CHARTPACK Click to edit Master title style Reporting hand hygiene Click to edit Master subtitle style compliance January 2018 Trusted information. Informed decisions. Improved healthcare. 1
Contents Key findings 3 Setting the scene 4 Hand hygiene data collection 5 Current reporting on hand hygiene compliance 6 Click to edit Master title style Data and reporting 7 Comparisons over time: ‘before moments’ and ‘all moments’ 8 Click to edit Master subtitle style Comparisons: by healthcare worker 9 Comparisons: by ward type 10 Comparisons: by local health district and specialty network 11 Comparisons: by facility 12 Patient survey data on hand hygiene 14 Compliance and patient-observed hand washing 15 Appendix: Additional information 16 Trusted information. Informed decisions. Improved healthcare. 2
Key findings 1. Compliance reporting based on the two ‘before moments’ resulted in similar findings as current compliance reporting using all five moments. 2. While there has been an increase in hand hygiene compliance rates over time, rates are starting to plateau. 3. Patient survey data also show an increase over time in the percentage of patients who said they ‘always’ saw nurses and doctors wash or clean their hands before touching them. However, there was no strong correlation between compliance and survey results for public hospitals. 4. More work is needed to understand compliance and hand hygiene data in relation to patient safety outcomes and patient experiences. 5. Future work on reporting may consider the impact of the case-mix by ward type, health care worker, and the mix of moments in compliance reporting. Regular monitoring may also benefit from using a minimal reporting level of 100 or more observations, which would increase the power of statistical significance testing. BACK TO CONTENTS Trusted information. Informed decisions. Improved healthcare. 3
Setting the scene The Clinical Excellence Commission (CEC) The ‘five moments’ of hand hygiene manages the National Hand Hygiene Initiative in NSW. The program, run in conjunction with Hand Hygiene Australia, provides training, education, and promotional and reporting resources in order to raise awareness of the importance of hand hygiene. Click to edit Master title style A key part of the program is audit. Throughout the year, trained hand hygiene auditors collect data using direct observation of their colleagues’ hand cleaning before and after Click to edit Master subtitle style clinical encounters. The audit focuses on the ‘five moments’ of hand hygiene as defined by the World Health Organisation. Hand hygiene compliance is reported as the percentage of observed moments for which appropriate hand hygiene was performed. This chartpack explores options for hand hygiene compliance reporting – specifically considering whether a focus on reporting the first two moments – the ‘before moments’ that occur before patients are touched – represents a viable alternative to reporting ‘all moments’. BACK TO CONTENTS Trusted information. Informed decisions. Improved healthcare. 4
Hand hygiene data collection Hand hygiene compliance (all staff) – Trends in overall hand hygiene compliance (%) Data collection by all staff, NSW and Australia, November 2009 to June 2017 More than 200 facilities in NSW submit data to the National Hand Hygiene Initiative. NSW Australia Participating facilities include acute inpatient hospitals, residential aged care centres, 100 community health networks and dental facilities % of staff complying with hand hygeine guidelines Click to edit Master title style and are located across the state’s local health 90 74.7 75.9 76.9 78.9 79.3 79.6 80.4 81.1 81.6 83.0 83.4 83.5 84.1 84.1 84.8 84.9 84.9 85.3 84.5 districts (LHDs) and specialty networks. 80 Observations are collected in plain sight by 71.6 71.8 68.5 70 trained staff on the ward or facility. 60.9 61.7 Click to edit Master subtitle style Reporting to date 60 The CEC provides progress reports in its 50 e-Chartbook. Results are generally reported by 40 type of moment, healthcare worker and ward. 30 Limitations 20 Hand hygiene compliance results may be influenced by the level and experience of the 10 staff auditors and inter-rater reliability is not routinely assessed. Results are not adjusted for 0 Nov 09 Apr 10 Aug 10 Nov 10 Mar 11 Jun 11 Oct 11 Mar 12 Jun 12 Oct 12 Mar 13 Jun 13 Oct 13 Mar 14 Jun 14 Oct 14 Mar 15 Jun 15 Oct 15 Mar 16 Jun 16 Oct 16 Mar 17 Jun 17 variation in staff mix, moment type and ward. BACK TO CONTENTS Trusted information. Informed decisions. Improved healthcare. 5
Current reporting on hand hygiene compliance Percentage compliance by healthcare worker, five moments, 2016 Hand hygiene compliance has improved over time in NSW, but varies across healthcare worker and ward types. 91.7 100 88.8 87.5 83.9 83.3 79.8 76.6 73.2 80 68.7 In 2016, dental staff, nurses and midwives 60 had the highest compliance, and domestic workers the lowest compliance, when all five 40 Click to edit Master title style moments of care are considered. 20 0 Compliance varied across ward types, ranging from 77.5% in emergency departments to 92.7% in dental wards. Click to edit Master subtitle style Compliance also varied across LHDs, ranging from 77.5% in Central Coast to Percentage compliance by ward type, five moments, 2016 90.0% in Far West. Results for the Justice and Sydney Children’s specialty networks 92.7 91.0 90.1 89.7 89.5 89.2 88.5 88.1 87.9 87.6 87.1 86.6 86.2 83.5 83.5 82.7 82.3 79.5 77.5 100 were relatively high, at 90.7% and 91.7%, respectively. Across the 238 individual 80 facilities included in the 2016 audit, 60 compliance ranged from 63.4% to 100.0% 40 [data not shown]. 20 0 BACK TO CONTENTS Trusted information. Informed decisions. Improved healthcare. 6
Data and reporting This chartpack explores the effect of a change in reporting practices – specifically whether a focus on compliance for the two before moments provides substantially different picture of performance when compared with compliance for all moments. Comparisons between the before moments and all moments Click to edit Master title style are shown over time, by healthcare worker, by ward type and by LHD. Compliance data: In 2016, a total of 647,447 moments were observed and of these, 40% Click to edit Master subtitle style were ‘before moments’ and 60% were ‘after moments’. Among the ‘before moments’ there were more than twice as many observations recorded before touching a patient than before a procedure (72% and 28%, respectively) [see Appendix]. Before moments Patient Survey data: Data drawn from patient surveys, detailing hand hygiene practices that were observed by patients, provides additional context. The 2016 NSW Adult Admitted Patient After moments Survey (AAPS) included responses from 28,693 patients across 80 public hospitals (response rate 42%). Reporting at a facility, hospital or group level is All moments limited to units with more than 30 observations. BACK TO CONTENTS Trusted information. Informed decisions. Improved healthcare. 7
Comparisons over time: ‘before moments’ and ‘all moments’ In many ways the first two moments of Compliance for ‘before moments’ and ‘all moments’, NSW, 2011 to 2017 hand hygiene – the ‘before moments’ – are more important in preventing 100 Before moments All moments healthcare associated infections. 90 The hand hygiene audit program has recorded an improvement in compliance Click to edit Master title style 80 83.5 82.9 over time. In recent collection periods, rates have plateaued, but remained above the 70 2017 national hand hygiene benchmark of 72.6 80% as set by the Australian Health Compliance (%) 60 Ministers' Advisory Council. Click to edit Master subtitle style Over time ‘before moment’ results have 50 been consistently lower than ‘all moment’ results, although the pattern of improvement 40 is similar. 30 20 10 0 2011 2012 2013 2014 2015 2016 2017 (up to June) BACK TO CONTENTS Trusted information. Informed decisions. Improved healthcare. 8
Comparisons: by healthcare worker Compliance for ‘before moments’ and ‘all moments’ by healthcare worker, NSW, 2016 Hand hygiene compliance varies by healthcare worker types. These differences may be important to consider when comparing facilities or regions with different mixes of workers. For ‘before moments’ and ‘all moments’, Click to edit Master title style dental staff and nurses/midwives had the highest compliance. Comparing ‘before moments’ and ‘all moments’, the largest difference in the two Click to edit Master subtitle style measures was for personal carers, where the gap in compliance between ‘before moments’ and ‘all moments’ was more than five percentage points. For dental staff, other workers and domestic workers (such as food preparation staff), compliance was higher for ‘before moments’. All other groups had higher compliance for ‘all moments’. BACK TO CONTENTS Trusted information. Informed decisions. Improved healthcare. 9
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