Given the complex issues and diverse stakeholders involved in infection prevention and control, effective communication is a critical, increasingly important leadership skill for the infection preventionist (IP). Communication involves the exchange of information or ideas with individuals and groups, including by using words, symbols, data, social media tools, listening, body language, and behavioral role modeling. Effective communication requires emotional intelligence and situational awareness. An effective communicator considers the informational needs, cultural background, and knowledge level of the audience, and the real and perceived patient safety risks, using an evidence-based approach to influence others and support and facilitate desired behaviors and performance.

IPs need to anticipate potential barriers to effective communication, which may be physical, psychological, attitudinal, or hierarchical. The skill of active listening is essential, as is awareness of nonverbal cues. IPs should cultivate the art of persuading and influencing others through composed, consistent consensus building based upon accurate data, analysis, and relevant rationale. The IP must evaluate the best method for communicating the message. The type of technology or social media will vary with the audience. The ultimate result of effective communication by an IP is the reduction of risk, enhanced interdisciplinary teamwork, education of key players in infection prevention and control (IPC), and improved patient outcomes.

For IPs, critical thinking means seeking and using all information at their disposal to examine a problem or situation and finding solutions through creative application of knowledge, experience, data, and evidence. It also means that the IP can apply knowledge gained from other situations and scientific evidence to a novel experience or challenge. Above all, critical thinking means the IP does not accept a process, policy, or procedure just because "that's the way we've always done it."

Critical thinking is a combination of key skills/tasks, including:

• Recognizing a problem exists (a problem can be an outbreak that requires immediate response or a policy that is no longer best practice)
• Identifying and analyzing options and potential solutions
• Making a decision based on the problem
• Prioritizing how to solve multiple problems at once
• Applying decision to the problem and effectively implementing the solution
• Examining what happened as a result of applying decision to improve results for the next time

Increasingly, and with the trend expected to continue to grow in the future, an IP's work is executed effectively and sustainably only through working with multiple departments and disciplines to carry out the IPC program's goals. Infection prevention and control touches many areas of health care and often involves sectors that are governed by their respective regulations and standards. An IP may be required to facilitate/lead interdisciplinary projects, serving as a champion for a culture of safety. Doing so requires situational awareness, emotional intelligence, and strategic vision. At other times, collaboration might mean encouraging teamwork and getting the most from others. It might also mean being able to negotiate your program needs in the larger context of the group or facility.

Different types of leadership skills are required to collaborate effectively, including "followership": learning to provide expertise in a supporting role while not officially being the team leader. Qualities of a good follower might include listening to and respecting others' opinions, demonstrating commitment, displaying loyalty, and working well with others to achieve consensus. It also means having a willingness to challenge leaders and offer constructive criticism.

Because both preventing person-to-person transmission and behavioral compliance are critical to the effectiveness and success of IPC interventions, it is important for IPs to be knowledgeable about the leadership resources offered by sciences (e.g., psychology, sociology) that seek to generalize human behavior in society using behavioral science theory. IPs benefit from the application of behavioral science theory, such as socio-adaptive strategies, when facilitating behavior change and developing education and training programs. Familiarity with socio-adaptive strategies and relationship management become valuable because prevention efforts in large part can be behaviorally focused, requiring collaboration, engagement, and communication across professional disciplines and clinical and administrative boundaries.

IPs can be agents of change as they build relationships with front line staff and leaders alike. These relationships assure sustained behavioral changes through deliberate actions and team building. With the knowledge of behavior science and change theories, IPs can better facilitate teamwork to define an agreed-upon measure of success, and they are uniquely positioned to recommend how this information is fed back to local leaders and institutional leaders for continued and actionable change.

In addition to being subject matter experts in IPC, IPs also need to be effective and efficient managers of budgets, resources, personnel, and programs. By demonstrating sound management and leadership skills, IPs will enhance their credibility, have a stronger voice, and gain a seat at key stakeholder tables, ensuring that their IPC expertise and perspective are present during key decision making. IPs need to have a clear vision and understanding of what an effective, successful, resilient IPC program looks like, and the interdisciplinary program management knowledge, skills, and awareness to achieve those essential organizational and operational realities.

Science, technology, health care business models, and regulatory and accreditation requirements are steadily evolving. IPs should develop and practice key skills such as forecasting, strategic planning, analyzing scenarios, and building consensus. Perseverance through adversity is required to meet targets, while being flexible and nimble when priorities, circumstances, roles, and responsibilities shift. The key is performance outcomes, recalibrating as needed to constantly narrow the gap between goals and results.

All IPs need team building skills and the ability to see complex challenges from a systems perspective. IPs in solo practice may not be able to exercise a more traditional leadership role afforded through direct employee reports but have a unique role in being a program manager. An IP director and/or manager needs additional skills to recruit, interview, onboard, mentor, and develop talent for interdisciplinary teams. An effective IP manager knows how to conduct her or himself with emotional intelligence, remain balanced, and align workloads for the team. That means seeing the big picture, monitoring key details, building collaborative relationships internally and externally, fostering a culture of accountability, and managing expectations and competing priorities. At the end of the day, nothing is as motivating as the shared success that comes through excellent teamwork.

Effective and timely mentorship can play a critical role in the success of IPs, especially those new to the profession, because IPs come to infection prevention and control from varied backgrounds from within nursing and non-clinical fields and have not shared standardized training. In addition, the focus on implementation and dissemination of prevention strategies and interventions makes it essential for IPs to learn from each other's experiences. Effective mentor-IPs impart infection prevention knowledge through the lens of their personal professional experience and assist colleagues in translating textbook concepts and evidence-based guidelines to real-life clinical needs and situations. In today's fast-changing health care environment good talent is becoming harder to find and even harder to keep. Successful mentoring improves retention by growing and developing IPs, which in turn increases their level of professional satisfaction. Mentorship is beneficial to both the mentee and the mentor because it provides an opportunity to contribute to the professional development and competency advancement of the future IP workforce.

A primary function of surveillance technology is leveraging data inputs to help identify HAIs and other reportable infection prevention data and managing reportable data, including communicating results through automated reporting. Applications may be homegrown or designed by vendors and may encompass all aspects of IPC work (beyond HAI surveillance), including: mining staff illness, risk management, antibiotic stewardship, and microbiology surveillance.

Surveillance technology has changed the workflow of the IP from manual processes to electronic solutions. Harnessed effectively, surveillance technology can be applied to proactively identify trends. The IP must perform due diligence in implementation and ongoing validation of surveillance technology, as errors in this process can lead to data quality issues.

As surveillance technology improves, the IP must keep pace with these improvements and anticipate ways to harness the program across the continuum of care and for historical relevant data within a system.

While some facilities may still use paper-based medical records, the national trend, with support of meaningful use initiatives, is toward electronic medical records (EMR). The EMR is the legal record created by hospitals and ambulatory environments that populates the broader electronic health record (EHR). An aggregation of discrete EHR data that can be queried and analyzed comprises the electronic data warehouse (EDW). An EDW differs from a data repository, such as NHSN, in that the data pulls directly from the EHR to the EDW with minimal manual data entry. An IPC electronic surveillance program may function as an EDW specific to IPC issues.

As a data repository, the EDW may be harnessed to provide impact of certain infections on resource utilization (e.g., length of stay), effectiveness of infection prevention and therapeutic interventions, algorithmic detection of possible HAIs, syndromic surveillance for public health or national security reasons, data validation, and identification of possible surgical site infections coded in claims data systems.

With a comprehensive understanding of the informatics needed for IPC, the IP is able to guide IT solutions for everyday IP issues such as simplifying and streamlining surveillance processes and building rules for clinical alerts and real-time decision making. IPs need to be involved in the evaluation and selection of an EMR vendor, should be trained in its use, actively tailor the system to enhance data accuracy and IP productivity, and be involved in changes made to the system that impact IPC.

Use of an EMR can include chart review, automated collection of device-days and procedures, alerts to clinicians of continued presence of devices such as urinary catheters, real-time management of patients in isolation precautions, and names of personnel needing post-exposure follow-up from possible occupational exposure to infectious disease.

Using the surveillance plan, the IP creates a data management process for the IPC program. Keeping abreast of the current technologies available to streamline the surveillance process is crucial as IPs incorporate the correct data streams to ensure relevant and accurate reporting of data in a resource-efficient manner. Advances in machine learning can help expedite identification of trends and assist IPs in the identification and early prevention of HAIs, outbreaks, and areas of focus for improvement activities. Understanding the gaps in the interpretation and use of data is vital to ensuring meaningfulness and accuracy.

Infection-related data must be validated, stored, protected, and processed correctly to ensure accessibility, reliability, and timeliness for all end users, identification of issues, and reporting needs. Techniques to transform raw data into usable information are essential in addressing infection prevention concerns. IPs should adopt visualization methods to help enhance identification of patterns, trends, and correlations that otherwise might go undetected, as well as incorporate and tailor data visualization methods when disseminating IPC data to end users.

Advancements in health care-related diagnostic testing methods will continue to occur at a rapid pace. IPs need to collaborate with the laboratory and radiology to assure ongoing self-education of novel diagnostic technologies being used at their facility. IPs also need to interpret and judiciously apply the findings from new diagnostic testing methods into their IPC program, such as determining the initiation or removal of a patient from isolation precautions and assessing the potential impact on surveillance plans, as well as NHSN HAI definitions in various patient populations. These diagnostic advances are important considerations for IPC and antimicrobial stewardship programs as they help identify infections and HAIs sooner, improve timeliness of proper antimicrobial use, expedite identification of clusters/outbreaks, and even identify markers/risk factors that can be used to prevent infections before they occur. Utilization of machine learning and artificial intelligence in diagnostic technology and data mining arenas will be important concepts for IPs to understand so that they are able to articulate data needs from electronic systems. Furthermore, predictive analytics will connect our diagnostic technology with clinical documentation to facilitate more rapid intervention in patient care and improve clinical outcomes. IPs will need to assure that these new diagnostic methodologies and results are incorporated into surveillance systems to assure reliable monitoring of HAIs. IPs also can play an important role in educating frontline staff, in an easy to understand manner, about new diagnostic test results and their relevance to IPC practices and data analysis/dissemination.

IPs are critically important leaders and subject matter experts (SME) in any health care setting, with a unique interdisciplinary skill set and the ability to see the big picture. As SMEs, IPs are a definitive source of IPC knowledge, technique, and expertise. They also have the experience, awareness, and systems perspective to understand how changes in the environment could potentially impact patient safety, such as during construction or renovation, or when a new technology or technique is introduced at the bedside. An IP's complex, critical role includes knowing when to manage or lead a project or support others as a SME consultant.

To maintain a position of leadership as SMEs in IPC, IPs must expand their knowledge to include disciplines beyond infection prevention and control. IPs must also demonstrate enhanced skills to communicate and work effectively with a wide range of experts, from doctors and nurses to laboratory scientists and environmental services staff. This varied knowledge and skills are invaluable not just during a crisis, but also in preventing outbreaks of infectious diseases. By establishing their expertise in IPC grounded in the latest, evidence-based knowledge, IPs will be more likely to secure a seat at the decision-making table.

IPs will continue to collaborate with other health care professionals on performance improvement (PI) processes to create transformational change leading to better clinical outcomes and sustained PI at the system level. Several methodologies with concomitant tools are available for PI. Regardless of the method chosen, the key elements of PI are assessing performance in a given area, setting achievable goals, using data to initiate changes, incorporating human factors engineering, and developing measures that will ensure sustainability of the improvement. Employee involvement and empowerment are vital to the success of PI. PI is a continuous, not static, process. Because of increasing demands for zero harm to patients and for high-reliability care, the IP must be proficient in participating in PI. The advancing IP must have the knowledge and ability to recognize when to lead or facilitate the PI team and when to be part of the team to achieve the goals of the project.

Patient safety is at the core of IPC programs, and IPs must be actively involved in the facility's overall patient safety program. That involvement can be demonstrated through participation on a patient safety committee, leading teams to reduce health care-associated infections (HAIs), and other patient safety initiatives. Concepts central to patient safety that IPs must take into account include systems thinking, high reliability, and sustainability.

Systems thinking requires IPs to consider connections inside and outside the health care setting and how they are interrelated in the provision of care. Rarely does the implementation of a new process or a defect in a process affect only one team or individual. These are often system issues, which must be addressed before change can occur. It is crucial that IPs be able to see beyond the walls of the unit or organization involved in order to have an impact. IPs must be able to recognize potential system issues and be prepared to address them as they are identified.

High-Reliability Organizations (HROs) are organizations that maintain a high level of safety with the goal of no failures (errors) over a long period. HROs are continuously looking for ways to improve system processes and reduce harm. There are five attributes of high reliability:

• Preoccupation with failure
• Sensitivity to operations
• Reluctance to simplify
• Commitment to resilience
• Deference to expertise

Given their knowledge and skills, IPs must remain highly competent in predicting possible failures in process and practices, and act to preempt or prevent them. An example is compliance with isolation precautions. IPs must develop a system for monitoring compliance, identifying failures, and working with stakeholders to improve practice.

Sustainability is the ability of an organization to maintain implemented processes over time. IPs coordinate and participate in surveillance activities related to processes implemented to reduce the risk of an HAI. Examples include hand hygiene audits, compliance with isolation precautions, and compliance with HAI bundle activities. IPs then use the data collected to improve processes and implement strategies to hardwire the changes.

To sustain and grow their influence, IPs must be viewed as super users of data. The purpose of data utilization is to aid in decision-making and goal setting, developing annual IPC plans and determining priority improvement opportunities, seeking collaboration with front-line staff, and presenting information to leadership. Productive data utilization demonstrates the value of the information that is available to the practitioner or the facility. In health care settings, information is derived from both individuals and groups.

IPs possess these skills to successfully use data:

• Select appropriate indicators to measure
• Determine types and sources of data
• Perform statistical analysis of the data (coordinate with others with this skill)
• Analyze and interpret the results so they can be applied to future actions.
• Discuss results and provide visualization of the results to interested parties.

Larger data sets, increasing integration of health care records across the care continuum, and enhanced data mining capabilities will present opportunities and challenges for the IP.

With the goal of assessing current risks, minimizing unprotected exposure to pathogens, and eliminating or reducing the transmission of pathogens, risk assessment (RA) is by its very function a future-oriented competency. It is and will remain a cornerstone of an effective IPC program. A risk assessment examines risk factors and vulnerabilities relative to persons, places, and things. The severity of the potential harm, the likelihood of occurrence, and existing control measures are considered when developing a risk assessment. This allows risks to be prioritized to determine the focus of the infection prevention plan and activities. In addition to using the annual risk assessment for program planning, this process can address other, more advanced situations, such as managing outbreaks of novel/emerging pathogens, environment of care considerations such as special locations, water management plans addressing water contamination, construction-related concerns, food handling safety, and equipment management.

Risk reduction occurs via implementation of evidence-based prevention strategies. These strategies will be directed by surveillance data, the annual risk assessment, and services provided by the organization. Risk reduction strategies should target high-risk, high-volume, high-cost events as determined by the IP and the infection prevention committee. Strategies should contribute to patient and staff safety. New technology for diagnosis, care, and treatment; advances in scientific research; and managing with limited resources must be considered for future risk reduction efforts. Future-oriented risk reduction strategies for special locations can be addressed by becoming familiar with and using United States Pharmacopeia (USP) standards, legionella mitigation interventions, Facility Guidelines Institute (FGI) guidelines, food handling safety standards, and manufacturer's instructions for use to reduce risks identified.

Epidemiology is the study of the frequency, distribution, cause, and control of disease in populations, while surveillance is a comprehensive method of measuring outcomes and related processes of care, analyzing the data, and providing information to members of the health care team to assist in improving those outcomes. Together, they form the basis of infection prevention analysis and workflow.

IPs bring a solid understanding of epidemiology to surveillance in order to be proactive and predictive in setting infection reduction targets and establish thresholds for action and response. To do this successfully, IPs must be able to apply and expand surveillance principles; use complex data display tools (control charts, affinity diagrams, scatter plots); conduct basic cluster/epidemic investigations; interpret results using statistics, rates, and ratios; and know what benchmarks to use for his/her program. The IP's surveillance skills can be augmented by familiarity with analytical computer programs or through productive collaboration with colleagues with this talent. This is a core area of IPC knowledge and skills, where IPs need to constantly refresh and deepen their knowledge, so that they are able to speak with authority and clarity to public health officials and diverse professionals in their facility and other facilities that may be impacted when dealing with novel or ambiguous outbreak situations or high-stakes emergencies.

Learning is often referred to as the most important 21st-century skill. Nowhere is that truer than in fast-paced health care settings today. A critical, ongoing IP role is to assess the IPC educational needs of staff, patients, students, and visitors; identify the right goals and objectives; and develop and deliver engaging education sessions and/or materials. Examples of educational delivery methodologies include oral presentations (formal or informal), one-on-one, handouts, posters, teach back, train-the-trainer, simulation labs, positive deviance dialogues, online, and videos. However, proficient IPs also have to deliver impromptu specific education (including microlearning) that addresses needs and gaps just in time, as new circumstances arise.

Effective education programs result in improved behavior, habits, mindsets, and performance outcomes. IPs need to be familiar with the core principles of adult learning and to stay abreast of innovations in teaching and learning design with the end in mind. IPs take into consideration what they want their learners to know, remember, feel, and/or be able to do. Increasingly, limited time is available for education and training, and most learning takes place outside of formal training contexts. Therefore, every effort is made to ensure learning opportunities are memorable, meaningful, and motivating, as well as increase the level of participation, impact, and engagement. IPs keep in mind the following: the one who does the work does the learning, and content covered is not content learned. IPs should always follow up a training to gauge its impact on the job and success in achieving desired outcomes. IPs understand that learners will be more likely to apply what they have learned if there is an expectation of accountability and they are intrinsically motivated.

IPC rounding requires experience and expertise, along with mentoring, training, and supervision, so that novice or becoming proficient IPs learn to see complex, constantly changing health care settings through the eyes of a highly experienced IP.

Based on annual and periodic risk assessments, IPs conduct rounds, which may be either interdisciplinary or individual, to ensure compliance with IPC standards while maintaining a sanitary and safe environment for patients, staff, and visitors. Enhanced skills require that observational rounding elements in each area or clinical practice are relevant and appropriate for that setting. Operating room environmental rounds will be different than observation of appropriate care and maintenance of indwelling catheters, and also different from rounds ensuring that patients are on appropriate isolation.

Beyond the infection control risk assessment for construction/renovation activities, the IP must round on these ongoing projects and audit the area for breaches in requirements. This requires a keen eye and knowledge of the details of the project as well as knowing what to look for when rounding, whether working with renovation of existing facilities or the construction of new buildings. IPs must have knowledge of the requirements for the specific areas and practices being observed. Findings of rounds must be communicated, and appropriate action plans implemented and sustained.

Beyond the lens of traditional IP rounding, IPs participate in interdisciplinary, clinical-centered rounding as programs are developed at their facility. This allows real-time assessment of device utilization as well as opportunities for antibiotic stewardship discussions with clinicians. IPs may also round on patients with devices, in transmission-based precautions, or with infectious diseases to provide patient safety education.

Cleaning, disinfection, and sterilization are essential elements of IPC programs in all health care settings. Surgical and non-surgical procedures, as well as contamination and bioburden within the health care environment, carry a risk of infection for patients. IPs play a crucial role by being knowledgeable about disinfection and sterilization practices used in all settings across their organization and closely collaborating with health care personnel and sterile processing teams in their respective settings to minimize contamination risks and ensure that medical instruments and equipment are properly cleaned and reprocessed.

Understanding and ensuring implementation of manufacturer's "instructions for use" for equipment or products used for cleaning, disinfection, and sterilization is a key IP function. IPs must become and remain familiar with expert organizations' sterilization and disinfection recommendations to facilitate compliance within their organization. Should breaches in performance or non-compliance with guidelines occur, IPs must collaborate with key stakeholders to identify the level of risk to patients and provide necessary follow-up.

The IPs' ability to critically evaluate technological advancements in cleaning, disinfection, and sterilization, and to determine appropriate use in their setting, is an important one. IPs offer assistance to determine if "new and improved" equipment and instruments can be appropriately cleaned, disinfected, and/or sterilized to ensure safe patient care. Knowledge of how to apply the Spaulding Classification system is fundamental when dealing not only with current instrumentation and equipment, but also with new and improved technology in the future.

The identification of adverse events such as infection(s) when they occur above the background rate or when there is an unusual pathogen or adverse event is a fundamental component of an IP's work that demands ongoing vigilance. The key components to outbreak detection and management include the confirmation of an outbreak; notification of key partners about the investigation; conducting a literature review; establishing and refining a case definition and case finding methodology; preparing a line list and epidemic curve; observing and previewing of implicated care activities; sampling of environment and device if indicated; implementing and ongoing review of control measures and performance; and implementing an analytic study if needed.

The future challenges for IPs will be detecting emerging or novel pathogens through the use of (but not limited to):

• Application of Diagnostic Testing Data and Techniques; see subdomain under IP Informatics (includes: predictive analytics, data mining, artificial intelligence, and application of big data sources)
• Natural language processing, which allows for a quick compilation of the data into terms obviously related to a research topic and other relations that may be unexpected. Capitalizing on the uncommon terms could give the researcher the ability to identify flags that may aid in investigation of or prediction of outbreaks.
• Using data and data feeds to identify risks to the health care continuum from threats related to domestic and international travel

Advances in and application of all of the above aid the IP in the detection, prediction, management, and investigation of outbreaks.

Technological change is taking place at an unprecedented, exponential rate, well beyond the capability of any one individual, group, profession, or society to fully understand or assimilate. In this environment, being receptive to learning new things, cultivating curiosity to want to know more, learning how to learn, and knowing what you know and do not know are important skills. Given the wide scope of IPC work, IPs should play to their natural strengths: interdisciplinary thinking, seeing the big picture, and knowing how to connect the dots across the complex landscape of health care facilities in the continuum of care. IPs may know a lot about a particular technology; however, it is important to monitor the possible IPC impacts of a broad range of current and emerging technologies.

Key areas to pay attention to may include information systems and patient care technology, diagnostic testing, telemedicine, and new environmental technologies.

IPs are involved with the facility's antimicrobial stewardship (AS) initiatives by providing consultative expertise, but also by being a leader and advocate in this very important area that increasingly impacts the health and safety of patients worldwide. The magnitude of these adverse outcomes will be more pronounced as disease severity, strain virulence, or host vulnerability increases. Failure to combat the continued evolution of antimicrobial resistance in the hospital and across the continuum of care threatens to significantly compromise the ability not only to prevent, but also to treat, serious infections.

IPs proactively contribute to AS efforts by identifying and detecting MDROs among the population served, reporting surveillance trends over time, using surveillance data (i.e., treating asymptomatic bacteriuria, collecting contaminated specimens), and analyzing antibiograms and antibiotic use. These processes are critical elements of annual and targeted risk assessments to determine the role of epidemiologically significant organisms. IPs further support antimicrobial stewardship initiatives by assisting with early organism and infected patient identification; promoting compliance with standard and transmission-based precautions and other infection prevention strategies such as care bundle practices and hand hygiene; and developing and providing educational programs for staff, patients, and visitors.

Recent advances in rapid-precision microbial technologies and radiographic imaging/interventions are transforming patient diagnostics in health care. Diagnostic stewardship means selecting the right test for the right patient at the right time in the right way, to optimize clinical care. IPs play an essential role in the collaborative effort that involves decisions about which new diagnostics are needed, how they will be used and interpreted, and the cost implications and trade-off. It requires a seamless partnership among providers, ID specialists, laboratories, radiologists, pharmacists, IPs, nurses, and other clinical team members so that tests are ordered appropriately and information is translated and used accurately in treatment decisions. IPs work with front-line staff to develop protocols for testing, including proper specimen collection techniques to optimize results. Development of auditing systems and use of data compliance monitoring to drive improvements in diagnostic stewardship is a key role for IPs. IPs monitor the impact of diagnostic stewardship via HAI data analysis and incorporate financial value in the evaluation process.

Even if IPs are not conducting research, they should understand whether or not the basic design of a study is strong and know whether they should implement the results. IPs implement the very best research into their facility's practices and conduct analysis of how it is working in their setting. Doing so requires the skills to review and assess the strengths, limitations, and application of research, and to critically assess content, validity, and reliability.

According to AHRQ, "Comparative effectiveness research (CER) is designed to inform health care decisions by providing evidence on effectiveness, benefits, and harms of different treatment options. The evidence is generated from research studies that compare drugs, medical devices, tests, surgeries, or ways to deliver health care." With this focus on the application of clinical research, CER supplements and strengthens implementation science efforts. An understanding of CER better equips the IP to ground IPC practice in evidence and informed decisions. The ability to compare the relative value of a treatment option, based in evidence, allows the IP to make informed decisions when recommending products, devices, and supplies to use and implement. IPs should become familiar with CER methodology, so they can apply this knowledge to compare one active intervention to another to assess benefits and harms to patients (e.g., rate of patient infection, not just microbial contamination).

Implementation and dissemination science may be defined as research that creates new knowledge about how best to design, implement, and evaluate quality improvement initiatives.

A critical element of IPs as consultants and influencers is the ability to promote the uptake of evidence-based practice and research findings into routine practice. Applying evidence to the practice of IPC is not always an easy task, and presenting people with evidence does not necessarily translate to a change in practice or behavior. Competency in the methods and working of implementation science provides the IP with the means of identifying what and how guidelines and standards should inform daily clinical practice, how the evidence should be adopted as accepted practice and implemented at the patient bedside, and how to apply research that appears in scientific, peer-reviewed journal to policies and practices.

Standardized frameworks for the successful implementation of evidence into practice should be familiar to and used by IPs in all settings. These frameworks should be considered when evaluating an implementation or designing an implementation study or activity. The PARiHS framework (Promoting Action on Research Implementation in Health Services) and Consolidated Framework for Implementation Research (CFIR) are two examples of frameworks that can be used.

Dissemination science refers to the targeted distribution of information and intervention materials to a specific audience. Knowledge of dissemination science principles directly strengthens key elements of the IP's role as educator and communicator. Implementation implies that the goal of the communication is, however, to do more than increase awareness; it is the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings.

It is important to note that quality improvement and research can look similar but there are differences. Research will be conducted with the idea of developing generalized knowledge for others; whereas a quality improvement initiative within a facility seeks to understand what works in that setting, but not to try to inform the whole practice. While not all IPs will design a study to conduct research, IPs do have a responsibility to add to the evidence through publications about work being done in their facility.

IPs not conducting their own research may participate in research studies by identifying gaps in knowledge and setting research priorities for their facilities. Such experience and knowledge serve IPs well in being successful and effective in leading and/or participating in local quality improvement initiatives.

As outlined in APIC's professional and practice standards, IPs must be able to demonstrate a consistent, high level of personal dependability in all aspects of their profession.

IPs must also be able to work effectively throughout an organization to ensure that accountability measures are in place for the performance of evidence-based practices, especially for those that impact quality metrics scrutinized by payers and regulators and prevent harm to patients. To maintain this level of accountability, IPs must have skills in communication, education, relationship-building, behavior change, and facilitation to ensure compliance is established and that all health care workers are educated and feel accountable for preventing and controlling infections.

Future competencies for the IP in this area include maintaining confidentiality of sensitive information, investigating claims of employee violations, and encouraging staff to take responsibility for those actions, implementing and sustaining new guidelines and procedures, providing information across the health system to educate staff on respective duties, emphasizing performance expectations, and revising and communicating expectations and methods for achieving health system IPC goals and results.

Ethics is a mindset that requires careful cultivation and stewardship, constant vigilance, and ongoing awareness and learning to provide a framework when deciding the best course of action, especially when dealing with highly complex, changing, or novel situations and systems. As stewards of the profession, IPs should demonstrate the highest standards of personal and professional conduct, accountability, behavior, and decision making, including consistent adherence to the ethical principles outlined in the APIC professional and practice standards.

IPs are advocates for quality and safety in all health care settings and work to guarantee the health of the entire population for which they are responsible while respecting the rights of individuals within that population. Ethical principles should be built into policies and procedures, with justification and solid evidence provided for measures so that they are clearly understood by all individuals who are impacted.

IPs should uphold the integrity of the profession through compliance with laws, regulations, and standards of best practice related to infection prevention and control. This includes conducting surveillance for health care-associated infections based on current National Healthcare Safety Network definitions and accurately reporting health care-associated infections according to state and/or federal mandates.

As stewards of departmental budgets, IPs must project the intended and unintended impact of IPC activities across the facility. A key component of understanding the business case for IPC is quantifying the costs and savings of IPC initiatives, such as implementation of new programs (hand hygiene observer, unit CAUTI champion), practices (adapting evidence-based guidelines), and products (reducing risk through engineering). Additionally, the IP often must justify her or his position within a facility, as well as compete for additional support (FTE). An IP who is able to make a cogent, clear, succinct business case that is customized as needed to diverse decision-makers, including the C-suite, may succeed in both implementing initiatives and supporting the role of the IP department, resulting in enhanced patient safety and reduced risk to the facility.

Another key aspect of making the business case and being a good steward of resources that impact IPC is understanding reimbursement models. IPC process and outcome metric performance are being used more in reimbursement models. In addition to facility-based reimbursement models, provider quality incentive reimbursement schemes use infection prevention metrics to stimulate more focus on improved patient outcomes.

With increased movement of patients among and between different health care settings and the community, population health concerns are becoming a progressively important aspect of an IP's work. Challenges include community-associated infections, self-prevention strategies, emerging diseases, outbreaks and epidemics, environmental hazards, and bioterrorism affecting the health outcomes of groups of individuals and the wider population.

Our rapidly evolving health care system demands that IPs attend to patient safety and health care-associated infections that go beyond an individual or hospital focus. Prevention, early detection, surveillance, and treatment modalities must be designed, implemented, and evaluated at the level of prospective preparedness. Today's health care system calls for IPs to be community- and population-focused, capable of recognizing and managing emerging infections, and able to deal effectively with environmental hazards and threats.

Population health requires collaboration among disciplines, critical analysis of systems and outcomes, and the creation of key improvements in health care delivery. Specific skills related to population health include community health assessment, community health improvement planning and action, community engagement and cultural awareness, systems thinking, and organizational planning and management. IPs consider and address population health concerns during the annual risk assessment process, taking into account the contextual demographics as well as global implications. IPs must think outside the walls of their facility setting(s) to keep the community healthy and safe.

The continuum of care refers to the provision of care through multiple types of health services, levels, and intensities. Infection prevention and control standards encompass a broad spectrum of practice settings (including, but not limited to, acute care, behavioral health, long-term care, outpatient facilities, rehabilitation centers, community health centers, home care, and dialysis) and can be applied to every health care delivery setting.

As the health care delivery system expands and patients receive care in multiple settings, it is critical that the IP develop collaborative relationships with IPs in other settings. IPs must consider IPC processes and products used in each practice setting and remain cognizant of the impact these may have on the patient, family, and health care staff as the patient moves from one setting to another. They must work to facilitate communication between facilities and may be called upon to develop plans for safe transfer and provision of care within other practice settings.

To grow into greater roles of influence and decision-making, IPs must advocate at the micro (facility) and macro (national) levels for IPC and their field at large.

At the national level, IPs need to (a) keep abreast of the political and regulatory health care landscape and understand its impact on the APIC Advocacy Agenda; (b) advocate for the profession and the critically important role that IPC plays across the continuum of care, especially as it impacts practice at the regional, state, and local levels; (c) inform and educate policymakers and regulatory agencies on evidence-based IPC practices that protect patients, staff, and specific populations from infection; (d) maintain vigilance for emerging issues where policy makers and the public are getting the facts wrong, which could lead to cuts to critically needed funding; and (e) practice persuasive reasoning while identifying what resonates with the audience. At the facility level, IPs need to use their position and influence to advocate for the desired future as well as realistic, incremental changes that meet the needs of patients, visitors, staff, and the IPC program itself.