Hand hygiene monitoring in residential aged care: national and international perspectives with relevance to Australian facilities

Elizabeth Orr 1, Noleen Bennett 1, Jennifer Bradford 1, Sandra Johnson 1, Ann Bull 1, Michael J Richards 1, Leon J Worth 1,2

VICNISS Coordinating Centre, Melbourne, VIC, Australia

University of Melbourne, Melbourne, VIC, Australia

 

Background:
In acute healthcare facilities, auditing of hand hygiene (HH) compliance informs quality improvement programs and is a requirement for accreditation standards. However, there is currently no program tailored for use in Australian residential aged care facilities (RACFs). The objective of this study was to review existing methods for assessing HH compliance within RACFs.

Methods:
Recommendations for monitoring HH in RACFs from World Health Organisation (WHO), the Centers for Disease Control and Prevention (CDC), National Health and Medical Research Council (NHMRC) and Hand Hygiene Australia (HHA) were reviewed.
Results:
The WHO recommends modification of the ‘5 moments for hand hygiene’ in outpatient settings, with omission of moment 5 in RACFs for auditing of HH in RACFs. CDC recommend process indicators for monitoring compliance in RACFs: auditing one moment, ‘after contact with a resident or the objects/surfaces in the immediate vicinity of the resident’, without differentiating between staff types. NHMRC recommends use of the WHO 5 moments within RACFs without recommendations on assessing compliance.
HHA does not currently recommend auditing in facilities with low staff/patient activity, and suggests alternative measures of assessing compliance such as staff knowledge surveys, HH technique audits and product placement/availability audits.

Conclusions:
Recommendations and models for assessing HH compliance within RACFs are not uniform. Observational auditing in these settings may be unjustified given the opportunity cost of resourcing. Although CDC process monitoring may be less resource-intensive, limited data are provided for quality improvement. Looking ahead, a range of methods should be piloted for acceptability/sustainability within Australian RACFs.

About the College

The ACIPC is the peak body for Infection Prevention and Control professionals in the Australasian region. Our stated vision is the prevention and control of infection in our communities. We commenced in January 2012 bringing together the various State and Territory infection control associations formerly in AICA (The Australian Infection Control Association) to support and encourage collaboration across Australasia.

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