About Hand Hygiene Audit information
Hand hygiene data are provided by state and territory health authorities for public hospitals and by some private hospitals. The data are derived from audits of hand hygiene ‘moments’ that are conducted up to three times per year under the National Hand Hygiene Initiative. Guidance on these audits is provided by Hand Hygiene Australia (HHA), a body established by the Australian Commission on Safety and Quality in Health Care. More information is available from HHA at www.hha.org.au
What is a ‘hand hygiene moment’?
Trained auditors observe staff at times when they are expected to perform hand hygiene. These times are referred to as ‘moments’. Auditors must have completed HHA auditor training and are required to observe a specified number of hand hygiene moments each Audit Period.
There are five types of these ‘moments’ based on the World Health Organization Guidelines on Hand Hygiene in Health Care:
- Before touching a patient
- Before a procedure
- After a procedure or body fluid exposure
- After touching a patient
- After touching a patient’s surroundings.
If hand washing or disinfecting is conducted AND done correctly, then this is recorded as a correct ‘moment’ of hand hygiene.
What period is the data from?
Hand hygiene data are collected for three Audit Periods (of uneven length) each year. Data can be collected at any time across the 3–5 month Audit Period. This release adds data for:
- Audit Period 1, ending March 2015 for 474 public and 164 private hospitals
- Audit Period 2, ending June 2015 for 467 public and 153 private hospitals.
How are the data presented?
The MyHospitals website presents the following information for hospitals who report on hand hygiene:
- The rate of hand washing or disinfecting expressed as a percentage (this is an estimate as it is based on a sample of ‘moments’, not as a result of observing every moment)
- The number of observed hand hygiene ‘moments’
- A bar graph showing how the rate compares to the national benchmark of 70.0%.
How is the estimated rate calculated?
The estimated hand hygiene rate for a hospital is expressed as the percentage of ‘moments’ in which hand hygiene practices are correctly performed. It is calculated by dividing the number of observed hand hygiene ‘moments’ during the Audit Period where proper hand hygiene was practised by the total number of observed hand hygiene ‘moments’ in the same Audit Period, then multiplied by 100 to make a percentage (reported to one decimal place) for example, 180/210 x 100 = 85.7%.
More information on the measure:
1. Ward sampling options for every audit include:
- Minimum of one Intensive Care Unit (ICU), and
- Minimum number of High Risk Wards.
Hospitals without an ICU or High Risk Wards are required to audit as per Option A or B:
- Option A – Other wards to be rotated every Audit Period*
- Option B – All other wards audited every Audit Period*.
The method used by each hospital can vary. This affects the comparability of data; for example, New South Wales and Victoria mostly use options A and B, Queensland uses B, etc.
2. Data may not appear on the MyHospitals website for a number of reasons, including:
- The hospital (public or private) has fewer than 25 occupied acute inpatient beds. Participation is voluntary for small hospitals in some jurisdictions
- The hospital primarily provides mental health or rehabilitation care. Participation is voluntary for such hospitals
- The hospital is a private hospital. Participation is voluntary for all private hospitals, including day hospitals
- The hospital had fewer than 100 observed ‘moments’ for the period. Data are not reported for all of these hospitals
- Data were not collected for this hospital for the Audit Period
- The data have otherwise not been provided to the MyHospitals website
- Day hospitals with fewer than 2,000 procedures per year.
In addition, no data are reported for hospitals that have fewer than 100 observed hand hygiene ‘moments’.
3. The method ‘samples’ moments and is therefore an estimate and necessary moments are based on sample size calculations. The MyHospitals website does not display confidence intervals around this measure. Also, staff are often aware they are being audited so may moderate their hand hygiene behaviour.