Hand hygiene

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Hand hygiene is the single most effective measure for preventing healthcare associated infections (HAI). It reduces the risk of transmitting pathogens to patients, staff and visitors across all healthcare settings.

All local health districts (LHDs) and specialty health networks (SHNs) must implement, monitor and report on hand hygiene through the National Hand Hygiene Initiative (NHHI). Our HAI team works with designated hand hygiene leads in each organisation to identify and act on improvement opportunities.

How to perform hand hygiene

Hand hygiene means cleaning your hands with:

  • plain liquid soap and running waste.
  • antiseptic liquid hand wash and running water
  • alcohol-based hand rub (ABHR).

Wash with soap and water when hands are visibly soiled, or when caring for a patient with Clostridioides difficile or norovirus.

Hand hygiene compliance

The NHHI is underpinned by:

The policy sets out specific hand hygiene practices required for health workers across NSW, including when staff must perform hand hygiene and the use of ABHR during patient care.

Essential elements of a hand hygiene program

Every NSW Health facility’s hand hygiene program should include:

  • strategic placement of ABHR for staff, patients and visitors
  • accessible hand-washing facilities for all staff, patients and visitors
  • education and awareness for all health workers
  • auditing and reporting of compliance to the NHHI
  • regular review of compliance results and improvement actions

Auditing

Health workers trained as hand hygiene auditors observe direct and indirect patient care using the WHO My Five Moments for Hand Hygiene framework. Audits are unannounced to capture a realistic picture of compliance.

NSW Health submits around 200,000 audited moments each audit period, representing about a third of the national data. Auditors submit data through the Hand Hygiene Compliance Application (HHCApp). NHHI hand hygiene audit periods occur in:

  • Period 1: 1 November to 31 March (mandatory)
  • Period 2: 1 April to 30 June (voluntary)
  • Period 3: 1 July to 31 October (mandatory)

After each period, we review and validate submitted audits before transferring them to the NHHI. Once approved, results appear on the NHHI compliance dial (NSW Health network only). Local hand hygiene leads use the compliance dial to display results for individual wards, departments and facilities.

Education and auditor training

There are two types of hand hygiene auditors:

  • Hand hygiene auditor educators (HAEs) train and support new auditors, lead the local NHHI program and act as a hand hygiene resource. HAEs must train at least three auditors or educators within a three-year period.
  • Hand hygiene auditors conduct audits and serve as role models for compliance.

The NHHI program sets the content, format and assessment process for both types.

How to access training

Hand hygiene auditor training is led by each LHD and SHN. Contact your local infection prevention and control team to find out about upcoming training.

For HAE training and statewide coordination, we work with NSW Health agencies to standardise access to training resources.

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