Guidelines for Data Submission to HHA - Hospitals

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Background
Auditing hand hygiene compliance serves multiple functions, including quality of care assessment, incentive for performance improvement, outbreak investigation and infrastructure design.[65]

To appropriately measure hand hygiene compliance, the Hand Hygiene Australia (HHA) 5 Moments approach allows a comparison of hand hygiene performance across a broad range of health care settings and within a facility across both high versus lower risk clinical environments.
 
Data Collection Process
All hand hygiene compliance data submitted must:
  • be collected by a validated auditor (see Section 7 HHA Manual, or Chapter 5 of the HHA Manual 2012 - to be released soon)
  • be collected from appropriate clinical areas as stated below
  • meet the minimum number of moments as outlined in Table 1 below
  • include an appropriate spread of data from different healthcare worker groups. It is suggested that 60%-70% of data is of nursing staff and 10-15% is of medical staff

Once submitted, HHA staff will confirm the adequacy of the data.

Clinical Area Selection
Several factors need to be considered when determining which wards should be audited. As hand hygiene is the single most important element of strategies to prevent healthcare associated infection, wards known to have greater potential for high infection rates should be targeted. Improvements in hand hygiene compliance rates in these wards will have the greatest impact on the prevention of infection and provide a safer environment for patients.
Generally, these wards also have the greatest staff/patient activity and interaction, which results in higher numbers of ‘Moments’ being audited in shorter time periods.
Auditing wards where there is little staff/patient activity and interaction will result in a small number of moments being observed (i.e. non-acute settings) and resources required to undertake auditing may be better utilised measuring other aspects of a hand hygiene program (e.g product placement, education etc).
The selection of wards should be made in conjunction with the appropriate committee at the hospital (e.g. Infection Control Committee, Hand Hygiene Committee, Quality Improvement Committee) and with Executive approval.
 
Numbers of Moments
Inevitably compliance data will be used for comparison, be it at a ward, hospital, jurisdictional or national level.
When data is used for comparison, it is important to remember that generally a higher number of Moments audited will generate a more reliable compliance rate, as demonstrated in Chart 1
 
HHA recommend 95% confidence intervals are included when reporting compliance rates.
  
CHART 1 
 

 Hand Hygiene Compliance Auditing Ward Selection Options

 

TABLE 1 - Hospital stratification with number of wards

Number of acute inpatient beds
Minimum Required number of ICU’s per audit
Minimum Required number of HRW per audit*
Minimum Required number of other wards per HH audit
(Option A)
Total number of Wards
(Option A)
Minimum Required number of HH moments per ward
Minimum Total number HH moments per audit
> 400
1
2
4
7
350
2450
301 to 400
1
1
4
6
350
2100
201 to 300
1
1
3
5
350
1750
151 to 200
1
or 1
3
4
200
800
101 to 150
1
or 1
2
3
200
600
51 to 100
1
or 1
1
2
100
200
25 to 50
1
or 1
or 1
(if no ICU or HRWs)
1
100
100
<25 **
1
or 1
or 1
(if no ICU or HRWs)
1
50
50

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
* If there is more than one ICU in a hospital, auditing in other ICU’s can be included as auditing in the High Risk Wards.
** Auditing in Hospitals < 25 beds is dependent on jurisdiction, see table below.
 

TABLE 2 – Current Jurisdictional requirements for hospital < 25 beds

Jurisdiction
Auditing required in hospitals < 25 beds? (Yes/No)
ACT
Yes
NSW
Yes
NT
Yes
QLD
No
SA
No
TAS
Yes
VIC
Yes
WA
Refer to Jurisdictional representative