Since its implementation in 2009, the National Australian Hand Hygiene Initiative (NHHI) has seen significant, sustained improvements in hand hygiene compliance among Australian healthcare workers, and reduced risks of potentially fatal healthcare-associated Staphylococcus aureus infection, according to new research being presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam, Netherlands, and published in The Lancet Infectious Diseases.

The incidence of S. aureus bloodstream infection in Australia

However, the national culture-change programme could be a template for similar initiatives in other countries; researchers say.”Hospital-acquired infections are a major concern for hospitals around the world and S. aureus is among the most dangerous,” says Professor Lindsay Grayson from Hand Hygiene Australia who led the research. “The risks to patients are enormous, as are the associated hospital costs. Despite robust evidence supporting improved practices for hand hygiene, securing compliance is notoriously difficult, and few national programmes have been sustained in the long-term.”

So, S. aureus is the leading Gram-positive bacterium responsible for hospital-acquired infections including endocarditis, acute pneumonia, and sepsis. S. aureus infections are; linked to poor hand hygiene compliance. However, in this study, Grayson and colleagues analysed outcomes of the NHHI in the 8 years after its implementation (Jan 2009 to June 2017). All hand hygiene compliance auditing was; done by direct observation three times a year (measured as a percentage of observed moments); and the clinical impact of the programme was; assessed by linking data on hospital-level incidence of S. aureus infection; with hospital-level hand hygiene compliance.

Association with reduced rates of staphylococcal bacteraemia

The researchers point out that a negative correlation between annual change in hand hygiene compliance; and annual change in S. aureus infection at the hospital level (especially for the largest hospitals); suggests that declines in S. aureus infection were not simply time dependent; but more likely associated with changes in hand hygiene compliance.”The National Australian Hand Hygiene Initiative has achieved impressive results; both in terms of improving healthcare worker hand hygiene compliance; and its association with reduced rates of healthcare-associated staphylococcal bacteraemia. Few national programmes have become successfully integrated into national health-care structures”, says Professor Grayson.

The authors note several limitations including that hand hygiene compliance reported in the NHHI; is likely to be better than average real-world compliance since some of the auditing was; done during evening or night shifts or on weekends, and healthcare workers are far more likely to comply with hand hygiene guidelines when they know they are being watched. Whilst auditors were trained to accurately record hand hygiene compliance in a busy clinical setting, the authors cannot be sure that all ‘Moments’ were captured. Finally, they note that while a strong link between improved hand hygiene compliance and declining incidence of S. aureus infection was found, other factors such as viral respiratory outbreaks or antimicrobial stewardship programmes may have had some impact.