights some results from Patient Experiences in Australia 2019–20 on patients’ satisfaction with their attending hospital doctors and nurses.

Highlights

Of the people aged 15 and over surveyed in 2019–20:

• 12.5% had been admitted to a public or a private hospital in the previous 12 months and 14.4% had visited a hospital emergency department
• People with a long-term health condition were more likely than those without a long-term condition to be admitted to hospital (18.4% compared to 6.3%) and be admitted to ED (19.5% compared to 9.1%)

• People aged 85 years and over were also more likely than those aged 15–24 years to be admitted to hospital (27.5% compared to 6.8%) and visit a hospital ED (24.3% compared to 14.6%).

Experiences with hospital staff

Of those who used hospital services, most people reported:

• Hospital doctors and specialists always spent enough time with them (74.5%), listened carefully (76.0%) and showed respect (79.6%).
• Hospital nurses always spent enough time with people (76.3%), listened carefully (78.6%) and showed respect (80.9%).
• Hospital ED doctors and nurses were less likely to spent enough time with people (67.1% and 71.7%, respectively).

People living in outer regional, remote and very remote areas reported more positive experiences with hospital ED doctors and nurses compared to those living in major cities.