Admitted patient safety and quality

What is SABSI?

Staphylococcus aureus (also known as golden staph or S. aureus) is a usually harmless bacteria commonly found inside the nose and on the skin. However, if the bacteria enters the bloodstream a Staphylococcus aureus bloodstream infection (SABSI) can occur.

Contracting SABSI can be life-threatening and hospitals aim to minimise cases by implementing infection prevention and control policies, including good hygiene practices. Surveillance and reporting of healthcare-associated SABSI rates in hospitals helps to improve patient safety.

Types of SABSI

The two types of SABSI reported on are:

• methicillin-sensitive Staphylococcus aureus (MSSA) – which can be treated with commonly used antibiotics, and
• methicillin-resistant Staphylococcus aureus (MRSA), which resists treatment by many types of antibiotics, and is associated with poorer patient outcomes.

Data on healthcare associated infections associated with hospital care are presented in the following data visualisation and summarised in the sections below. The data presented are for the latest year for which national data are available, and over time.

Hand hygiene refers to the washing of hands or use of alcohol-based rubs. Good hand hygiene is a first-line defence against viruses and infections, such as COVID-19, influenza and Staphylococcus aureus bloodstream infections. This is especially important for hospital patients whose immune systems may already be weakened due to existing health conditions, or medical treatment they are undergoing, such as surgery.

How is hand hygiene measured in hospitals?

Hand hygiene amongst healthcare workers in hospitals is continuously monitored through hand hygiene audits, and data are reported for three consecutive audit periods a year for participating hospitals as part of the National Hand Hygiene Initiative (NHHI) coordinated by the Australian Commission on Safety and Quality in Health Care (ACSQHC). In the last audit period (November 2022 to March 2023), data are reported here for 619 public hospitals, which is over 90% of the 680 public hospitals listed on the Australian Government Department of Health’s list of Commonwealth Declared Hospitals as at 31 October 2022.

There are certain times when the risk of healthcare workers transmitting disease in hospitals is greater. Known as hand hygiene ‘moments’, these are:

• before touching a patient (Moment 1)
• before a procedure (Moment 2)
• after a procedure or body fluid exposure risk (Moment 3)
• after touching a patient (Moment 4)
• after touching a patient’s surroundings (Moment 5).

Hand hygiene compliance rates are calculated by dividing the number of compliant hand hygiene moments by the number of moments observed by auditors. Since 2017 the national benchmark for hand hygiene compliance has been 80%.

Hand hygiene compliance for each audit period is reported here for public hospitals at national, and individual-hospital levels, as well as by hand-hygiene moment and healthcare-worker group. 

Hand hygiene in public hospitals 

The latest national-level data (from Audit period November 2022 to March 2023), show:

• the national hand hygiene compliance rate was 86% – above the 80% national benchmark
• hand hygiene for each of the 5 moments was also above the benchmark:
  1. before touching a patient: 83% 
  2. before a procedure: 91% 
  3. after a procedure or body fluid exposure risk: 93%
  4. after touching a patient: 89%
  5. after touching a patient’s surroundings: 81%
• the highest rates of hand hygiene were among:
  1. dental professionals, for example, dentists’ compliance was 94%
  2. nurses and midwives: 89%
• the following healthcare-worker groups did not meet the 80% benchmark: 
  1. doctors (medical practitioners): 76%
  2. ambulance workers: 69%
  3. domestic staff (for example, food services, cleaning and maintenance workers): 76%.

The ACSQHC (2023) reports that for Audit period 1 of 2023 the highest rates of compliance were in departments for:

1. dentistry: 93%
2. renal care: 90%
3. neonatal care, mental health care, ambulatory care, oncology/haematology, palliative care (89%).

Emergency department (78%) was the only department type that did not been the 80% benchmark.

Hand hygiene in your hospital

The interactive table in the data visualisation above presents data on hand hygiene by participating public hospitals from 2010 onwards – see 'Hospitals' tab.

Data downloads

Summary tables

See the Hospital Safety and Quality theme page for more data downloads for hand hygiene in public hospitals from 2010 onwards.

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 include pressure injuries, healthcare-associated infections, delirium, malnutrition, and neonatal birth trauma.

Highlights

In 2021–22:

• one or more hospital-acquired complications was reported for 146,000 hospitalisations from a potential 11.3 million hospitalisations
• 55% of hospital-acquired complications was for healthcare-associated infections affecting 81,000 hospitalisations
• other hospital-acquired complications included Delirium (17%), Cardiac complications (16%) and Respiratory complications (15%)
• 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 per 100 hospitalisations for public hospitalisations and 0.9 per 100 for private hospitalisations.

Changes over time

From 2017–18 to 2021–22, the rate of hospital-acquired complications has decreased for both public hospitals (from 2.6 per 100 to 2.1 per 100 hospitalisations), and private hospitals (from 1.1 per 100 to 0.9 per 100 hospitalisations).

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

In 2021–22, the average length of stay (ALOS) for overnight hospitalisations with at least one hospital-acquired complication was 20.6 days in public hospitals and 16.8 days in private hospitals, longer than the ALOS without a hospital-acquired complication reported (5.0 days and 4.7 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) is associated with each diagnosis. The COF 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.

For 2021–22, the COF data were provided for 100% of hospitalisations in public hospitals and 99% of hospitalisations in private hospitals – a similar level of coverage to the past five years.  

In 2021–22 (based on data for which the COF was provided):

• 938,000 hospitalisations (8.3% of hospitalisations) recorded a condition that arose during the episode of care.
• 10% of public hospital hospitalisations recorded a condition that arose during the hospital stay compared to 5.3% of private hospital hospitalisations
• the Childbirth category had the highest proportion of hospitalisations with a condition that arose during hospital stay (48% for same-day hospitalisations and 67% for overnight hospitalisations), reflecting the conditions that arise after admission that impact on obstetric care (for conditions that affect the mother)
• for General Intervention (Surgical) (emergency), 30% of overnight hospitalisations had a condition that arose during hospital stay compared to 1.7% of same-day hospitalisations
• the most common condition which arose during hospital stay was Hypotension affecting 125,000 hospitalisations, followed by Perineal laceration during delivery (87,300) and Other disorders of fluid and, electrolyte and acid-base balance (81,700).

From 2017–18 to 2021–22 (based on data for which the COF was provided), the proportion of private hospital hospitalisations that recorded a condition that arose during a hospital stay decreased by 0.7% from 6.0% to 5.3%

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

Highlights

In 2021–22:

• just over 1 in 17 (5.7%, 660,000) of all hospitalisations were classified as PPHs
• 3 in 4 PPHs (75%) were in public hospitals, which reflects that public hospitals experience a larger number of emergency or unplanned admissions. Private hospitals focus more on planned or ‘elective’ admissions.  For example, private hospitals provided 175,000 emergency medical procedures and 1.4 million non-emergency medical procedures, whilst public hospitals provided 2.3 million emergency medical procedures and 2.5 million non-emergency medical procedures
• the most common acute PPH was Dental conditions (79,000 hospitalisations, or 25% of acute PPHs)
• the most common chronic PPH was iron deficiency anaemia (64,000 hospitalisations, or 21% of chronic PPHs)
• 94% of PPHs were for Acute conditions (48%) or Chronic conditions (46%) and a small proportion were for Vaccine preventable conditions (7%). A hospitalisation can be classified as multiple PPH types based on relevant diagnoses recorded.

Variation in PPH across population groups 

In 2021–22:

• for Indigenous Australians, the rate of PPHs per 1,000 population was 65 – this was 3 times the rate for other Australians (22 per 1,000 population)
• the overall rate of PPHs was highest for residents of Remote and Very remote areas (38.6 and 58.6 per 1,000 population, respectively) and lowest for residents of Major cities (21.5 per 1,000)
• the rate of PPHs generally decreased with increasing levels of socioeconomic advantage, ranging from 17.7 per 1,000 for residents of the highest socioeconomic areas to 26.6 per 1,000 for residents of the lowest socioeconomic areas.

Changes over time

From 2017–18 to 2021–22, rates of PPHs decreased from 27.9 per 1,000 population to 23.1 per 1,000 population, an annual average decrease of 4.7%.

This decrease in the number of PPHs was greatest for Vaccine preventable conditions (16.1% annually), possibly reflecting the impact of measures implemented to stop the spread of COVID-19 or 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.