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Hand hygiene NZ

Hand hygiene NZ

What is Hand Hygiene New Zealand?

Hand Hygiene New Zealand (HHNZ) is a national quality improvement initiative led by Health Quality and Safety Commission (HQSC), aiming to improve hand hygiene practice in New Zealand hospitals. This initiative commenced in early 2012 with quarterly ‘Gold Audits’ performed by trained auditors.  The audit measures how many times staff comply with the World Health Organisation’s 5 moments of hand hygiene.

Value: Better, Best, BrilliantWaitemata DHB was one of nine DHBs to participate in the first HHNZ Gold Audit in March 2012, which now includes all 20 DHBs. HHNZ Gold Audits allow benchmarking of hospitals and development of DHB-specific strategies to improve hand hygiene practice.

Why is Hand Hygiene important?

Clean hands save lives

Hand hygiene It is one of the most important measures in the fight against healthcare associated infections (HCAIs), making it a key patient safety issue within New Zealand hospitals.  HCAI affects 5-15% of hospitalised patients and 9-37% of those admitted to intensive care units (ICUs), and contributes to death in at least 2.7% of cases.  HCAIs also results in prolonged hospital stay, long-term disability, increased resistance to antibiotics, massive additional financial burden, and high costs for patients and their families[1].

There is substantial evidence that hand hygiene reduces the incidence of HCAI and the incidence of multidrug-resistant bacteria[1]Performing hand hygiene correctly at each of the five moments reduces the risk that infectious organisms will be spread between patients from the hands of healthcare workers.

Hand Hygiene is an important indicator of safety and quality of care delivered in our hospitals. It is one of the Health Quality and Safety Commission’s national quality and safety markers.

  1. WHO guidelines on hand hygiene in health care, 2009


What are we trying to achieve?

We want staff to wash / gel  their hands before and after touching patients, before doing a procedure, after a body fluid exposure risk, and after touching patient surroundings.

We are also trying to improve the way we use gloves.  Using gloves doesn’t replace the need for hand hygiene.  Hands need to be washed before and after gloves are used, and gloves should only be used when there will be contact with blood or other potentially infectious materials, or non-intact skin.   The same pair of gloves should not be used for more than one patient.

The 5 Moments of Hand Hygiene

[As defined by the World Health Organisation (WHO)]
5 moments of hand hygiene

What can you do to help us?

At any time during your hospital stay

Ask everyone (including visitors) before they touch you or your surroundings:

Have you washed your hands?


What have we done?

The June 2013 audit results are encouraging as we continue to improve and are a reflection of hard work of staff, including infection control nurses, link nurses, clinician champions and managers to promote this simple yet highly effective practice.  The following measures / actions have contributed to our results:

  • Ensuring staff have access to hand gel when they need it.
  • Training and educating staff using multiple methods, for example,  electronic learning, small group sessions, and hand hygiene seminars.
  • Raising awareness of the importance of hand hygiene with patients and families by putting up posters, using doctors, physiotherapists and nurses as role models of good practice, and encouraging staff to remove watches and jewellery when  in  a clinical environment.
  • Having our senior management team including the Chief Executive, act as role models and reinforce good practice.
    Senior management team hand hygiene
  • Providing real time feedback to our staff about good practice or when a hand hygiene moment is missed.
  • Monitoring how well we are doing by observing and reporting results (auditing) with quarterly HHNZ Gold Audits and additional local ward/clinical area audits.
  • Providing ‘transparency reports’ to the wards and services showing how well they are tracking, and regular reporting to the senior management team and the board on our progress.

Hand hygiene transparency report
An example of our transparency of reporting - this is a breakdown of  hand hygiene compliance in different clinical areas and by each of the '5 Moments of hand hygiene' contact with a patient

How do we measure good hand hygiene?

Gold Audits

Gold Audits are observational audits of compliance with the five hand hygiene moments.  They are undertaken by highly trained auditors who must have a clinical professional background.  These audits take place on a select number of wards and departments.  The results of the audits are reported as an overall rate of compliance, rates of compliance for each hand hygiene moment, and rates of compliance for healthcare worker categories (for example, nurses, doctors, student doctors etc).

The national target is for staff to practice hand hygiene for more than 70% of observed hand hygiene moments.

Rates of Staphloccus aureus bacteraemia

In addition to rates of compliance with hand hygiene moments, the rate of healthcare associate Staphlococcus aureus (S.aureus) bacteraemia (blood stream infection) is measured to monitor the impact of improvement in hand hygiene practice.

S. Aureus bacteraemia is expressed as a rate of infection per 1,000 bed days

How are we doing?

We have seen significant improvement in compliance with hand hygiene since the first Gold Audit in March 2012 (49% compliance) to the fifth national audit in June 2013 (74% compliance).  The national hand hygiene compliance average has increased from 66% to 70%.  We have remained above the national average for the second successive period and are now ranked third in the national audit report.

Waitemata DHB Hand Hygiene Compliance Comparison to the National Average
Waitemata DHB Hand Hygiene Compliance Comparison to the National Average

Historically we have low rates of Staphylococcus aureus bacteraemia (0.02-0.08 infections per 1,000 bed days) compared to the national rate, and our rate has essentially remained unchanged despite improved hand hygiene compliance.  This may be because with a low baseline (low rate) we require an even higher change in compliance to show a reduction in rates of bacteraemia.

Where to from here?

We need to continue to improve our compliance with hand hygiene moments.  Our results show areas of excellence, including our special care baby unit (SCBU) and ICU, while other areas need to improve significantly. We also need to improve compliance across healthcare worker categories, particularly among our doctors and students.