Hospital hygiene: 7 key performance indicators (KPIs) that managers must monitor monthly
Hospital hygiene is not evaluated "by eye." A clean floor or a pleasant smell does not confirm that processes are correct and that the risk of infection is under control. If you manage a medical facility, you need measurable data, collected constantly and analyzed objectively.
1. Healthcare-Associated Infection (HAI) rate
The HAI rate directly reflects the performance of the infection prevention and control system. According to ECDC recommendations and the national framework for the surveillance, prevention, and control of healthcare-associated infections, every healthcare unit must collect and use this data for internal monitoring.
Calculation formulas
HAI rate (%) = (Number of HAIs / Number of patients discharged during the analyzed period) × 100
or
HAIs per 1,000 patient-days = (Number of HAIs / Total number of hospitalization days) × 1,000
The second formula provides a more accurate picture in departments with long lengths of stay, such as the ICU.
What does this indicator show you?
An increase in the HAI rate can indicate:
- failure to comply with disinfectant contact times;
- under-dosing of concentrated products;
- gaps in instrument sterilization;
- low compliance with hand hygiene.
Analyze data separately by department. For example, a surgical ward with 5 HAIs per 1,000 patient-days, while the hospital average is 2, requires an immediate audit: check workflows, terminal disinfection protocols, clean/dirty circuits, and instrument sterilization.
2. Compliance rate with hand hygiene protocols
Hand hygiene remains one of the most effective measures for preventing the transmission of pathogens. Order 1101/2016 includes hand hygiene and cleaning measures within HAI prevention and control strategies, and healthcare units must implement mechanisms for monitoring and evaluating compliance. The WHO defines the 5 moments for hand hygiene, and their observance must be systematically monitored:
- Before patient contact.
- Before aseptic procedures.
- After exposure to biological fluids.
- After patient contact.
- After contact with the patient's surroundings.
Calculation formula
Compliance (%) = (Compliant actions / Observed opportunities) × 100
A trained auditor directly observes staff and records hand hygiene opportunities. For stable results, collect a sufficient number of observations per department monthly.
Targets and interventions
Many infection prevention and control programs use compliance targets of over 80%, but thresholds must be adapted to the local context and the risk level of the department. Values significantly below the unit's established target may indicate an increased risk of microorganism transmission and require further analysis.
If you identify drops in compliance:
- check the placement of dispensers;
- ensure constant refilling;
- resume practical training, not just theoretical;
- provide individual and team feedback.
In small clinics or practices, where the team is limited, compliance can be monitored through periodic self-audits, complemented by an analysis of hand hygiene product consumption relative to the volume of activity.
3. Compliance with surface cleaning and disinfection protocols
Frequently touched surfaces – handles, railings, buttons, treatment tables – can become transmission vectors if staff do not comply with concentrations and contact times.
Calculation formula
Compliance (%) = (Compliant spaces at audit / Checked spaces) × 100
Randomly select at least 20% of rooms monthly. In the ICU or operating room, increase the frequency of checks.
What to check?
- concentration of the prepared solution;
- date and time of preparation;
- compliance with contact time;
- compatibility of the product with the surface.
For example, a high-level concentrated disinfectant, such as Klintensiv® Dezicon – high-level concentrated disinfectant, requires correct dilution to achieve the effectiveness declared according to EN standards (bactericidal, fungicidal, virucidal, etc., according to the technical data sheet and product authorization). If staff prepare the solution "by eye," effectiveness may decrease. See the full range of Klintensiv surface and floor disinfectants! Use graduated containers and written procedures.
In offices or laboratories, where the volume of surfaces is lower, consistent adherence to cleaning and disinfection procedures must be periodically verified through internal audit.
4. Average room decontamination time (TAT – Turnaround Time)
TAT measures the interval between a patient's discharge and the availability of the room for the next admission, following complete cleaning and disinfection.
Record the time of discharge and the time the process is completed. Calculate the monthly average per department.
Why should you track TAT?
A TAT that is too long blocks patient flow. A TAT that is too short may indicate superficiality.
Target values for TAT must be established by each healthcare unit in Romania based on the complexity of the cleaning process, the type of department, and the risk level, while respecting the disinfectant contact times imposed by Ministry of Health Order 1761/2021. In local medical practice, hospitals track intervals between 30 and 90 minutes. A TAT under 30–45 minutes in a standard operating room may raise suspicions of superficiality in applying disinfection protocols, while a TAT that consistently exceeds 90 minutes signals logistical problems or a shortage of auxiliary staff.
If you notice repeated delays, check the logistics. A lack of products or manual preparation of solutions can be time-consuming. In areas where speed is important, using a ready-to-use product, such as Klintensiv® ready-to-use surface disinfectant, reduces steps and limits dosage errors.
Choose the product based on the required microbiological spectrum and compatibility with surfaces (stainless steel, PVC, plastic materials).
5. Rate of non-compliant microbiological monitoring tests
While the audit methods above are visual and administrative, microbiological monitoring is a complementary method for verifying the efficiency of cleaning and disinfection processes. In Romania, HAI surveillance and the organization of prevention measures are carried out within the applicable regulatory framework, and microbiological monitoring activities are part of the internal infection control system.
Calculation formula:
Non-compliant test rate (%) = (Number of positive microbiological tests / Total self-control tests collected) x 100
The hospital (through the SPIAAM structure and its own or outsourced laboratory) implements a microbiological monitoring program adapted to risk assessment and internal procedures, which may include:
- tests of surfaces and objects;
- monitoring of airborne microflora;
- sterility control;
- swabs from staff hands, when provided for in the unit's procedures or epidemiologically justified.
6. Consumption of cleaning and disinfection products relative to activity
Consumption shows you whether processes are sustainable and technically correct.
Calculation formula
Average consumption = Quantity of product used / (Number of patients, patient-days, or m² cleaned)
Compare similar departments. A significant difference between areas with comparable activity requires analysis.
- Consumption too low: risk of under-dosing or insufficient application.
- Consumption too high: waste, incorrect preparation, or unnecessary over-disinfection.
Standardize protocols and limit variations. Use only products approved for medical use from the professional disinfectant category, with a clear microbiological spectrum declared and tested according to EN standards.
7. Patient satisfaction score regarding cleanliness
Patient perception influences trust in the medical unit. Discharge questionnaires can include questions about:
- room cleanliness;
- hygiene of restrooms;
- frequency of cleaning;
- behavior of cleaning staff.
Calculate the score as an average on a 1–10 scale or as a percentage of positive responses. Many units track scores over 8/10 or over 85% favorable responses, depending on internally set objectives.
Correlate this score with the HAI rate. If satisfaction is high but HAIs are increasing, the problem is technical and invisible. If satisfaction is low, even with stable HAIs, you must improve organization and communication.
How to turn KPI analysis into concrete actions
After each monthly report:
- Identify indicators that exceed established thresholds.
- Analyze the root cause, not just the effect.
- Establish an action plan with a responsible person and deadline.
- Re-evaluate at 2–4 weeks for high-risk areas.
For example, if the HAI rate increases in the orthopedics department, simultaneously check:
- hand hygiene compliance;
- disinfection of frequently touched surfaces;
- instrument sterilization;
- product consumption.
Address the problem in an integrated way. A single isolated measure will not solve the root cause.
Monitor constantly and do not delay interventions. Hygiene is maintained through daily operational discipline, not through one-off actions.
The 7 KPIs give you a complete picture of safety, compliance, and the efficiency of hygiene processes. If you track them monthly and intervene quickly, you reduce the risk of infection, optimize costs, and increase patient trust.
