Hand Hygiene

Hand hygiene (HH) is recognised as the cornerstone of infection prevention and can reduce the risk of transmission of pathogens to patients, staff and visitors.

HH is the act of cleaning hands with:

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

All NSW Health Local Health Districts (LHDs) and Specialty Health Networks (SHNs) are required to implement, monitor and report on HH using the National Hand Hygiene Initiative (NHHI) program. All NSW LHDs and SHNs have leads for HH. These key leads work closely with the HAI team to identify and monitor opportunities for improvement with HH and the NHHI.

The NHHI is underpinned by:

  • ACSQHC National Standard for Prevention and Controlling Healthcare-Associated Infection
  • NSW Health Infection Prevention and Control Policy.

The NSW Health Infection Prevention and Control policy outlines the specific HH practices required by health workers (HWs) within NSW Health, to minimize the risk of patients, visitors and staff acquiring a HAI. It identifies when staff must perform HH and requires the use of ABHR for most instances of HH during patient care.

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

Essential elements of a HH program are:

  • Strategic placement of ABHR for staff, patients and visitors
  • Provision of hand washing facilities for all staff, patients and visitors
  • Education and awareness of HH for all HWs
  • Auditing and reporting of HH compliance to NHHI
  • Provision of compliance results
  • Identification of improvement opportunities
  • Regular evaluation of the local HH program.


The role of a HH auditor is integral to reducing HAIs through auditing of HH practices. HH auditing occurs regularly in patient areas with trained HH auditors observing direct and indirect patient care and or interactions, in line with the WHO My Five moments for Hand Hygiene.

NSW Health submits around 200,000 audited 'moments' each audit period. This represents approximately a third of the national data. HH auditors submit data through the Hand Hygiene Compliance Application (HHCApp). HH compliance data is required to be submitted by all NSW Health Organisations to the NHHI three times a year. NHHI HH audit periods are the same every year:

  • Audit period one: November 1 – March 31
  • Audit period two: April 1 – June 30
  • Audit period three: July 1 – October 31.

At the end of each audit period, the HAI team review and validate the submitted NSW Health HH audits. Once approved, the validated HH audits are formally transferred to the NHHI. At the end of this process, the NSW Health results will be updated on the NHHI HH compliance dial.

The compliance dial is used by local HH leads for visual communication and display of the HH compliance results for individual wards, departments, and facilities.

Education and auditor training

HH auditors are an important and valuable resource for HH and the NHHI. There are two types of HH auditors:

  • Hand Hygiene Auditor Educators (HAE)
  • Hand Hygiene Auditors (HA).

Both HA's and HAE's are considered role models for HH. The content, format and assessment process for HA and HAE training is specified by the NHHI program.

Hand Hygiene Auditor (HA) training

Hand hygiene Auditor training is led and facilitated by all NSW LHDs and SHNs. The local infection prevention and control team is the first point of contact to seek further information for local HH auditor training.

Hand Hygiene Auditor Educator (HAE) training

HAEs differ to HAs as they are required to:

  • train and support the development of HH auditors for local hand hygiene programs
  • support the local facility's NHHI program and be a HH resource within their workplace
  • conduct training for 3 HAs/HAEs in a 3 year period.

For NSW Health, the jurisdictional role sits with the HAI team at the CEC who are working closely with other NSW Health agencies to standardise access to HH training resources.