The key components of the programme included engaging with key stakeholders, capturing of process and outcome measures using a national standardised auditing approach (aligned with Hand Hygiene Australia), use of smart phone technology, effective communication and promotional strategy, use of the ‘Front Line Ownership’ quality improvement methodology and building resilience within the DHB HHNZ teams.
The HQSC reports a set of Quality & Safety Markers against all of its programmes; targets for the HHNZ QSM were revised regularly. The QSM comprised of process and outcome measures
Process measure: the total number of appropriately performed hand hygiene moments. This is reported thrice yearly as a percentage of the total number of moments captured by the auditors for an audit period.
Outcome measure: the rate of healthcare-associated Staphylococcus aureus bacteraemia per 1000 inpatient days. This was reported biannually.
The HHNZ programme has led to significant and sustained improvement in hand hygiene practice by healthcare workers in DHB hospitals. The nationally aggregated measure hand hygiene compliance rate in March 2016 was 81%. The QSM target increased from 70% in March 2014, to 75% in July 2014 and to 80% April 2015. The level of compliance has been at ≥ 80% since April 2015. Improvement has occurred across all of the 5 moments and across all healthcare worker groups.
The outcome measure has remained stable.
Culture change programmes such as HHNZ require executive sponsorship, clinical leadership, quality improvement capability, and an effective communication strategy to be successful.
Good hand hygiene practices form a platform upon which all other interventions to reduce healthcare-associated infections can be built. Linking improvement in hand hygiene performance with a simple and convenient outcome measure is a challenge.
D. Jowitt, None