title: Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative.
abstract: OBJECTIVE
  To report outcomes from the first 2 years of the National Hand Hygiene Initiative (NHHI), a hand hygiene (HH) culture-change program implemented in all Australian hospitals to improve health care workers' HH compliance, increase use of alcohol-based hand rub and reduce the risk of health care-associated infections.
  
  
  METHODS
  The HH program was based on the World Health Organization 5 Moments for Hand Hygiene program, and included standardised educational materials and a regular audit system of HH compliance. The NHHI was implemented in January 2009.
  
  
  METHODS
  HH compliance and Staphylococcus aureus bacteraemia (SAB) incidence rates 2 years after NHHI implementation.
  
  
  RESULTS
  In late 2010, the overall national HH compliance rate in 521 hospitals was 68.3% (168,641/246,931 moments), but HH compliance before patient contact was 10%-15% lower than after patient contact. Among sites new to the 5 Moments audit tool, HH compliance improved from 43.6% (6431/14,740) at baseline to 67.8% (106,851/157,708) (P < 0.001). HH compliance was highest among nursing staff (73.6%; 116,851/158,732) and worst among medical staff (52.3%; 17,897/34,224) after 2 years. National incidence rates of methicillin-resistant SAB were stable for the 18 months before the NHHI (July 2007-2008; P = 0.366), but declined after implementation (2009-2010; P = 0.008). Annual national rates of hospital-onset SAB per 10,000 patient-days were 1.004 and 0.995 in 2009 and 2010, respectively, of which about 75% were due to methicillin-susceptible S. aureus.
  
  
  CONCLUSIONS
  The NHHI was associated with widespread sustained improvements in HH compliance among Australian health care workers. Although specific linking of SAB rate changes to the NHHI was not possible, further declines in national SAB rates are expected.
authors: Infectious Diseases Department, Austin Health, Melbourne, VIC, Australia. Lindsay.Grayson@austin.org.au
authors: M Lindsay
authors: ML
authors: Grayson
authors: Philip L
authors: PL
authors: Russo
authors: Marilyn
authors: M
authors: Cruickshank
authors: Jacqui L
authors: JL
authors: Bear
authors: Christine A
authors: CA
authors: Gee
authors: Clifford F
authors: CF
authors: Hughes
authors: Paul D R
authors: PD
authors: Johnson
authors: Rebecca
authors: R
authors: McCann
authors: Alison J
authors: AJ
authors: McMillan
authors: Brett G
authors: BG
authors: Mitchell
authors: Christine E
authors: CE
authors: Selvey
authors: Robin E
authors: RE
authors: Smith
authors: Irene
authors: I
authors: Wilkinson
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D001315:Australia; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000592:standards*; D006801:Humans; D006920:Hygiene / Q000592:standards; D017053:Infection Control / Q000379:methods / Q000592:standards; D007318:Inservice Training / Q000379:methods / Q000592:standards; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D017063:Outcome Assessment, Health Care; D010564:Personnel, Hospital / Q000706:statistics & numerical data; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D014944:World Health Organization
chemical_list: D000890:Anti-Infective Agents