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:
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
Last updated 25/03/2021 v24.0
Staphylococcus aureus (S. aureus, or ‘golden staph’) bloodstream infections (SABSI) associated with hospital care can be serious, particularly when bacteria are resistant to common antimicrobials. SABSI can be acquired after a patient receives medical care or treatment in a hospital. Contracting SABSI while in hospital can be life threatening and hospitals aim to have as few cases as possible.
This measure is sourced from the National Staphylococcus aureus Bacteraemia Data Collection (NSABDC). Data for public hospitals are provided by state and territory health authorities, while data for participating private hospitals are provided on a voluntary basis by individual private hospitals and private sector hospital groups. In 2020, the Victorian government granted an exemption to all Victorian hospitals from reporting routine surveillance during the period 1 April to 31 December inclusive due to some hospitals having resource issues due to pandemic response requirements. This included an exemption from submitting data on SABSI and hand hygiene audits.
The current nationally agreed benchmark set under the National Healthcare Agreement (NHA) is no more than 2.0 cases of healthcare-associated SABSI per 10,000 days of patient care for public hospitals in each state and territory.
In the data visualisation below you can explore information on healthcare associated infections by hospital between 2010–11 and 2019–20.
All data in these visualisations are available for download in the Data & downloads section of the MyHospitals website.
Hospitals and LHNs
This figure shows the number of healthcare-associated infections between 2010–11 and 2018–19. Data is presented by measure (number of healthcare-associated infections, number of patient days under surveillance, rate of healthcare-associated infections), infection category, public/private and peer group. Hospital data is available.
Changes over time
Between 2015–16 and 2019–20:
Private hospitals participate in the NSABDC on a voluntary basis. The casemix of patients treated in private hospitals may also be different to that in public hospitals, therefore direct comparisons are unreliable. Not all private hospitals report data so reported data may not be representative of the sector as a whole.
In the absence of focused clinical studies, the relationship between Staphylococcus aureus bloodstream infections and COVID-19 is unclear. However, the impact of hand washing as means of combatting rates of infection transmission is significant. Between 2009 and 2017, among Australia's 132 major public hospitals, improved hand hygiene compliance was associated with declines in the incidence of healthcare-associated SABSI (incidence rate ratio 0.85; 95% CI 0.79–0.93; p≤0.0001) (Grayson et al., 2018). For every 10% increase in hand hygiene compliance, the incidence of healthcare-associated SABSI decreased by 15%.
NSABDC Data Quality Statement
National Healthcare Agreement: PI 22-Healthcare associated infections: Staphylococcus aureus bacteraemia
Appendixes and caveat information is available on the About the data page.
Definitions of the terms used in this section are available in the Glossary.
Data for public hospitals are provided by state and territory health authorities. Data for private hospitals are voluntarily provided by individual private hospitals and private sector hospital groups. The nationally agreed benchmark set under the National Healthcare Agreement (NHA) is no more than 2.0 cases of healthcare-associated SABSI per 10,000 days of patient care for public hospitals in each state and territory.
Note that the national benchmark changed to 1.0 cases per 10,000 patient days under surveillance from 1 July 2020. This will apply to NSABDC data from 2020–21.
The SABSI rate is calculated as the number of healthcare-associated cases of S. aureus divided by the total number of patient days under surveillance (x 10,000).
Rates based on less than 5,000 patient days under surveillance are denoted as NP.
If the surveillance rate (patient days under surveillance/total number of patient days) is less than 95%, the rate is reported as interpret with caution (using the symbol *), as the sample under surveillance may not be representative of the hospital.
A case (patient-episode) of SABSI is defined as a positive blood culture for S. aureus. For surveillance purposes, only the first isolate per patient is counted, unless at least 14 days has passed without a positive blood culture, after which an additional episode is recorded.
A case of SABSI is considered to be healthcare-associated if the first positive blood culture is collected more than 48 hours after hospital admission or less than 48 hours after discharge, or if the first positive blood culture is collected 48 hours or less after admission and one or more of the following clinical criteria was met for the case of S. aureus:
The definition of healthcare-associated S. aureus was developed by the Australian Commission on Safety and Quality in Health Care (the Commission). The Commission changed the definition in 2016, with clarification of the neutropenia criterion above. This definition of a healthcare-associated case of S. aureus was used by all states and territories for the 2015–16, 2016–17, 2017–18, 2018–19 and 2019–20 reporting years.
Patient days under surveillance
Patient days under surveillance is the total number of days of admitted patient care under surveillance by infection control surveillance systems within the hospital.
Antimicrobial resistance occurs when some of the bacteria that cause infections resist the effects of the medicines used to treat them. This may lead to ‘treatment failure’, or the inability to treat the cause of the infection (Department of Health, 2020). Methicillin is an antimicrobial used to treat SABSI.
A case of SABSI that is identified by a laboratory as being caused by a methicillin-resistant strain of S. aureus is referred to as MRSA. A SABSI case that is identified by a laboratory as being caused by a S. aureus strain that is sensitive to commonly used antimicrobials (methicillin-sensitive) is referred to as MSSA.
SABSI caused by MRSA may cause more harm to patients and is associated with poorer patient outcomes as there are fewer antimicrobials available to treat the infection.
More information on antimicrobial resistance is available from the Department of Health website.
Grayson ML, Stewardson AJ, Russo PL, Ryan KE, Olsen KL, Havers SM et al. 2018. Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes. The Lancet. 18 (11), 1269-1277.
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.
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).
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:
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.
In the data visualisation below you can explore information on hand hygiene rates by hospital between 2010–2020.
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.
This figure shows hand hygiene compliance between 2012 and 2020. Data is presented by audit period and hospital.
The National Hand Hygiene Initiative (NHHI) has been in operation for ten years, supported by the Australian Commission on Safety and Quality in Health Care, and since 1 November 2019, the Commission has coordinated and supported all aspects of the NHHI. Hand hygiene is a key element of a comprehensive suite of initiatives to prevent and reduce healthcare-associated infections in Australian healthcare settings.
The NHHI is implemented by states, territories and private health service organisations, and includes auditing of hand hygiene practice as well as educational and promotional activities.
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 moments that are conducted continuously over three reporting periods each year. These audit periods are:
Hospitals provide information on hand hygiene by providing the total number of moments observed and the total numbers of correct moments observed. The rate is then generated from these validated data.
Further information on the data collection process is described in the NHHI Manual.
Hand hygiene (HH) is a general term applying to the use of soap/solution (non-antimicrobial or antimicrobial) and water, or a waterless antimicrobial agent (e.g. alcohol-based handrub) to the surface of the hands (HHA, 2019).
Hand hygiene compliance is defined when HH is performed when considered necessary and is classified according to one of the “5 Moments”. If the action is performed outside of these Moments, then it is not included in the compliance audit.
The number of Moments observed constitutes the denominator for assessing HH compliance. The actual HH actions undertaken are compared to the number of Moments observed to calculate the rate of HH compliance (HHA, 2019). The rate is rounded to one decimal place.
HH non-compliance is defined when there is an indication for HH (i.e. a “Moment”) and yet no HH was undertaken.
Hand hygiene compliance rates are based on audits from a sample of hand hygiene moments, and 95% confidence intervals are provided for all breakdowns.
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 (for example, those associated with particular healthcare worker types), the confidence interval will be wider, indicating there is less certainty regarding the true compliance rate. When a large number of moments are audited, the confidence interval will be narrower, indicating there is more certainty regarding the true rate.
Confidence intervals are used to assess whether or not the compliance rate for the sample of moments meets the benchmark. If the confidence interval includes the value of the benchmark 80%, then that figure is considered to have met the benchmark.
In 2015, the Australian Health Ministers’ Advisory Council agreed to:
Hand Hygiene Australia 2019. Glossary of Terms. Melbourne: HHA
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.
More data about patient admissions is available in the Info & Downloads section.
Performance indicator: Unplanned or unexpected readmissions after surgery
Comparisons among states and territories should be treated with caution given the small numbers of procedures for some surgeries, as an increase or decrease of one case can have a substantial impact on the rate of readmissions. Additionally, only selected surgeries are included in this measure.
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.
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.
Data on hospital acquired complications can be found in the Admitted patient care 2020–21: Safety and quality of health systems data tables, refer to tables 8.9–8.11.
More information, Appendixes and caveat information, and data tables are available in the Info & downloads section.
Definitions of the terms used in this section are available in the Glossary.
The average length of stay for a patient is the average number of days between admission and separation.
Hospital-acquired complications include conditions that:
The clinical information available in the National Hospital Morbidity Database (NHMD) can be used to provide some information on the safety and quality of admitted patient care in hospitals, such as instances of actual or potential harm. However, the available information does not provide a complete picture. For example, there is no routinely available information on some aspects of quality, such as continuity of care or responsiveness of hospital services.
It should be noted that:
Last updated 24/01/2023 v8.0
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):
More information on type of care is available in Admitted patient care 2020–21: Safety and quality of the health system, refer to tables 8.5, 8.6, S8.7–S8.8.
More information on the coverage of COF data is available in Admitted patient care 2020–21: Appendix A tables, refer to table A3.
More information on the COF code is available on METeOR (686100).
The National Hospital Morbidity Database (NHMD) includes ‘condition onset flags’ (COF) that can help to identify conditions that arose during hospital stay (that is, conditions that were not present on admission).
Conditions that arise during stay include adverse events (some of which may have been preventable) and therefore may provide information on the safety and quality of the care.
Conditions that arose during hospital stay include conditions that:
The flag is not assigned for conditions previously existing or suspected on admission – such as the presenting problem, co comorbidity, chronic disease, or disease status.
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.
Potentially preventable hospitalisations
This bar graph shows the number of potentially preventable hospitalisations per 1,000 population, between 2015–16 and 2019–20. Data is presented by type of potentially preventable hospitalisation (acute conditions, chronic conditions and vaccine preventable conditions). National data is available. In 2019–20, there were 25.5 potentially preventable hospitalisations per 1,000 population compared with 26.4 in 2015–16.
This bar graph shows the number of potentially preventable hospitalisations by public and private hospital sectors. Data is presented by type of potentially preventable hospitalisation (acute conditions, chronic conditions, vaccine preventable conditions and diabetes complications). National data is available. In 2019–20, there were 555,575 potentially preventable hospitalisations in public hospitals and 156,442 potentially preventable hospitalisations in private hospitals.
Compared with 2019–20, in 2020–21:
More information about these data are available in tables 8.1–8.4 and S8.2 in Admitted patient care: Safety and quality of the health system.
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.
Hospitalisation rates for PPHs are viewed as indicators of the quality or effectiveness of non-hospital care. A high rate of PPHs may indicate an increased prevalence of the conditions in the community, poorer functioning of the non-hospital aspects of the health care system or an appropriate use of the hospital system in response to greater need.
There are 3 broad categories of PPHs:
A more detailed analysis of selected potentially preventable hospitalisations can be found in the data tables, refer to Table S8.2.
The Indigenous status data in the NHMD for all states and territories are considered to be of sufficient quality for statistical reporting. In 2011–12, an estimated 88% of Indigenous patients were correctly identified in public hospitals. The overall quality of the data provided for Indigenous status is considered to be in need of some improvement and varied between states and territories. It is unknown to what extent Indigenous Australians might be under-identified in private hospital admissions data.
For more information, see ‘Indigenous identification in hospital separations data: quality report’
Remoteness area of usual residence
Remoteness area of usual residence is defined by the physical distance of the location of the patients’ usual residence from the nearest urban centre. The categories of remoteness area are:
Socioeconomic status of usual residence
ED presentations by socioeconomic status (SES) of area of usual residence are presented by SES quintiles (fifths). The lowest SES group represents the areas containing the 20% of the population with the most disadvantage and the highest SES group represents the areas containing the 20% of the population with the least disadvantage.
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.
From the survey, among people aged 15 and over in 2021–22, in their previous 12 months:
Of those who used hospital services as an admitted patient, most people reported:
Of those who visited a ED, most people reported:
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.
For more information about patient experience data, refer to the Australian Bureau of Statistics’ Patient Experiences survey.
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