Lessons in Implementation from the National Hand Hygiene Initiative

Havers, SM1,4, Ryan KE1, Olsen KL1, Grayson ML1,2,3

1 Hand Hygiene Australia, c/- Infectious Diseases Dept., Austin Health, PO Box 5555, Heidelberg, VIC 3084, sally.havers@austin.org.au
2 Department of Infectious Diseases, Austin Hospital, Melbourne, VIC, Australia
3 Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
4 Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove QLD, Australia


The National Hand Hygiene Initiative (NHHI) is funded by the Australian Commission for Safety and Quality in Health Care.


Since 2009 participation in the National Hand Hygiene Initiative (NHHI) has increased from 105 hospitals to 937 in 2017. Hand hygiene compliance in this time has increased from 63.6% (63.2-63.9) to 84.3 % (84.2-84.4). A number of key strategies have supported the implementation of this standardised, national safety and quality initiative.


A longitudinal study of the effects of the NHHI was undertaken in 2017, identifying an association between hand hygiene rates and reduced incidence of health-care-associated Staphylococcus aureus bacteraemia (HA-SAB). In this study a number of key structural features that influenced implementation were also reported.


Key structural features of the NHHI that supported large-scale implementation included: evidence-based program methodology, strong organisational structure and governance across health system levels, standardised and freely-accessible education resources, validated data collection and feedback processes, coordinated and highly prescriptive participation requirements; availability of technology to minimise the burden of data collection and introduction of a regulatory mechanism to oversee organisation compliance.


Successful implementation of the NHHI has been facilitated by a number of coordinated and considered strategies designed to guide practice improvement and organisational engagement at a national level.

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