|Title:||National Hand Hygiene Initiative in Western Australian Hospitals|
|Document ID:||Operational Directive OD 0429/13|
|Date of issue:||Wednesday, 24 April 2013|
|Description:||Describes the minimum hand hygiene requirements that public and licensed private hospitals funded to provide care for public patients in WA are required to implement and outlines the key components of the National Hand Hygiene Initiative.
Compliance with this Operational Directive is mandatory for all Western Australian public healthcare facilities and those licensed private healthcare facilities, including satellite haemodialysis units, contracted to provide services to public patients.
|Framework:||Public Health Policy Framework|
|Period of effect:||from 9 April 2013 to 9 April 2018|
|Authorised by:||David Russell-Weisz, A/Director General, Department of Health WA, 15-Apr-2013|
|Print version:||View print version|
National Hand Hygiene Initiative in Western Australian Hospitals
Hand disinfection: application of either an antimicrobial soap/solution and water or an alcohol based hand rub product, to the surface of the hands. This process reduces microorganism counts on hands.
Hand hygiene: a process that reduces the number of microorganisms on hands. Hand hygiene is a general term applying to the use of soap (non-antimicrobial and antimicrobial) and water or the application of an alcohol-based antimicrobial agent to the hands.
Hand hygiene product: any product used to perform hand hygiene, including soap.
Healthcare facility: includes all public hospitals, ambulatory or community services under the governance of specific Health Services and licensed private healthcare facilities funded to provide care to public patients.
Healthcare worker: includes all employees of the healthcare facility and all students, trainees, contractors and volunteers engaged at the facility.
The purpose of this Operational Directive is to describe the minimum hand hygiene (HH) requirements and the key components of the National Hand Hygiene Initiative (NHHI) that Western Australian (WA) public healthcare facilities (HCFs) and licensed private HCFs funded to provide care to public patients in WA are required to implement.
Infections resulting from the provision of healthcare are one of the most common causes of unintended harm suffered by health consumers and are associated with increased morbidity and mortality. It is increasingly recognised that healthcare associated infections (HAIs) are preventable adverse events, rather than an inevitable outcome of medical care.1
The association between poor HH practices by healthcare workers (HCWs), the transmission of infection and the spread of antibiotic resistant microorganisms is well established. Despite this, it has been consistently demonstrated that compliance by HCWs performing appropriate HH is sub-optimal.2-6
It has been established that a multifaceted, multidisciplinary, facility-wide hand hygiene program, which includes executive leadership, education, local ‘champions’ and environmental enablers can be effective at reducing the incidence of HAI’s and minimising transmission of microorganisms within HCFs.7-11
In December 2008, Australian Health Ministers endorsed the NHHI and a nationally coordinated approach to the monitoring of HH compliance by HCWs in Australian HCFs. Hand Hygiene Australia (HHA) was contracted by the Australian Commission on Safety and Quality in Healthcare to develop, monitor and report on the NHHI.
Participation in the NHHI was endorsed by the WA Director General of Health in the Operational Directive OD: 0197/09 Healthcare Associated Infection Surveillance in WA and has been a mandatory requirement for WA public HCFs and private HCFs contracted to provide care to public patients since February 2010.
The NHHI is based on the World Health Organization’s Global Patient Safety Challenge ‘Save Lives: Clean Your Hands’ and adopts the ‘5 Moments for Hand Hygiene’ framework. The primary aim of the NHHI is to improve HH compliance among HCWs, thereby reducing the transmission of infection in HCFs throughout Australia. This involves a multi-interventional culture-change program to improve HH compliance via the increased use of alcohol based hand rub (ABHR).
The introduction of ABHR has played a key role in improving HCW compliance with HH and reducing HAIs. It is an integral component of the NHHI. ABHR is the gold standard of care for HH practices in HCFs, whereas hand washing is reserved for situations when hands are visibly soiled, contaminated with blood or body fluids or when gloves have not been worn following known or suspected exposure to bacterial spores (e.g. Clostridium difficile), non-enveloped viruses (e.g. norovirus), or parasites. ABHR is the recommended HH product for the prevention of intravascular catheter related infections.12
The five key elements of the program are: system change; training and education; evaluation and feedback; workplace reminders and institutional safety climate. The outcome measures to be reported nationally for the NHHI are:
5.1 Compliance with this Operational Directive is mandatory for all public HCFs and licensed private HCFs funded to a provide care to public patients. These facilities are required to align their HH program with the NHHI.
5.2 Each HCF is to ensure the five key elements described in Table 1 (Appendix 1) are incorporated into local policy as minimum requirements. In addition, local policy needs to incorporate uniform and procedure requirements where, for religious reasons, a HCW may wish to cover their forearms.13, 14
5.3 Each HCF is to ensure there is a facility-wide approach to improving HH compliance that incorporates both clinical and non-clinical areas.
5.4 Public HCFs shall only utilise HH products that have been awarded under the mandatory ‘Whole of Health’ contract HCNS110809 for the supply of Antiseptics and Disinfectants to Western Australian Public Healthcare Units and the mandatory ‘Whole of Government’contract CUA42309 for Cleaning, Kitchen and Bathroom Products. These awarded products have been evaluated on behalf of WA Health by clinical and technical representatives from various HCFs. There is an ability to purchase ‘off contract’ if new technology becomes available prior to refresh of contracts, however, any request for alternative HH products must be discussed with the infection control professional at the HCF and Health Corporate Network procurement officers.
Private HCFs funded to provide services to public patients are exempt from these contractual requirements. However, they must ensure there are rigorous product evaluation systems in place to cover the purchase of HH products for use in all areas of the HCF. Private facilities with limited resources to evaluate products may wish to be guided by choosing products awarded on government contracts.
Hand hygiene products used to disinfect hands in any HCF must be approved by the Australian Therapeutic Goods Administration (TGA) and be included on the Australian Register of Therapeutic Goods (ARTG). It is recommended that ABHRs also meet the EN1500 (European Committee for Standardisation) testing standard for bactericidal effect.12
5.5 Mental health facilities are exempt from the routine compliance auditing component of the NHHI as meaningful data is unlikely to be obtained, however, the remaining key elements of the program are required to be implemented.
5.6 Ambulatory care settings which are under the governance of specific Health Services e.g. school clinics, community midwifery centres and home birthing services, are also exempt from the auditing component, however they are to ensure the remaining key elements of the NHHI are implemented.
Educational resources and implementation tools to assist HCFs meet the requirements of this Operational Directive are available from the HHA website (www.hha.org.au).
7.1 Executive Directors of public HCFs and licensed private HCFs funded to provide care to public patients are responsible for ensuring implementation and compliance with this Operational Directive.
7.2 Each HCF is to ensure processes are in place to address non-compliance issues for HCWs failing to comply with hand hygiene requirements.
8.1 Each HCF is to report hand hygiene compliance to internal stakeholders and to the highest level of governance in the HCF.
8.2 Each HCF is to ensure compliance data for the three audit periods is submitted online to HHA as per the HHA schedules, which allows for timely collation and publication of national data.
8.3 Data submitted by HCFs will be integrated into the Healthcare Infection Surveillance Western Australia (HISWA) reports and other reports as directed by the Director General of Health WA. Publication of identifiable hospital hand hygiene compliance data will be available at http://www.health.wa.gov.au/handhygiene/home/
8.4 De-identified hospital healthcare-associated Staphylococcus aureus bloodstream infection data will be submitted to HHA by the Healthcare Associated Infection Unit (HAIU) to allow collation of national data.
8.5 The percentage of employed HCWs who have received HH education is to be reported annually by hospitals to the HAIU (with audit period three data) to permit comparison with HAI rates.
Table 1: Minimum requirements for hand hygiene programs
This circular last updated: Wednesday, 24 April 2013 at 2:54pm