title: Implementing and sustaining a hand hygiene culture change programme at Auckland District Health Board.
abstract: OBJECTIVE
  In January 2009 Auckland District Health Board commenced implementation of the Hand Hygiene New Zealand (HHNZ) programme to bring about a culture change and to improve hand hygiene compliance by healthcare workers. We describe the implementation process and assess the effectiveness of this programme 36 months after implementation.
  
  
  METHODS
  In keeping with the HHNZ guideline the implementation was divided into five steps: roll-out and facility preparation, baseline evaluation, implementation, follow-up evaluation and sustainability. The process measure was improvement in hand hygiene compliance and the outcome measure was Staphylococcus aureus clinical infection and bacteraemia rates.
  
  
  RESULTS
  The mean (95% CI; range) baseline compliance rates for the national reporting wards was 35% (95% CI 24-46%, 25-61%). The overall compliance by the 7th audit period was 60% (95% CI 46-74; range 47-91). All healthcare worker groups had improvement in compliance. The reduction in healthcare-associated S. aureus bacteraemia rates following the implementation was statistically significant (p=0.027).
  
  
  CONCLUSIONS
  Compliance with hand hygiene improved following implementation of a culture change programme. Sustaining this improvement requires commitment and strong leadership at a senior level both nationally and within each District Health Board.
authors.affiliation: Department of Microbiology, LabPlus, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand. sallyrob@adhb.govt.nz
authors.forename: Sally A
authors.initials: SA
authors.lastname: Roberts
authors.forename: Christine
authors.initials: C
authors.lastname: Sieczkowski
authors.forename: Taima
authors.initials: T
authors.lastname: Campbell
authors.forename: Greg
authors.initials: G
authors.lastname: Balla
authors.forename: Andrew
authors.initials: A
authors.lastname: Keenan
mesh_terms: D003468:Cultural Evolution; D003469:Culture; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006225:Hand; D006235:Hand Disinfection / Q000592:standards*; D006282:Health Personnel / Q000193:education*; D006284:Health Plan Implementation / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D006920:Hygiene / Q000592:standards*; D017053:Infection Control / Q000592:standards*; D009520:New Zealand; D010564:Personnel, Hospital / Q000193:education; D017410:Practice Guidelines as Topic; D015397:Program Evaluation