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HAIs and the high prevalence of HAIs in larger hospitals may be, in part, due to poor hand hygiene adherence. Consequently, efforts to improve hand hygiene compliance and minimise subsequent HAIs should be targeted at larger hospitals, since such infections place significant financial and resource burdens on the healthcare sector.

doi: 10.1111/1753-6405.12160

Hand hygiene and bacteraemia rates in Australian hospitals Adrian Y. S. Lee1 1. Medical Student, University of Tasmania

Hand hygiene remains a pressing issue for the healthcare sector and one of the most significant interventions in the fight against healthcare-associated infections (HAIs) world-wide.1 In Australia, HAIs number about 200,000 every year, including more than 12,000 serious bloodstream infections (BSIs).2 MyHospitals (http://www.myhospitals.gov. au/) is an Australian government-run, publicaccessible website that contains information on hospitals and healthcare facilities around the country. Measures of patient safety and quality, supplied for most hospitals, look at two factors: (i) the rate of Staphylococcus aureus bacteraemia BSI cases (SAB) per 10,000 days of patient care; and (ii) healthcare worker hand hygiene compliance based on the ‘Five Moments for Hand Hygiene’.1 Using the latest data available for these factors (accessed in June 2013), hospitals around Australia were examined for any possible trends. Data from 1,035 hospitals were collected. Of these, only 411 hospitals (39.7%) were sufficiently complete in their data to be included for analyses. The hospitals were categorised according to their size into five groups (500 beds). Considered as a whole, a weak negative correlation for SABs was seen with increasing hand hygiene compliance (Spearman’s r = −0.288, p500 beds), there was a curious moderate positive correlation with hand hygiene compliance and increasing SABs (r = 0.490, p=0.011). The latter trend was also observed in a recent investigation that looked at 21 large health institutions using MyHospitals data.3

This small investigation has several limitations in its analyses, including the failure to account for the differing foci of larger hospitals; for example, demographics (children vs. adult hospitals) and medical specialisations. In addition, although the latest values were used, the incongruity in the timing between hand hygiene and SAB rates may not necessarily be reflective or causal of each other. It was hoped that the latest values would be somewhat reflective of overall hand hygiene and SAB rates, and that the analysis of a large number of hospitals minimised these inconsistencies. The anomaly in the large hospitals raises the questions of whether SAB rates are truly reflective of hand hygiene compliance, or if this is an artefact of research methodology. Indeed, hand hygiene compliance is a complex area that is affected by a host of factors; however, the ultimate focus of future research ought to explore the extent of that effective hand hygiene reduces HAIs.

References 1. World Health Organization. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge. Clean Care is Safer Care. Geneva (CHE): World Health Organization; 2009. 2. Cruickshank M, Ferguson J, editors. Executive Summary. In: Reducing Harm to Patients from Health Care Associated Infection: The Role of Surveillance. Sydney (AUST): Australian Commission on Safety and Quality in Health Care; 2008. 3. Playford GE, McDougall D, McLaws M-L. Problematic linkage of publicly disclosed hand hygiene compliance and health care-associated Staphylococcus aureus bacteraemia rates. Med J Aust. 2012;197(1):29-30.

Correspondence to: Mr Adrian Lee, University of Tasmania Rural Clinical School, Private Bag 3513, Burnie, Tasmania 7320; e-mail: [email protected]

The rates of hand hygiene compliance and SABs were examined, with respect to hospital size, using the Kruskal-Wallis test with Dunn’s post-hoc analysis. It was established that hand hygiene compliance decreases with increasing hospital size (H(4) = 56.42, p

Hand hygiene and bacteraemia rates in Australian hospitals.

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