The challenges of hand hygiene auditing in the operating room

Mrs Elizabeth Orr1, Ms Sally Havers2, Ms Ellen McRae1, Ms Nicole Fernandez1, Ms Tracey Cleary1, Prof Lindsay Grayson1,2

1Austin Health, Heidleberg, Australia
2Hand Hygiene Australia


Introduction: The National Hand Hygiene Initiative (NHHI) program is well embedded in acute wards. Implementation of this methodology is challenging in the operating room (OR) environment. Difficulty defining the patient zone, large number of moments performed by Anaesthetists and workflow bring challenges not considered in the current program.

Methods: The NHHI standardised auditing program was modified to the anaesthetic setting, including; the top of the airway and medication trolleys, anaesthetic machine, technician equipment and the theatre table. The desk/computer area and speciality trolleys in the outskirts of the room were all considered healthcare zone. Auditing was conducted as per Hand Hygiene Australia methodology using these defined zones.  Education was given to OR staff including appropriate use of gloves, hand washing education, and explanation of the patient and healthcare zones.

Results: This intervention facilitated improved hand hygiene (HH) compliance in both campuses from 49.5% (95%CI 42.7-56.3%) to 63.3% (95%CI 53.9-71.8%) and 36.5% (95%CI 27.9-46.1) to 57.4% (95%CI 50.3-64.2%) at Austin and Repatriation Hospitals respectively (Audit 1 to 2, 2018). This improvement was driven by the OR staff with engagement from department managers and executives.

Conclusion: The NHHI methodology provides a validated starting point for HH improvement but requires adaptation in different contexts. Redefining zones is important in facilitating improvement in the auditing process specific to OR, and improving HH compliance in a challenging area. It is important to engage the relevant department and managers in the change process to facilitate quality improvement and drive change.


Elizabeth Orr is an Infection Control Consultant who is passionate about hand hygiene and improving patient care through quality activities that strive for best practice. Elizabeth has held positions as an Infection Control Consultant within Monash Health, VICNISS, Hand Hygiene Australia and Austin Health.

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