Hand Hygiene Index (HHI)
The Hand Hygiene Index (HHI) is a numeric representation of how closely hospital staff members comply with appropriate hand hygiene practices around patients. It is used by hospital staff to monitor compliance with hand hygiene practices. It exists to ensure that staff members follow appropriate hand hygiene protocols, which is crucial for patient safety and infection control. The HHI is used whenever hand hygiene compliance needs to be tracked and evaluated.
Where you can find this feature: The HHI value can appear in the HHI column of list views for each location (bed) on the Patient Tracking Portal. The unit Hand Hygiene Index can appear as an RTKI at the top of the Patient Tracking Portal console.
How Hand Hygiene Index Works
Functionality
Hand hygiene reduces the spread of infection at the hospital.
All staff members are expected to cleanse their hands thoroughly when entering and exiting a patient location.
If Capacity IQ® is integrated with Location IQ®, it is possible to monitor hand hygiene compliance for units and locations.
Staff members can see a Hand Hygiene Index for each unit and each location within each unit through the Patient Tracking Portal application.
Management can generate the Hand Hygiene Index standard report to determine where measures might be needed to increase compliance.
To use the Hand Hygiene feature, the following prerequisites must be met:
Capacity IQ® must be integrated with Location IQ®.
Location IQ® locations must be associated with Capacity IQ® locations.
The campus must have Hand Hygiene and Staff Tracking licenses from TeleTracking.
The Hand Hygiene Timer Interval Master Configuration setting must be configured.
Hand hygiene monitors must be mounted on soap or gel holders.
Staff members must wear staff badges with valid identification numbers.
Hand Hygiene settings must be configured for each unit.
The Hand Hygiene setting must be enabled for individual locations (beds) to display the HHI in the Patient Tracking Portal list view.
A compliant hand-washing is one where the staff member cleansed their hands when entering and exiting a patient location in accordance with the parameters set in the Unit Hand Hygiene settings.
Hand washings completed with soap or gel holders not affixed with monitoring devices are not considered.
This means staff members could wash their hands in the staff lounge and those hand washings might not be counted.
The HHI is a numeric representation of staff compliance with hand hygiene practices around patients in a unit or specific location.
When an employee enters and exits a room and is there more than the number of seconds configured for the Minimum Time in Room setting and less than the Maximum Time in Room setting, that is called a qualifying trip.
A contiguous trip is when an employee enters a room and then quickly exits and re-enters. A contiguous trip can occur when an employee comes into a room and then steps outside briefly to put on or remove a gown and gloves and then enters the room again.
HHI considers parameters configured in the Unit Hand Hygiene settings in Admin > Settings > Capacity Management.
For example, if the parameters dictate that a hand-washing that occurred when a staff member was leaving one patient location also counts as a hand-washing when they entered the next patient location, then this is considered in the calculation.
Tracking: The HHI is tracked through monitoring staff badges and the use of gel or soap holders with hand hygiene monitors. Only staff members with electronic badges and hand-washings with monitored gel or soap holders are counted. Tracking of dispenser use is done through Location IQ®.
The staff member's staff badge must interact with the hand hygiene monitor in order for the hand washing to be recorded. When a green light flashes on the hand hygiene monitor, this indicates that the badge and monitor have interacted. When staff members cleanse their hands, they should look for the green light on the monitor to ensure that their hand washing is being counted.
Configuration: Capacity IQ® administrators configure settings that define what counts as a "hand-washing," the timeframe for counting hand-washings, and qualifying room trips.
If your hospital campus has a license for the Hand Hygiene feature, the administrator has configured unit hand hygiene settings, and the administrator has enabled the Hand Hygiene settings for individual locations within the unit, then you can add the HHI (Hand Hygiene Index) column to a list view.
For each patient location that has the Hand Hygiene setting enabled, this column displays the HHI.
If the Treat Semi Private Rooms with One Patient as a Single Room Master Configuration setting is enabled, then if only one location in a semi-private room has an occupying patient, the occupied location and the unoccupied location within the semi-private room will be treated as one occupied location only for the purposes of Hand Hygiene room trip calculation.
The caregiver can move around the room without being concerned about whether they are in an occupied or an unoccupied location.
This results in a more accurate Hand Hygiene Index score.
For reporting purposes and to ensure that interactions are recorded accurately, location data will be recorded separately for each location.
If the unoccupied location in the semi-private room becomes occupied, the locations then will be treated as separate locations in a semi-private room.
Having the Show Unit Hand Hygiene Index (HHI) on Patient Tracking Portal setting enabled helps nursing unit staff to monitor hand hygiene compliance for the unit through the Patient Tracking Portal application.
The higher the value of the number, the more compliant the unit currently is.
If you want the Hand Hygiene Index value for the unit to appear as an RTKI (Real-Time Key Indicator) at the bottom of the console in the Patient Tracking Portal application, then enable the Show Unit Hand Hygiene Index (HHI) on Patient Tracking Portal setting.
If there is no hand hygiene data for the unit, then the HHI does not appear at the top or bottom of the console.
Visual Indicators: The HHI column shows the Hand Hygiene Index for a specific location or bed.
The HHI column background can turn yellow or red based on configured thresholds, indicating low compliance levels.
If the HHI value background turns yellow or red, it indicates low compliance levels. Staff may need to ensure hand hygiene monitors are working properly and that soap or gel holders are filled.
Isolation Beds
Isolation beds may require different hand hygiene settings due to the additional time needed for appropriate hand hygiene. The Use Separate Hand Hygiene Settings for Isolation Patients Master Configuration setting must be enabled to configure these settings. If certain isolation types should not have separate settings, the Isolation Types to Ignore for Isolation Hand Hygiene Master Configuration setting can be enabled. A TeleTracking representative can assist with enabling these settings.
To configure settings for isolation beds, go to the Hand Hygiene Configuration for Isolation Beds section of the Unit Hand Hygiene Settings tab. For other beds, use the Hand Hygiene Configuration section.
Settings for Isolation Beds:
Minimum Time in Room (Seconds)
Maximum Time in Room (Minutes)
Minimum Time Between Entry and Exit Handwashes (Seconds)
Window to Receive Credit Before Entering Room (Seconds)
Window to Receive Credit After Entering Room (Seconds)
Window to Receive Credit Before Exiting Room (Seconds)
Window to Receive Credit After Exiting Room (Seconds)
Unit Hand Hygiene
If the Show Unit Hand Hygiene Index (HHI) on Patient Tracking Portal setting is enabled, the HHI for the unit will appear at the top of the console, even if the Display RTKI console setting is disabled.
Unit hand hygiene settings determine:
If the Hand Hygiene Index value for the unit is shown in the Patient Tracking Portal application as an RTKI.
When a staff member is given credit for washing their hands on a qualifying room trip.
The timeframe for displaying hand hygiene data in the Patient Tracking Portal list view.
If a red or yellow background will be shown on a Hand Hygiene Index value based on configured thresholds.
Calculation
Only staff members who wore electronic staff badges are counted in the calculation.
Only hand-washings completed with gel or soap holders that were affixed with working hand hygiene monitors are counted.
Only hand-washings that occurred within the number of minutes in the past set for the Lookback Timeframe to Calculate HHI setting are considered in the calculation.
For example, if the Lookback Timeframe to Calculate HHI value is 30 minutes, then only hand-washings that occurred within 30 minutes before the Patient Tracking Portal list view was refreshed are included in the calculation.
The calculation includes only qualifying room trips.
This means that the calculation includes only instances where the staff member entered the room and stayed a certain minimum amount of time, but left before a specified maximum amount of time, without re-entering.
A contiguous trip could be included within a qualifying room trip, but it does not count as a separate trip in and out of a room.
This means that a staff member could enter a room, leave briefly (for example, to put on a gown and gloves), and then re-enter the room, and this would not be considered a separate trip.
The HHI value calculated is compared to parameters set for the unit in the Admin > Settings > Capacity Management component to determine if the unit is compliant with hand hygiene practices.
As staff and physicians are continuously coming into and leaving patient locations, the Hand Hygiene Index is calculated periodically, based on the value configured for the Hand Hygiene Timer Interval Master Configuration setting. For example, if that setting is 120 seconds, then the Hand Hygiene Index is calculated every 120 seconds.
The Patient Tracking Portal list views are refreshed periodically. As the Hand Hygiene Index is calculated continuously, and the list views are refreshed periodically, you need to set an amount of time in the past at which point the hand-washings from that time until the current time should be counted and included in the HHI calculation. This is called setting the Lookback Timeframe to Calculate HHI. For example, if you select 30 minutes as the Lookback Timeframe to Calculate HHI, then when the Patient Tracking Portal list view is refreshed, the hand-washings from the last 30 minutes will be included in the HHI calculation.
The HHI value is calculated as follows:
(Count of Compliant Hand-Washings within the Lookback Timeframe} / (Count of all Qualifying Room Trips within the Lookback Timeframe} \times 2)) \times 100
Example 1: Unit Hand Hygiene Index
Scenario: 10 compliant hand-washings and 6 qualifying room trips on Unit A in the last 30 minutes.
Calculation: 10 / (6 \times 2) \times 100 = 83
HHI Value: 83
Example 2: Location (or Bed) Hand Hygiene Index
Scenario: 6 compliant hand-washings and 4 qualifying room trips in Location 1 in the last 30 minutes.
Calculation: 6 / (4 \times 2) \times 100 = 75
HHI Value: 75
Permissions Required
To configure Unit Hand Hygiene settings, you need:
Admin Tool Menu permission
Unit-Cluster Management permission
Membership to the selected campus with admin rights enabled
Workflows
Accessing the Unit Hand Hygiene Settings Tab
To access the Unit Hand Hygiene Settings tab:
Add or edit the unit.
Complete the unit information.
Click the Unit Hand Hygiene Settings tab.
Displaying the Hand Hygiene Index in the Patient Tracking Portal Application
To display the Hand Hygiene Index:
Access the Unit Hand Hygiene Settings tab.
Ensure "Yes" appears for Show Unit Hand Hygiene Index (HHI) on Patient Tracking Portal. If "No" appears, click it to change it to "Yes."
Click Save.
Configuring Hand Hygiene Index Red and Yellow Threshholds
Access the Unit Hand Hygiene Settings tab.
Under Threshold Settings in the Hand Hygiene Index row, do the following
In the Yellow column type the Hand Hygiene Index number that will cause the background of the HHI column to become yellow. For example, if you type 95, then the HHI column will show a cell with a yellow background for any location that has a Hand Hygiene index of 95 or less. The yellow background should be an indication that compliance is approaching a low level for that location and some attention is needed. If you enter a 0, that indicates that this setting will not be used and the cell background will never become yellow. It will remain green until the red threshold is met. The yellow background will also appear on the unit HHI when that value reaches the threshold.
In the Red column, type the Hand Hygiene Index number that will cause the background of the HHI column to become red. For example, if you type 75, then the HHI column will show a cell with a red background for any location that has a Hand Hygiene index of 75 or less. The red background should be an indication to the nursing staff that compliance is at a critically low level for that location and attention is needed immediately. The number in the Red column must be less than the number in the Yellow column. If you enter a 0, that indicates that this setting will not be used and the cell background will never become red. It will remain green (or yellow if the yellow setting is in use and the HHI is at or below the yellow threshold number).
Click Save.
Setting How Long an Employee Must be in a Room to Receive Credit for Hand Hygiene Compliance
To set the duration for credit:
Access the Unit Hand Hygiene Settings tab.
Under Hand Hygiene Configuration or Hand Hygiene Configuration for Isolation Beds, in the Value column for:
Minimum Time in Room (Seconds): Type the minimum number of seconds an employee must be in a room to receive credit.
Maximum Time in Room (Minutes): Type the maximum number of minutes an employee must be in a room to receive credit.
Setting the Amount of Time for a Contiguous Trip
To set the duration for a contiguous trip:
Access the Unit Hand Hygiene Settings tab.
Under Hand Hygiene Configuration, in the Value column for the Contiguous Trip window, type the number of seconds an employee is allowed to stay outside the room before re-entering.
Setting the Amount of Time in the Past to Consider in HHI Calculations Displayed in Patient Tracking Portal List Views
Access the Unit Hand Hygiene Settings tab.
Under Patient Tracking Portal Calculation Settings, in the Value column for Lookback Timeframe to Calculate HHI (Minutes), type the number of minutes in the past where hand-washings that occurred between then and the time that the list view is refreshed will be included in the HHI calculation
Setting the Window of Time Employees Have to Wash Hands Before and After Entering or Exiting a Room
To configure the window of time for hand hygiene:
Access the Unit Hand Hygiene Settings tab.
Under Hand Hygiene Configuration or Hand Hygiene Configuration for Isolation Beds, configure the following settings:
Window to Receive Credit Before Entering Room (Seconds)
Window to Receive Credit After Entering Room (Seconds)
Window to Receive Credit Before Exiting Room (Seconds)
Window to Receive Credit After Exiting Room (Seconds)
Setting Parameters for Hand Hygiene Windows
Setting | What it Means | How to Set It | Parameters | Example |
Window to Receive Credit Before Entering Room (Seconds) | The amount of time the employee has to cleanse their hands before entering a room to receive credit for washing their hands upon entry. The employee will only be given credit if entering the room was part of a qualifying trip (within the Minimum and Maximum Time in Room limits, the employee entered and exited without re-entering). | Type a number of seconds. | Must be a whole number greater than or equal to 0. | The setting is 15 seconds. Employee cleanses hands 13 seconds before entering the room. Employee receives credit for washing hands upon entry. |
Window to Receive Credit After Entering Room (Seconds) | The amount of time the employee has to cleanse their hands after entering a room to receive credit for washing their hands upon entry, if the employee did not cleanse their hands already before entering the room. The employee will only be given credit if entering the room was part of a qualifying trip (within the Minimum and Maximum Time in Room limits, the employee entered and exited without re-entering). | Type a number of seconds. | Must be a whole number greater than or equal to 0. | The setting is 15 seconds. Employee cleanses hands 13 seconds after entering the room. Employee receives credit for washing hands upon entry. |
Window to Receive Credit Before Exiting Room (Seconds) | The amount of time the employee has to cleanse their hands before exiting a room to receive credit for washing their hands upon exit. The employee will only be given credit if exiting the room was part of a qualifying trip (within the Minimum and Maximum Time in Room limits, the employee entered and exited without re-entering). | Type a number of seconds. | Must be a whole number greater than or equal to 0. If the employee receives credit and this window falls within the window for entering the next room for the next qualifying trip, then the employee will also receive credit for washing hands upon entry for that trip. | The setting is 15 seconds. Employee cleanses hands 9 seconds after exiting the room. Employee receives credit for washing hands upon exit. Employee enters next room 8 seconds later. As the Window to Receive Credit Before Entering Room (Seconds) is 15 seconds, employee receives credit for washing hands on entry to the next room, as long as it is a qualifying trip. |
Window to Receive Credit After Exiting Room (Seconds) | The amount of time the employee has to cleanse their hands after exiting a room in order to receive credit for washing their hands upon exit, if the employee did not cleanse their hands already before exiting the room. The employee will only be given credit if exiting the room was part of a qualifying trip (within the Minimum and Maximum Time in Room limits, the employee entered and exited without re-entering). | Type a number of seconds | Must be a whole number greater than or equal to 0. If the employee receives credit and this window falls within the window for entering the next room for the next qualifying trip, then the employee will also receive credit for washing hands upon entry for that trip. | The setting is 15 seconds. Employee cleanses hands 12 seconds after exiting the room. Employee receives credit for washing hands upon exit. Employee enters next room 8 seconds later. As the Window to Receive Credit Before Entering Room (Seconds) is 15 seconds, employee receives credit for washing hands on entry to the next room, as long as it is a qualifying trip. |
Minimum Time Between Entry and Exit Handwashes | The minimum duration between the first compliant hand washing when the staff member enters the room and the last compliant hand washing before the staff member exits the room. This setting helps to offset the potential for a hand washing to be misrepresented as compliant, when it is not. Sometimes, employees who have cleansed their hands upon entering a room must perform a task that requires them to cleanse again soon after, but before they interact with the patients. An example is picking up trash from the floor. After the second handwashing, the employees attend to the patients. This setting helps to ensure that the second handwashing after picking up the trash, but before attending to the patient, does not count as an exit handwashing. In other cases, employees inadvertently double-pump a gel or soap holder when entering a room to extract the cleanser. This setting helps to prevent the second pumping from being counted as an exit handwashing erroneously. | Type a number of seconds. | Must be a whole number greater than or equal to 0. | The setting is 20 seconds. Employee cleanses hands after entering the room, stays in the room for 30 seconds, and then cleanses their hands again before exiting the room. This is compliant. If the employee enters the room, cleanses their hands, stays 18 seconds, and then washes their hands again before exiting, the hand washing that they completed before exiting the room will not be counted. |