Doctors are among the worst hospital staff in regional Victoria for washing their hands when they should, trumped only by cleaning and food workers, ACM can reveal.
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Hand sanitising in the major hospitals spiked during the height of the COVID-19 pandemic but at some it has dropped off sharply since.
Compliance with hand hygiene standards varied from hospital to hospital and Warrnambool recorded the best results of any hospital, an analysis by ACM of the most recent data shows.
Scores for nine regional hospitals, plus the Royal Melbourne Hospital, ranged from Warrnambool's 92.2 per cent down to 70.2 per cent in March 2023.
Four of those hospitals came in below the benchmark of 85 per cent:
- Albury Wodonga's Wodonga campus (70.2 per cent)
- Ballarat Base Hospital (77.7 per cent)
- Geelong Hospital (80.2 per cent)
- Royal Melbourne Hospital (83.5 per cent).
Which hospital worker has the cleanest hands?
In Ballarat the hand hygiene rate was as high as 91.7 per cent in October 2020 at the height of the pandemic.
A spokesperson for Grampians Health, which runs Ballarat Base Hospital, said it was "deeply committed to upholding the highest standards of hygiene and safety measures".
They said Grampians Health had brought in "stringent" safety and hygiene measures during COVID to "successfully contain cross contamination".
"We continue to have several procedures in place to evaluate and ensure that our infection prevention and control procedures meet the highest standards," the spokesperson said.
But the data also shows which types of hospital employees clean their hands most at the right moments.
Dental assistants and dentists state-wide topped the charts at 93.9 per cent and 89 per cent respectively. Nurses and midwives were similar to dentists.
Domestic staff, who work in kitchens and deliver meals, had the lowest compliance at 78.6 per cent, just below doctors at 78.9 per cent.
How hospital 'hand hygiene' is checked
Hand hygiene data is compiled by the Australian Commission on Safety and Quality in Health Care to keep hand washing rates high and hospital-acquired infection rates low.
The data is collected by specialist "hand hygiene auditors" who monitor their colleagues and record whether they clean their hands at specific key "moments", like before or after touching a patient.
Every four months a hospital gets a percentage score showing how frequently its staff clean their hands.
In March 2023 Latrobe Regional Hospital came in at exactly 85 per cent, although it dropped to 51.8 per cent in October 2020.
Shepparton (88.3 per cent), Mildura (91.1 per cent), Wangaratta (91.8 per cent), and Warrnambool (92.2 per cent) hospitals were all above the benchmark.
Wodonga Hospital suffered a big drop in hand hygiene from 95.5 per cent in March 2020 to 70.2 per cent three years later.
An Albury Wodonga Health spokesperson "acknowledged" the "concerning decline", but said its non-public data showed staff hand cleaning had improved through 2023, reaching 78.3 per cent by the end of the year.
They said the incomplete early data for 2024 was even better, at 88.5 per cent.
When everyday bacteria gets deadly
Controlling bacteria in a hospital was deadly serious, Associate Professor Deb Friedman, who oversees Victoria's hospital hand hygiene surveillance, said.
"Everyone in a hospital - even if they're not in there with an infection - is carrying bacteria," she said.
"They carry bacteria on their skin, they carry bacteria in their respiratory tract, and they carry bacteria in their gastrointestinal tract."
Humans are covered with bacteria, inside and out, and most of the time this isn't an issue.
But in a hospital the risks were magnified, Professor Friedman said.
"We've got a whole lot of random people covered with bacteria ... then we've got people who already have infections, people with wounds for example.
"And then there's the fact people in hospitals are already sicker than average - which means they're more vulnerable - but also that they've had more exposure to antibiotics and, therefore, carry more resistant bacteria," she said.
Better to avoid infection in the first place.
In a hospital the most common way for bacteria to pass from person to person is on the hands of healthcare workers.
That's where the auditors come in.
The hand wash police
Auditors are staff from within the hospital specifically tasked with policing hand hygiene.
"Usually they're standing there on an iPad; it's pretty transparent," said long-time auditor Donna Taylor.
"Nine times out of 10 they will tell people what they're doing."
And what happened when a nurse or doctor failed to clean their hands?
"Most of the time the auditor will give feedback at the time. That's what they're trained to do," Ms Taylor said.
"The staff are pretty understanding. They know the auditing is mandated."