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24 month outcomes from the Australian National Hand Hygiene Intiative (NHHI)

Introduction / objectives

The NHHI was implemented in January 2009 to establish a standardized hand hygiene (HH) culture-change program, including the increased use of alcohol-based handrub (ABHR), throughout all Australian hospitals.


A multi-modal culture-change program based on the World Health Organization “5 Moments” program was implemented in all States/Territories, including development of Australian HH guidelines, HHA and State-based healthcare worker (HCW) training program, data collection and analysis tools. Training to standardize HH compliance (HHC) auditing (>90% internal/external validity) was conducted nationally and a 4 monthly data submission schedule established. Electronic and online data submission capability enhanced efficiency and participation. Outcomes 24 months after NHHI commencement were assessed.


After 24 months, 521 healthcare facilities from all States/Territories submitted HH compliance data, representing approximately 85% and 50% of acute public and private hospital beds, respectively. The overall national (public/private) HHC rate was 68.3% (95%CI: 68.1-68.5%), with State-based rates (public hospitals) of 60.8%>72.6%. National HHC by Moment were: M1: 63.1%, M2: 68.4%, M3: 79.1%, M4: 76.0%, M5: 60.0%, suggesting that education needs to be focused on improvements in HH prior to patient contact, especially before performing procedures (M2). Overall HHC among public hospital medical staff was 53.4% (95%CI: 52.8%>53.9%).


The NHHI has been associated with a rapid national culture-change among Australian HCWs resulting in significantly improved HHC and a shift to greater use of ABHR. Analysis of NHHI impact on nosocomial disease rates is underway and further improvements in HHC can be expected.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Russo, P., Cruickshank, M. & Grayson, M. 24 month outcomes from the Australian National Hand Hygiene Intiative (NHHI). BMC Proc 5 (Suppl 6), O64 (2011).

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