Objective: To report outcomes from the first 2 years of the National Hand Hygiene Initiative (NHHI), a hand hygiene (HH) culture-change programme implemented in all Australian hospitals to improve health care workers' HH compliance, increase use of alcohol-based hand rub and reduce the risk of health care-associated infections.

Design and setting: The HH programme was based on the World Health Organization 5 Moments for Hand Hygiene programme, and included standardised educational materials and a regular audit system of HH compliance.  The NHHI was implemented in Jan 2009.

Main outcome measures: HH compliance and Staphylococcus aureus bacteraemia (SAB) incidence rates 2 years after NHHI implementation.

Results: In late 2010, the overall national HH compliance rate in 521 hospitals was 68.3% (168,641/246,931 moments), but HH compliance before patient contact was 10% to 15% lower than after patient contact.  Among sites new to the 5 Moments audit tool, HH compliance improved from 43.6% (6431/14,740) at baseline to 67.8% (106,851/157,708) (P less than 0.001).  HH compliance was highest among nursing staff (73.6%; 116,851/158,732) and worst among medical staff (52.3%; 17,897/34,224) after 2 years.  National incidence rates of methicillin-resistant SAB were stable for the 18 months before the NHHI (Jul 2007 to 2008; P = 0.366), but declined after implementation (2009 to 2010; P = 0.008).  Annual national rates of hospital-onset SAB per 10 000 patient-days were 1.004 and 0.995 in 2009 and 2010, respectively, of which about 75% were due to methicillin-susceptible S. aureus.

Conclusions: The NHHI was associated with widespread sustained improvements in HH compliance among Australian health care workers.  Although specific linking of SAB rate changes to the NHHI was not possible, further declines in national SAB rates are expected.