About Hand Hygiene Audit information
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 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, typically other hospital staff, observe staff at times when they are expected to wash or disinfect their hands. 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 based on the number of occupied acute beds in a hospital (or the number of procedures performed annually in a private day hospital).
There are five types of these ‘moments’ and this list is based on the World Health Organization Guidelines on Hand Hygiene:
- 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.
If hand washing or disinfecting is conducted AND done correctly, then this is recorded as a successful moment of hand hygiene.
What period is the data from?
Hand hygiene data is collected for three audit periods (of uneven length) each year. The auditing can be spaced out across the 3–5 month audit period or can all occur in a single week. This release adds data for Audit period 3, 2013 so therefore covers the July to October 2013 period.
How is the data presented?
MyHospitals presents the following information for hospitals reporting on hand hygiene:
- The rate of hand washing or disinfecting (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’
How is the rate calculated?
The estimated hand hygiene rate for a hospital is the percentage of how often hand hygiene is 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 fraction (reported to one decimal place).
There are three acceptable ward sampling strategies that can be used:
- Option A - high risk wards with rotation of other wards
- Option B - high risk wards with auditing of all other wards
- Option C - intensive care unit with auditing of all other wards.
The method used by each hospital can vary although the same method(s) tend to be used by hospitals within each state or territory. This affects the comparability of data, e.g. New South Wales mostly uses options A and B, Victoria uses A, Queensland uses B, South Australia uses a modified version of C, etc.
Data may not appear on MyHospitals for a number of reasons, including:
- The hospital has fewer than 25 occupied acute care beds. Participation is voluntary for small hospitals
- 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 MyHospitals
There is some suppression applied to data, for example, the comparison to the national benchmark is not shown for:
- Hospitals with fewer than 25 occupied acute care beds
- Day hospitals with fewer than 2,000 procedures per year
- Private hospitals with fewer than 25 occupied acute care beds
- Hospitals where the number of observed hand hygiene ‘moments’ was fewer than 100.
In addition, no data is reported for hospitals that have fewer than 100 observed hand hygiene ‘moments’.
Remember that 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 of being audited so can moderate their behaviour.
For this audit period, more than 350 public hospitals and more than 70 private hospitals updated their hand hygiene information.