Implementing a hand hygiene program nationally requires a culture change
Given the evidence supporting the dramatic efficacy of hand hygiene (HH) culture-change programs and use of alcohol-based hand rub (AHR) solution worldwide and locally,1-4 a national HH initiative has been launched by the Australian Commission on Safety and Quality in Health Care, with the support of all states and territories. Although some jurisdictions have already undertaken programs in this important area,2-5 including some impressive studies described in the supplement to this issue of the Journal,6-9 this national program, organised by Hand Hygiene Australia (HHA), aims to introduce a standard HH culture-change program throughout all Australian public and private hospitals. The aims of the program are to improve HH compliance, increase the use of AHR, and establish a common system of measuring the disease outcomes associated with improved HH that can be used by hospitals to compare their performance against national and international benchmarks. The HHA program has three crucial components.
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- 2. Johnson PDR, Martin R, Burrell LJ, et al. Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust 2005; 183: 509-514. <MJA full text>
- 3. Grayson ML, Jarvie LJ, Martin R, et al. Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out. Med J Aust 2008; 188: 633-640. <MJA full text>
- 4. Grayson ML, Melvani S, Druce J, et al. Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers. Clin Infect Dis 2009; 48: 285-291.
- 5. Clinical Excellence Commission, NSW Health. Clean hands save lives: final report of the NSW Hand Hygiene Campaign. Sydney: NSW Health, 2007. http://www.cec.health.nsw.gov.au/moreinfo/cleanhands_report.html (accessed Aug 2009).
- 6. Pantle AC, Fitzpatrick KR, McLaws ML, Hughes CF. A statewide approach to systematising hand hygiene behaviour in hospitals: Clean hands save lives, Part I. Med J Aust 2009; 191 (8 Suppl): S8-S12. <MJA full text>
- 7. Fitzpatrick KR, Pantle AC, McLaws ML, Hughes CF. Culture change for hand hygiene: Clean hands save lives, Part II. Med J Aust 2009; 191 (8 Suppl): S13-S17. <MJA full text>
- 8. McLaws ML, Pantle AC, Fitzpatrick KR, Hughes CF. Improvements in hand hygiene across New South Wales public hospitals: Clean hands save lives, Part III. Med J Aust 2009; 191 (8 Suppl): S18-S25. <MJA full text>
- 9. McLaws ML, Pantle AC, Fitzpatrick KR, Hughes CF. More than hand hygiene is needed to affect methicillin-resistant Staphylococcus aureus clinical indicator rates: Clean hands save lives, Part IV. Med J Aust 2009; 191 (8 Suppl): S26-S31. <MJA full text>
- 10. Sax H, Allegranzi B, Uckay I, et al. “My five moments for hand hygiene”: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007; 67: 9-21.
One AHR solution currently marketed in Australia (DeBug [Orion Laboratories, Perth, WA]) was co-developed by Lindsay Grayson with partial funding from the Victorian Department of Human Services. The intellectual property for this development is held by Austin Health, which handles all patent, trademark and licensing issues. Austin Health, but neither author, receives a small income stream from the sale of DeBug.