Hand hygiene in the healthcare environment

Hands are one of the main pathways for germ transmission within healthcare and the community.  Effective hand hygiene is one of the most effective measures to prevent the spread of infections.

There are around 165,000 healthcare associated infections each year, making healthcare associated infections (HAI) the most common healthcare complication affecting patients in hospital.

Studies show that effective hand decontamination (hand hygiene) can significantly reduce the rate of healthcare associated infection.

National Hand Hygiene Initiative

As part of the World Health Organization's (WHO) First Global Patient Safety Challenge, the Australian Commission on Safety and Quality in Health Care (ACSQHC) established the National Hand Hygiene Initiative (NHHI) in 2008 as part of a suite of initiatives to prevent and reduce healthcare-associated infections in Australian healthcare settings.

The NHHI uses a multi-modal approach to improving hand hygiene and includes:

  • the use alcohol-based hand rub at the point-of-care
  • ensuring uniform hand hygiene and infection prevention and control education
  • monitoring hand hygiene compliance and performance feedback
  • using hand hygiene programs that ensure culture change.

Compliance with hand hygiene according to the WHO '5 Moments for hand hygiene' is recorded by trained and validated auditors. Hospitals are required to submit data three times per year according to the NHHI schedule. The number of 'moments' required to be audited is proportional to the size of the hospital.

South Australia

As per the NHHI, each hospital or Local Health Network (LHN) should have a Hand Hygiene Program Coordinator who is responsible for the governance and oversight of local hand hygiene programs.

For queries related to the NHHI, refer to the ACSQHC NHHI website or contact your LHN Hand Hygiene Program Coordinator:

Local Health NetworkContact details
Central Adelaide Local Health Networkhealth.calhninfectionpreventionandcontrolunit@sa.gov.au
Northern Adelaide Local Health Network health.mhinfectioncontrol@sa.gov.au
Southern Adelaide Local Health Network health.salhninfectioncontrol@sa.gov.au
Women's & Children's Health Networkhealth.wchninfectionpreventionandcontrol@sa.gov.au 
Rural Support Services (RSS) *health.rssinfectioncontrol@sa.gov.au

* RSS will forward queries to the Hand Hygiene Lead for regional LHNs as applicable.

Policy directive, guideline and supporting resources

The SA Health Hand Hygiene Policy Directive (PDF 299KB) establishes a uniform approach to hand hygiene across the public health sector.

The associated SA Health Hand Hygiene Guideline (PDF 223KB) summarises best practice for healthcare workers in the clinical setting.

Hand hygiene compliance rates

The SA Health Why is hand hygiene important? infographic details the overall hand hygiene compliance rates for SA Health and for each LHN; this infographic is updated annually.

The national and state hand hygiene target is 80%.


The Australian Institute of Health and Welfare (AIHW) My Hospital website also provides safety and quality information for local hospitals, including hand hygiene compliance rates. 

Educational resources

NHHI educational resources

The ACSQHC NHHI hosts a suite of online eLearning modules (including hand hygiene) to provide information on the principles of infection prevention and control in the Australian healthcare setting. These modules are suitable for healthcare workers, student healthcare workers and for other industries where infection prevention and control is important, including residential care facilities and in the community.

The Basics of Infection Prevention and Control module provides a basic orientation and foundation on which to build infection prevention and control knowledge.

SA Health eLearning courses

Infection prevention courses are available to all SA Health employees to support the National Safety and Quality Health Service Standards. There are currently three infection prevention related courses available to staff:

  • Infection Prevention and Control
  • Aseptic Technique
  • Safe Use of Personal Protective Equipment (PPE)

For further information, visit the Infection control education and training page.

NHHI auditor training

The NHHI is due to release a national auditor training framework for General Auditors (GA) and Gold Standard Auditors (GSA) by the end of March 2023.  Refer to the NHHI manual for further information.  

Hand hygiene auditors are selected, trained, validated and supported according to requirements as per the NHHI and 5 Moments of Hand Hygiene to ensure consistent data collection and reporting. 

As an interim measure, until the NHHI releases the national audit framework, South Australia provides exemplar guidance for GA and GSA training:

NHHI audit tools

The NHHI has a number of audit tools available to support hand hygiene auditing in acute and non-acute settings.

Facilities not meeting the requirements for national data submission may choose to utilise the SA Health Hand hygiene observation audit tool (PDF 196KB) to estimate overall hand hygiene compliance and is in keeping with the 5 Moments for hand hygiene.

The SA Health Hand hygiene competency tool (PDF) 87KB) has been developed to assess staff competency in carrying out an effective hand hygiene rub or handwash.

Healthcare facilities can track their progress through the use of hand hygiene resources, promotional activities, planning their actions and aiming for improvement and sustainability through the use of the following resources:

Fact sheets, posters and promotional materials

The following fact sheets have general information including the use and selection of alcohol-based hand rub products and the appropriate use of gloves in health care.

Click on the below images to download the relevant poster.

Hand hygiene poster - So You&aposre Worred.Hand hygiene poster - Clean hands save livesHand hygiene poster - Go ahead clean your handsHand hygiene poster - You had me at clean hands Hand hygiene poster - Stop & Clean Before Contact Hand hygiene poster - I feel the need, the need for clean handsHand hygiene poster - Hands clean now you mustHand hygiene poster - I see clean handsHand hygiene poster - I&aposll be back after I clean my hands

The ACSQHC has a range of promotional materials to support the improvement of hand hygiene in Australia.

World Hand Hygiene Day

World Hand Hygiene Day, 5 May, is part of a major global effort led by the World Health Organization (WHO) and supported by SA Health annually. This day aims to support health-care workers to improve hand hygiene in healthcare and accordingly support the prevention of life-threatening healthcare associated infection (HAI).

Information on the latest campaign can be found on the WHO hand hygiene and ACSQHC World Hand Hygiene Day webpages.

Further information

For further information on hand hygiene contact SA Health Infection Control Service on (08) 7425 7161.