Admitted patient 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 2020–21:

• rates of unplanned readmissions in public hospitals were highest for Tonsillectomy (47.9 per 1,000 separations), Prostatectomy (30.7 per 1,000 separations) and Hysterectomy (30.5 per 1,000 separations) 
• rates of unplanned readmissions were lowest for Cataract extractions (2.9 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.

Highlights

In 2020–21:

• one or more ACSQHC hospital-acquired complications was reported for 148,600 hospitalisations from a total of 9.1 million hospitalisations that were in scope for analysis
• just over 1 in 2 (52.7%) hospital-acquired complications was for Healthcare-associated infections affecting 78,300 hospitalisations
• other hospital-acquired complications included Cardiac complications, Delirium and Respiratory 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 2.0 per 100 separations for public hospitalisations and 0.9 per 100 for private hospitalisations.

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

In 2020–21:

• the ALOS for overnight hospitalisations with at least one hospital-acquired complication was 18.8 days in public hospitals and 16.2 days in private hospitals, longer than the ALOS for hospitalisations  without a hospital-acquired complication reported (4.7 days and 4.6 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.

A condition onset flag (COF) associated with each diagnosis, identifies conditions that arose during a hospital stay (that is, conditions not present on admission). Some of these conditions may have been preventable, but others may not have been preventable. The information in this section does not include separations for which the COF data were not provided.

For 2020–21, the COF data were provided for 100% of public hospital separations and 98% of private hospital separations – a similar level of coverage to the past five years.  

In 2020–21 (based on data for which the COF was provided):

• 935,000 separations (7.9% of separations) recorded a condition that arose during the episode of care.
• 9.8% of public hospital separations recorded a condition that arose during hospital stay compared to 5.2% of private hospital separations.
• the Childbirth category had the highest proportion of separations with a condition that arose during hospital stay (43% for same-day separations and 63% for overnight separations), reflecting the conditions that arise after admission that impact on obstetric care (for conditions that affect the mother).
• for General Intervention (Surgical) (emergency), 28% of overnight separations had a condition that arose during hospital stay compared to 1.6% of same-day separations.
• the most common condition which arose during hospital stay was Hypotension affecting 125,000 separations, followed by Other disorders of fluid and, electrolyte and acid-base balance (85,200) and Perineal laceration during delivery (83,000).

Potentially preventable hospitalisations (PPHs) are conditions where the 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 2020–21:

• Just over 1 in 17 (5.7%, 672,000) of all hospitalisations were classified as PPHs
• 3 in 4 PPHs (75%) received care in public hospitals
• 96% of PPHs were for Acute conditions (49%) or Chronic conditions (48%) and a small proportion were for Vaccine preventable conditions (4%). A hospitalisation can classified as multiple PPH types based on relevant diagnosis records
• almost 1 in 6 (18%) PPHs for Chronic conditions were for Diabetes complications.

Variation in PPH across population groups

In 2020–21:

• for Indigenous Australians, the overall age standardised rate of PPHs per 1,000 population was 68, this is almost 3 times the rate for other Australians (23 per 1,000 population)
• the overall age standardised rate of PPHs was highest for residents of Remote and Very remote areas (42 and 61 per 1,000 population, respectively) and lowest for residents of Major cities (22 per 1,000 population)
• the age standardised rate of PPHs generally fell with increasing levels of socioeconomic advantage, ranging from 19 per 1,000 population for residents of areas classified as being in the highest SES group (least disadvantaged) to 27 per 1,000 population for residents of areas classified as being in the lowest (most disadvantaged) SES group.

Changes over time

Compared with 2019–20, in 2020–21:

• age standardised rates of PPHs decreased from 26 per 1,000 population to 24 per 1,000 population
• the large decrease in the number of PPHs was the greatest for Vaccine preventable conditions (58%) possibly reflecting the impact of measures implemented to stop the spread of COVID-19 on the spread of other viral illnesses such as influenza.

The Australian Bureau of Statistics (ABS) conducts an annual survey, Patient Experiences. This survey collects data on the access and barriers to, and satisfaction with healthcare services. This section contains results from the survey on patient experiences during hospital admissions and emergency department visits.

Cohort characteristics

From the survey, among people aged 15 and over in 2021–22, in their previous 12 months:

• 12.8% had been admitted to a public or a private hospital and 14.8% had visited a hospital emergency department (ED).
• Those with a long-term health condition were more likely than those without a long-term condition to be admitted to hospital (17.9% compared with 7.1%) and visit an ED (20.1% compared with 8.9%).
• Those aged 85 years and over were more likely than those aged 15–24 years to be admitted to hospital (22.8% compared with 7.9%) and visit a hospital ED (23.7% compared with 16.7%).
• Those living in areas of most socio-economic disadvantage were more likely than those living in areas of least disadvantage to be admitted to hospital (13.4% compared with 12.3%) and visit a hospital ED (16.5% compared with 12.2%).
• Those living in outer regional, remote or very remote areas were more likely to be admitted to hospital than those living in major cities (15.0% compared with 12.1%) and visit a hospital ED (18.0% compared with 13.6%).

Experience of hospital care

Of those who used hospital services as an admitted patient, most people reported:

• Hospital doctors and specialists always spent enough time with them (73%), always listened carefully (76%) and always showed respect (79%).
• Hospital nurses always spent enough time with them (74%), always listened carefully (78%) and always showed respect (80%).

Of those who visited a ED, most people reported:

• Hospital ED doctors and specialists always spent enough time with them (64%), always listened carefully (66%) and always showed respect (72%).
• Hospital ED nurses always spent enough time with them (70%), always listened carefully (73%) and always showed them respect (76%).

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