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New studies illustrate need for rigorous review of infection preventionist staffing models across healthcare systems

06/26/2018

 

Contact: Shannon Quinn
202-683-3160
shannon.quinn@mslgroup.com

Liz Garman
202-365-7421
egarman@apic.org
 

New studies illustrate need for rigorous review of
infection preventionist staffing models across healthcare systems

Arlington, Va., June 26, 2018 – Severe gaps in staffing and outdated coverage benchmarks point to the critical need for evaluating and updating standards for infection preventionist (IP) staffing levels, according to two new studies that explored infection prevention and control resourcing across a variety of healthcare settings. The studies were published in the American Journal of Infection Control (AJIC), the journal of the Association for Professionals in Infection Control and Epidemiology (APIC).

A comprehensive staffing and coverage assessment conducted at Providence Health & Services, a large nonprofit healthcare system, revealed that actual IP labor needs were 31 to 66 percent higher than the current benchmarks system wide. 

The Providence study was conducted for all physical locations within the system that required IP oversight, including 34 critical access, community, and tertiary hospitals; 1 rehabilitation hospital; 13 in-home care programs; 13 long-term care facilities; and 583 ambulatory locations.

After aggregating system-wide needs, the assessment team concluded the new benchmark should be 1.0 IP full-time equivalent (FTE) per 69 beds, indicating a greater IP need than the previously accepted standard of 0.5-1.0 FTE per 100 beds. The new benchmark considers IP oversight for all physical locations including ambulatory, long-term care, and home care settings.

“The study shows how important it is to conduct thorough needs assessments before determining staffing models for any given organization,” said Rebecca Bartles, MPH, CIC, FAPIC, the study’s lead author. “While a one-size-fits-all model can’t necessarily account for differences across systems, there would be immense value in large healthcare systems pooling together quantitative needs assessment data for analysis.”

The results also revealed that the actual percentage of time IPs spent conducting surveillance activities – which include monitoring health outcomes, analyzing processes of care, and working to improve those processes based on the outcomes –  took an average of 51 percent of current working hours. All IPs interviewed agreed that although most of their time was spent on surveillance and reporting, the most valuable use of their time is conducting environmental rounding and engaging in caregiver education activities. 

A second study, analyzing infection prevention staffing and resources in U.S. acute care hospitals based on results from the 2015 APIC MegaSurvey, exposed similar gaps. The article, by Monika Pogorzelska-Maziarz, PhD, MPH, CIC, and colleagues, drawing from 1,623 survey respondents, provided a snapshot of IP staffing and resources in acute care hospitals, finding important differences between small and large facilities.

Among the APIC MegaSurvey’s findings:

  • The way in which IPs spent their time differed between those that were employed by larger vs. smaller hospitals. IPs working in smaller hospitals spent a significantly smaller proportion of their time on surveillance and prevention and control of HAI transmission, and a larger proportion of their time on employee and occupational health, along with education and research. The way in which IPs spent their time in smaller hospitals potentially reflects the additional responsibilities they may have in addition to infection control.
  • Overall median IP staffing was 1.25 IPs per 100 inpatient census.
  • Responses echoed results from other published studies, finding that few IPs had data management or secretarial support, particularly in smaller hospitals. Being able to delegate administrative tasks frees the IP to spend more time on infection prevention-related work.

“The relationship between IP staffing and rates of healthcare-associated infections has been documented,” said Monika Pogorzelska-Maziarz, PhD, MPH, CIC, FAPIC, lead author of the APIC MegaSurvey article.  “This study sheds light on the fact that individual organizations should conduct routine assessments to ensure IP staffing is matching the demands of the facility, and it demonstrates the need for information-sharing among organizations.”

Both studies support the view that IP staffing recommendations should be based on the care and services provided by a healthcare institution, rather than on a single ratio, which may not be appropriate for all models.

“As the responsibilities of infection prevention and control departments have grown, and the settings of care requiring IP services have expanded, many IPs find that they lack time to conduct activities that will have the most impact on preventing healthcare-associated infections, such as interacting with frontline teams in patient care areas,” said Janet Haas, 2018 APIC President Janet Haas, PhD, RN, CIC, FSHEA, FAPIC. “These studies demonstrate the critical need to reevaluate staffing models to ensure that the demand for IP services is being adequately met so that we can effectively protect patients from infections.”



ABOUT AJIC
AJIC (www.ajicjournal.org) covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL.

ABOUT APIC
APIC’s mission is to create a safer world through prevention of infection. The association’s more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at www.apic.org. Follow APIC on Twitter: www.twitter.com/apic and Facebook: www.facebook.com/APICInfectionPreventionandYou. For information on what patients and families can do, visit APIC’s Infection Prevention and You website at www.apic.org/infectionpreventionandyou

NOTES FOR EDITORS

“A systematic approach to quantifying infection prevention staffing and coverage needs,” by Rebecca Bartles, Angela Dickson, and Oluwatomiwa Babade, appears in the American Journal of Infection Control, Volume 46, Issue 5 (May 2018).

Authors:

A systematic approach to quantifying infection prevention staffing and coverage needs

Rebecca Bartles, MPH, CIC, FAPIC
Providence St. Joseph Health System
Renton, WA

Angela Dickson, MN, BSN, RN, CIC
Providence Southwest Washington Service Area
Centralia, WA

Oluwatomiwa Babade, MD, MPH
Providence St. Joseph Health System
Renton, WA

Infection Prevention Staffing and Resources in U.S. Acute Care Hospitals: Results from the APIC MegaSurvey

Monika Pogorzelska-Maziarz, PhD, MPH, CIC, FAPIC
Thomas Jefferson University
Jefferson College of Nursing 

Heather M. Gilmartin, PhD, NP, CIC, FAPIC
Denver/Seattle Center of Innovation
Denver VA Medical Center, Denver, CO

Sara M Reese, PhD, MPH, CIC, FAPIC
Denver Health Medical Center
Department of Patient Safety and Quality

 

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Contact Info

Liz Garman


egarman@apic.org