Marilyn Cruickshank

Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative.

Objective: To report outcomes from the first 2 years of the National Hand Hygiene Initiative (NHHI), a hand hygiene (HH) culture‐change program implemented in all Australian hospitals to improve health care workers’ HH compliance, increase use of alcohol‐based hand rub and reduce the risk of health care‐associated infections.

Global collaboration to encourage prudent antibiotic use

www.thelancet.com/infection Vol 13 December 2013 1003 higher direct costs of products whose manufacturing methods are altered. A pricing paradox exists in farming whereby antibiotics, a scarce natural resource, cost less than implementation of more eff ective hygiene practices. Reversal of this paradox might lead to higher food prices. In the UK, a cross-government antimicrobial strategy has been launched. The key elements are: improvement of infection prevention and control practices in human and animal health; optimisation of prescribing practice; improvement of professional education, training, and public engagement; development of new drugs, treatments, and diagnostics; better access to and use of surveillance data; better identifi cation and prioritisation of research into antimicrobial resistance; and strengthened international collaboration. The UK Govern ment is working alongside other governments under the auspices of the WHO to improve global anti microbial steward ship and surveillance.

Use of an Innovative Personality-Mindset Profiling Tool to Guide Culture-Change Strategies among Different Healthcare Worker Groups

Introduction Important culture-change initiatives (e.g. improving hand hygiene compliance) are frequently associated with variable uptake among different healthcare worker (HCW) categories. Inherent personality differences between these groups may explain change uptake and help improve future intervention design. Materials and Methods We used an innovative personality-profiling tool (ColourGrid®) to assess personality differences among standard HCW categories at five large Australian hospitals using two data sources (HCW participant surveys [PS] and generic institution-wide human resource [HR] data) to: a) compare the relative accuracy of these two sources; b) identify differences between HCW groups and c) use the observed profiles to guide design strategies to improve uptake of three clinically-important initiatives (improved hand hygiene, antimicrobial stewardship and isolation procedure adherence). Results Results from 34,243 HCWs (HR data) and 1045 survey participants (PS data) suggest that HCWs were different from the general population, displaying more individualism, lower power distance, less uncertainty avoidance and greater cynicism about advertising messages. HR and PS data were highly concordant in identifying differences between the three key HCW categories (doctors, nursing/allied-health, support services) and predicting appropriate implementation strategies. Among doctors, the data suggest that key messaging should differ between full-time vs part-time (visiting) senior medical officers (SMO, VMO) and junior hospital medical officers (HMO), with SMO messaging focused on evidence-based compliance, VMO initiatives emphasising structured mandatory controls and prestige loss for non-adherence, and for HMOs focusing on leadership opportunity and future career risk for non-adherence. Discussion Compared to current standardised approaches, targeted interventions based on personality differences between HCW categories should result in improved infection control-related culture-change uptake. Personality profiling based on HR data may represent a useful means of developing a national culture-change “blueprint” for HCW education.

A literature review supporting the proposed national Australian definition for Staphylococcus aureus bacteraemia

Staphylococcus aureus bacteraemia (SAB) is a major cause of morbidity and mortality. During 2009, a national surveillance definition for SAB was developed through the Australian Commission on Safety and Quality in Healthcare (ACSQHC). The aim of this paper is to review the literature surrounding SAB surveillance and in doing so, evaluate the recently developed Australian national definition for SAB. The issues examined in this paper that relate to SAB surveillance include detection, the management of duplicates, classification and acquisition of SAB. Upon reviewing the literature, it was clear that the national Australian SAB surveillance definitions developed by the ACSQHC Healthcare Associated Infection Surveillance Committee are consistent with the majority of literature. Where inconsistencies exist, for example the lack of acquisition information in SAB surveillance programs in the United Kingdom, it is clear that the Australian surveillance definitions are more robust and provide more useful information. The national surveillance definitions for SAB developed by the ACSQHC surveillance committee sets an improved standard for other countries.

Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study

BACKGROUND The National Hand Hygiene Initiative (NHHI) is a standardised culture-change programme based on the WHO My 5 Moments for Hand Hygiene approach to improve hand hygiene compliance among Australian health-care workers and reduce the risk of health-care-associated infections. We analysed its effectiveness. METHODS In this longitudinal study, we assessed outcomes of the NHHI for the 8 years after implementation (between Jan 1, 2009, and June 30, 2017), including hospital participation, hand hygiene compliance (measured as the proportion of observed Moments) three times per year, educational engagement, cost, and association with the incidence of health-care-associated Staphylococcus aureus bacteraemia (HA-SAB). FINDINGS Between 2009 and 2017, increases were observed in national health-care facility participation (105 hospitals [103 public and two private] in 2009 vs 937 hospitals [598 public and 339 private] in 2017) and overall hand hygiene compliance (36 213 [63·6%] of 56 978 Moments [95% CI 63·2-63·9] in 2009 vs 494 673 [84·3%] of 586 559 Moments [84·2-84·4] in 2017; p<0·0001). Compliance also increased for each Moment type and for each health-care worker occupational group, including for medical staff (4377 [50·5%] of 8669 Moments [95% CI 49·4-51·5] in 2009 vs 53 620 [71·7%] of 74 788 Moments [71·4-72·0]; p<0·0001). 1 989 713 NHHI online learning credential programmes were completed. The 2016 NHHI budget was equivalent to AUD

Outbreak of health care-associated Burkholderia cenocepacia bacteremia and infection attributed to contaminated sterile gel used for central line insertion under ultrasound guidance and other procedures

0·06 per inpatient admission nationally. Among Australias major public hospitals (n=132), improved hand hygiene compliance was associated with declines in the incidence of HA-SAB (incidence rate ratio 0·85; 95% CI 0·79-0·93; p≤0·0001): for every 10% increase in hand hygiene compliance, the incidence of HA-SAB decreased by 15%. INTERPRETATION The NHHI has been associated with significant sustained improvement in hand hygiene compliance and a decline in the incidence of HA-SAB. Key features include sustained central coordination of a standardised approach and incorporation into hospital accreditation standards. The NHHI could be emulated in other national culture-change programmes. FUNDING Australian Commission on Safety and Quality in Health Care.

More Doctor–Patient Contact Is Not the Only Explanation For Lower Hand-Hygiene Compliance in Australian Emergency Departments

Background: We report an outbreak of Burkholderia cenocepacia bacteremia and infection in 11 patients predominately in intensive care units caused by contaminated ultrasound gel used in central line insertion and sterile procedures within 4 hospitals across Australia. Methods: Burkholderia cenocepacia was first identified in the blood culture of a patient from the intensive care unit at the Gold Coast University Hospital on March 26, 2017, with 3 subsequent cases identified by April 7, 2017. The outbreak response team commenced investigative measures. Results: The outbreak investigation identified the point source as contaminated gel packaged in sachets for use within the sterile ultrasound probe cover. In total, 11 patient isolates of B cenocepacia with the same multilocus sequence type were identified within 4 hospitals across Australia. This typing was the same as identified in the contaminated gel isolate with single nucleotide polymorphism‐based typing, demonstrating that all linked isolates clustered together. Conclusion: Arresting the national point‐source outbreak within multiple jurisdictions was critically reliant on a rapid, integrated, and coordinated response and the use of informal professional networks to first identify it. All institutions where the product is used should look back at Burkholderia sp blood culture isolates for speciation to ensure this outbreak is no larger than currently recognized given likely global distribution.

The keys to success: initial findings from the Hand Hygiene Australia (HHA) program review

To the Editor—Previous reports have demonstrated low hand-hygiene (HH) compliance in emergency departments (EDs).1,2 Barriers to compliance in this setting include crowding, higher patient acuity, nonstandardized workflow, higher staff turnover, lower penetration of HH promotion activities, and high representation of doctors in ED audits, a group with known suboptimal HH compliance.1,3,4 We sought to use a nationwide dataset to describe HH performance in Australian EDs and to test the hypothesis that lower HH compliance in EDs is explained by a higher proportion of observed HH activity by doctors in this setting.

Implementation of the Australian national hand hygiene initiative

The Australian Commission on Safety and Quality in Health Care engaged HHA to implement the National Hand Hygiene Initiative (NHHI) in 2008. The NHHI is based on the World Health Organisation clean care is safer care program. In 2014 HHA was asked to review hospital hand hygiene (HH) programs to evaluate their alignment with the NHHI.

National program to reduce infections in patients

In 2008, the Australian Commission on Quality and Safety in Health Care (ACSQHC) engaged Hand Hygiene Australia (HHA) to implement the National Hand Hygiene Initiative (NHHI), a national approach to hand hygiene (HH) culture change adapted from the WHO Multimodal HH Improvement Strategy.