Health is in your hands

Sometimes the most important things are also the simplest.

It is said that cleanliness is next to godliness, which is very much the case for health professionals.

An estimated 12,000 blood stream infections associated with health care occur in Australia each year.

Of these, 4500 are due to Staphylococcus aureus blood stream infections (SAB), which include methicillin-resistant Staphylococcus aureus (MRSA), or golden staph. One third of patients with an SAB die within 30 days of infection.

These infections, which are increasingly resistant to antibiotics, mean longer lengths of stay, higher health costs, poorer patient outcomes and, too often, unnecessary deaths.

The cure, however, is simple. It’s about timely and effective hand washing.
In May, a new world-first national hand hygiene program was rolled out across Australian hospitals in a bid to halve the rate of these antibiotic-resistant superbug patient infections.

The National Hand Hygiene Initiative is based on groundbreaking Australian research that shows using alcohol-based hand rub is the single most effective intervention in controlling SAB and MRSA infections.

The step-by-step program was developed to improve hand hygiene in hospitals and other health services and to monitor hand hygiene compliance among healthcare workers.

If healthcare workers use alcohol-based hand rub before and after contact with patients in the prescribed way, the rate of SAB is expected to halve, according to the Australian Commission on Safety and Quality in Health Care, which instigated the initiative.

“This is a very exciting development in the fight against patient infection and represents a simple but highly effective program to improve hand hygiene in every public and private hospital in Australia,” says Professor Chris Baggoley, chief executive of ACSQHC.

“By improving infection control, the initiative has the potential to save the lives of more than 1500 Australians a year – a figure similar to the national road toll.”

The National Hand Hygiene Initiative officially began in May, to coincide with the World Health Organization’s Save Lives: Clean your Hands day.

“MRSA or golden staph disease is a major problem for hospitals worldwide. We need to make infection control everyone’s business in the health system and the wider community to help address this problem,” says Baggoley.

Implemented by Hand Hygiene Australia, its director Professor Lindsay Grayson undertook the ground-breaking research featured last year in the Medical Journal of Australia that demonstrates the effectiveness of alcohol-based hand rub in reducing blood stream infections.

“The research demonstrates that where health professionals consistently use an alcohol-based hand rub for just 15 seconds, the rates of golden staph infections are half those in hospitals where health professionals are required to wash their hands for one minute using traditional soap and water,” says Grayson.

Grayson carried out a two-year pilot program using alcohol-based hand rub solutions in six Victorian health care institutions. Hand hygiene compliance improved significantly at all pilot program sites – from 21 per cent to 48 per cent at the end of the two-year trial.

Hand Hygiene Australia will work closely with existing state and territory strategies and campaigns to maximise the success of the initiative. While the initial focus is on acute-care hospitals, resources will also be available for all public and private healthcare facilities.

The program represents clear, national guidelines for hand hygiene, Grayson says. It includes an online education program to inform all healthcare workers about infection control and hand hygiene, and will push for all Australian medical and nursing curricula to include training on the importance of effective hand hygiene.

A key part of the guidelines include the Five Moments for Hand Hygiene approach, which identify the critical times when Hand Hygiene should be performed. It was developed by the World Health Organisation as part its Global Patient Safety Challenge.

Time to perform hand hygiene has been described as one of the key factors in persistently low compliance. WHO found that embracing the five moments approach would go towards eliminating doubt in terms of the required times when hand hygiene should be applied.

The approach targets the precise moments in time at which, if hand hygiene occurs, germ transmission will be halted and future harm prevented.

These are: before touching a patient and their immediate surroundings, immediately before a procedure, after performing a procedure or body fluid exposure risk, after touching a patient and their immediate surroundings and after touching any objects in a patient’s immediate surroundings – even when the patient has not been touched.

The program also includes a national register of bloodstream infections to compare infection rates between hospitals, states, territories and with other countries. Every month each state will be required to record their SAB and MRSA infection rates and send them to Hand Hygiene Australia.

VRE or other antibiotic resistant infections will not be measured as part of this initiative. However, it is believed its strategies to reduce SAB infections will decrease the number of other infections including VRE.

Although VRE is a serious problem, it does not have the same death rate as SAB and is currently more difficult to measure, says the Australian Commission on Safety and Quality in Health Care.

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