Competency in infection prevention: a conceptual approach to guide current and future practice

Development and implementation of learning collaboratives for infection prevention and control education in long-term care facilities

Infections in long-term care facilities pose a critical challenge, with 1 to 3 million serious infections annually and up to 380,000 associated deaths. The vulnerability of aging populations and inadequate infection prevention and control programs underscore the need for intervention. This initiative provided tailored continuing education through 8 virtual learning collaboratives serving 541 infection preventionists. The project also developed 9 infection prevention and control toolkits and a manual to further support long-term care facilities' infection prevention efforts.

Competency level and determinants among infection prevention and control staff in the Middle East and North Africa region

BACKGROUND

Competency of the staff working in infection prevention and control (IPC) is the cornerstone of successful IPC programs. The objective was to assess competency level and associated factors among IPC staff working in the Middle East and North Africa (MENA) region.

METHODS

A cross-sectional study was carried out in 2019 among active IPC staff who were members of the Arab Countries Infection Control Network. The questionnaire covered demographic and professional characteristics of IPC staff and characteristics of work facilities and IPC programs. A competency score was created from self-perceived responses to 8 competency domains. The competency score was then transformed into 100-scale and categorized into two groups (≥ median and < median).

RESULTS

A total of 176 participants completed the survey. Participants were mostly female (65.7%), and the mean age was 40.2 ± 8.3 years. The mean competency score was 61.4%. It was slightly variable between domains, being highest with preventing transmission of infection (65%) and lowest with sterilization and disinfection (59%). Higher (≥ median) competency score was associated with having CBIC certification (p < 0.001). It was also associated with facilities having IPC plan (p = 0.005), IPC committee (p = 0.049), regular meetings of IPC committee (p < 0.001), and IPC plan included communications with healthcare workers (p < 0.001). Domain-specific competency scores were significantly associated with receiving same domain-specific training (p < 0.05 for all).

CONCLUSIONS

The competency levels of IPC staff in the MENA region is still suboptimal. The current finding calls for more regional and national investment in IPC staff by providing up-to-date customized educational and training opportunities.

Evaluation of Infection Preventionists' Competencies Using the Association for Professionals in Infection Control and Epidemiology Competency Model in Tertiary Care Government Hospitals, Bahrain

Introduction Infection preventionists (IPs) are healthcare workers (HCWs) who received specialized training in infection prevention and control (IPC) to be able to deliver specific tasks to prevent and control infection transmission to patients, HCWs, and visitors in all healthcare settings. Most IPs started their professional life as nurses, physicians, microbiology, public health, or allied health specialties before moving to the IPC field, not necessarily with specialized training or diploma, which may need more focus on unified competency tool to evaluate their skills and strengths and improve IPC program outcome. Aim This study aimed to examine IPs' self-rated competency level using the Association for Professionals in Infection Control and Epidemiology (APIC) core competencies and to determine what factors influence the level of competency among IPs in Government Hospitals (GHs) in Manama, Bahrain. Subject and methods This cross-sectional study was conducted among non-certified IPs in Bahrain's GHs. A self-administered questionnaire was distributed among the targeted IPs using the Microsoft 365 form (Microsoft® Corp., Redmond, WA). The questionnaire includes socio-demographic characteristics (e.g., age, gender, years of experience, etc.), the APIC competency tool to assess IP competency, and the perceived effectiveness of the IPC program. Results Of the 17 IPs, 88.2% were females, and 47.1% were between 31 and 35 years old. Among the eight APIC core competencies, management and communication had the highest mean percentage score (84.2%), followed by preventing/controlling the transmission of infectious diseases (84.1%) and the identification of infectious disease processes (81.5%). The total mean competency score was 142.8 (SD: 20.3), with 70.6% classified as having a good level of competency. Increasing years of IP experience was the only factor associated with increased competency scores. Conclusion The level of IPC competency among "novice" or "becoming" proficient IPs was sufficient. Using the APIC competency tool, IPs showed competence in managing and communicating, preventing or controlling transmission of infectious agents, identifying infectious disease processes, and surveillance and epidemiologic investigations. Further research is needed to give more insights into the level of IPC competency of IPs in our region.

Human resource management to assist infection prevention and control professionals: a scoping review

Infection prevention and control (IPC) professionals are key intermediaries between hospital managers and frontline staff. During the novel coronavirus disease pandemic, IPC professionals faced new challenges. Unfortunately, research on human resource management (HRM) to support IPC during and between pandemics is lacking. Therefore, this scoping review aimed to elucidate the existing knowledge on HRM measures in this context and thus contribute to the pandemic preparedness of healthcare facilities. It was conducted as part of the "PREparedness and PAndemic REsponse in Germany (PREPARED)" project within the Network University Medicine (NUM), using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. PubMed was searched without time restriction until 2023 (filter: English, German). Two reviewers assessed titles/abstracts and full texts, respectively. A total of nine publications were included, eight of which were published in the USA. All publications reported survey data (quantitative: six). Measures targeting personnel development and the qualification of IPC personnel were reported in six studies, i.e., almost two-thirds of the studies, of which five focused on the tasks of IPC professionals. In contrast, management of personnel costs and remuneration systems were reported less frequently (three studies), and only regarding issues around retention, compensation and dismissal. In conclusion, research gaps include trials on implementation and effectiveness of HRM for IPC. Given the increasing shortage of IPC professionals, HRM measures during and between pandemics become more important for establishing pandemic preparedness.

Relationships Between Perceived Organizational Support, Psychological Capital and Work Engagement Among Chinese Infection Control Nurses

Background

Few studies have focused on the work engagement of infection control nurses (ICNs). The perceived organizational support (POS) and psychological capital (PsyCap) might be important factors influencing ICNs' work engagement. Moreover, PsyCap might play a mediating role in the relationship between POS and work engagement.

Objective

This study aims to clarify the relationships among POS, PsyCap and work engagement of Chinese ICNs.

Methods

A cross-sectional design was performed to collect data on 7382 ICNs from 20 provinces in China. Data collection was conducted by an online questionnaire, including questions about demographics, the Chinese version of the Utrecht work engagement scale (UWES), the Chinese version of the psychological capital questionnaire (PCQ) and the perceived organizational support scale for medical staff. Univariate analysis, the Spearman correlation method and the mediating effect test were conducted.

Results

The work engagement was at a relatively high level, with a total score of 80.87 ± 14.95. The total scores of POS and PsyCap scale were 41.45 ± 7.37 and 89.14 ± 9.06 respectively, both of which were at the upper-middle level. Work engagement was positively associated with both POS and PsyCap (both P<0.01). Furthermore, the mediating effect of PsyCap on the relationship between POS and work engagement was 0.394, the total effect was 0.443, and the ratio of mediating effect to total effect was 88.94%.

Conclusion

The findings suggest that both POS and PsyCap can directly increase the work engagement of the Chinese ICNs. Besides, POS can indirectly improve work engagement, partially through PsyCap. Therefore, enhancing POS and PsyCap could be effective in improving the work engagement of ICNs.

Core competencies in applied infectious disease epidemiology: a framework for countries in Europe

In 2009, the European Centre for Disease Prevention and Control (ECDC) developed a competency framework to support European Union countries and the European Commission in ensuring a competent public health workforce for Europe. The coronavirus disease (COVID-19) pandemic emphasised the importance of harmonised public health strategies and competencies across international boundaries, specifically for infectious diseases. This perspective presents the process to update the competency framework for applied infectious disease epidemiology, highlighting ECDC's efforts to support countries with using the framework. ECDC commissioned the Association of Schools of Public Health in the European Region (ASPHER) to update the framework through publication and dissemination of a technical report and a self-assessment tool linked to training resources. A mixed methods approach to gather input from experts in relevant specialities included qualitative interviews with 42 experts, workshops with ECDC Technical Advisory Group and an online survey of 212 public health professionals across Europe and beyond. Modifications resulted in 157 core competencies in 23 domains, each mapping to one of six subject areas of importance in applied infectious disease epidemiology. The framework serves as a basis to update the curriculum of the ECDC Fellowship programme with two alternative paths: intervention epidemiology or public health microbiology.

Recommendations for change in infection prevention programs and practice

Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for infection preventionists. This article provides guidance and recommendations in 14 key areas. These interventions should be considered for implementation by United States health care facilities in the near future.

An e-Problem-Based Learning Program for Infection Control in Nursing Homes: A Quasi-Experimental Study

Infection is a significant factor adversely affecting the health of nursing home (NH) residents, potentially even leading to death. Therefore, educating NH staff to think critically is necessary to prevent and control infection. In this study, we developed an electronic problem-based learning (e-PBL) program using the Network-Based Instructional System Design model to enhance South Korean NH staff's critical thinking competencies; subsequently, its effectiveness was evaluated. This study utilized a quasi-experimental nonequivalent pretest-post-test design. The participants (n = 54) were randomly allocated into an experimental group (n = 28) and a control group (n = 26). The results indicate that the e-PBL program significantly improved the critical thinking disposition in the experimental group compared with in the control group.

Application of a Novel PM Model to Assess the Risk of Clostridioides difficile Infections in Medical Facilities as a Tool for Improving the Quality of Health Services and the Safety of Patients

Infections with multi-drug resistant microorganisms associated with the provision of health services have become an acute problem worldwide. These infections cause increased morbidity as well as mortality and are a financial burden for the healthcare system. Effective risk management can reduce the spread of infections and thus minimize their number in hospitalized patients. We have developed a new approach to the analysis of hazards and of exposure to the risk of adverse events by linking the patient's health record system to the entire infrastructure of the hospital unit. In this study, using the developed model, we focused on infections caused by the Clostridioides difficile bacterium, as they constitute a significant number of nosocomial infections in Poland and worldwide. The study was conducted in a medical facility located in the central part of Poland which provides tertiary care. In the proposed PM model, a risk analysis of hospital acquired infections at the Intensive Care and Anesthesiology Unit combined with the hospital's technical facilities and organizational factors was conducted. The obtained results indicate the most critical events which may have an impact on potential hazards or risks which may result from the patient's stay at the specific ward. Our method can be combined with an anti-problem approach, which minimizes the critical level of infection in order to determine the optimal functioning of the entire hospital unit. Research has shown that in most situations the spread dynamics of nosocomial infections can be controlled and their elimination may be attempted. In order to meet these conditions, the persons responsible for the daily operation of the medical facility and its individual wards have to indicate potential events and factors which present a risk to the hospitalized patients. On the basis of a created spreadsheet directions for improvement may be finally established for all potential events, their frequency may be minimized, and information may be obtained on actions which should be undertaken in a crisis situation caused by the occurrence of a given phenomenon. We believe that the proposed method is effective in terms of risk reduction, which is important for preventing the transmission of multi-drug resistant microorganisms in the hospital environment.

Development and validation of a competency evaluation model for hospital infection prevention and control practitioners in the post-pandemic era: a mixed methods study

Background

During the coronavirus disease 2019 pandemic, the management of nosocomial infections became even more crucial. There is an urgent need to develop a competency model for healthcare practitioners to combat public health emergencies.

Aim

To determine practitioners' competency in hospital infection prevention and control measures.

Methods

A theoretical framework was developed based on a literature review, key informant interviews, the Delphi method and a questionnaire survey. These items were evaluated based on response rate, maximum score, minimum score and mean score. Factor analyses, both exploratory and confirmatory, were used to determine the structure of the competency model.

Results

The effective response rate for the questionnaire was 88.29%, and Cronbach's α-coefficient was 0.964. Factor analysis revealed a Kaiser–Meyer–Olkin score of 0.945. Bartlett's test gave a χ²-value of 10523.439 (df=435; P<0.001). After exploratory factor analysis, the five-factor model was retained, four items were deleted and a five-dimensional, 26-item scale was obtained. The new structure's confirmatory factor analysis revealed high goodness of fit (comparative fit index=0.921; Tucker–Lewis index=0.911; standardized root mean square residual=0.053; root mean square error of approximation=0.044).

Conclusion

The proposed scale is a useful tool to assess the competency of hospital infection prevention and control practitioners, which can help hospitals to improve infection prevention and control.

Strategies for Effective Infection Prevention Programs: Structures, Processes, and Funding

Successful Infection Prevention Programs (IPPs) consist of a multidisciplinary team led by a hospital epidemiologist and managed by infection preventionists. Knowledge of the economics of health care-associated infections (HAIs) and the ability to make a business plan is now essential to the success of programs. Prevention of HAIs is the core function of IPPs with impact on patient outcomes, quality of care, and cost savings for hospitals. This article discusses the structure and responsibilities of an IPP, the regulatory pressures and opportunities that these programs face, and how to build and manage a successful program.

Infection preventionist retention and professional development strategies: Insights from a national survey

This brief report explores why Infection Preventionists (IPs) leave their positions and strategies implemented to retain and professionally develop IPs. National survey data of over 500 APIC members found turnover is due to personal reasons, professional advancement opportunities and work-life balance challenges. In addition, IPs are retiring in great numbers. The creation of career pathways and providing an environment that supports work-life balance are novel strategies that could retain and professionally develop IPs.

Infection control teams for reducing healthcare-associated infections in hospitals and other healthcare settings: a protocol for systematic review

INTRODUCTION

Healthcare-associated infections (HCAIs) are a worldwide problem. Infection control in hospitals is usually implemented by an infection control team (ICT). Initially, ICTs consisted of doctors, nurses, epidemiologists and microbiologists; then, in the 1980s, the infection control link nurse (ICLN) system was introduced. ICTs (with or without the ICLN system) work to ensure the health and well-being of patients and healthcare professionals in hospitals and other healthcare settings, such as acute care clinics, community health centres and care homes. No previous study has reported the effects of ICTs on HCAIs. This systematic review aims to assess the effectiveness of ICTs with or without the ICLN system in reducing HCAIs in hospitals and other healthcare settings.

METHODS AND ANALYSIS

We will perform a comprehensive literature search for randomised controlled trials in four databases: PubMed, Embase, CINAHL and the Cochrane Library. The primary outcomes are: patient-based/clinical outcomes (rate of HCAIs, death due to HCAIs and length of hospital stay) and staff-based/behavioural outcomes (compliance with infection control practices). The secondary outcomes include the costs to the healthcare system or patients due to extended lengths of stay. Following data extraction, we will assess the risk of bias by using the Cochrane Effective Practice and Organization of Care risk of bias tool. If data can be pooled across all the studies, we will perform a meta-analysis.

ETHICS AND DISSEMINATION

We will use publicly available data, and therefore, ethical approval is not required for this systematic review. The findings will be submitted for publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

CRD42020172173.

Recruitment and hiring practices in United States infection prevention and control departments: Results of a national survey

BACKGROUND

Infection prevention is a profession that requires highly specified skills and clinical experience. Infection Preventionists (IPs) direct interventions that protect patients from health care-associated infections across clinical and community settings. To enhance the hiring and recruitment of diverse IPs, it is key to understand current recruitment and hiring practices METHODS: A national on-line survey was performed with members of the Association for Professionals in Infection Control and Epidemiology (APIC) who participate in the recruitment and hiring of IPs in their organization. Descriptive statistics were calculated for respondent and organizational demographics, IP recruitment strategies and hiring practices.

RESULTS

In the fall of 2019, 522 APIC members from 101 of 113 APIC chapters (89% chapter response rate) participated in the survey. A vacant IP position was reported by 25% (n = 126) of respondents. Recent IP hires were primarily nurses (70%; n = 346) recruited from outside the organization (54%; n = 270). Online job-boards (eg, Indeed and Monster) and internal organizational job postings were the most frequently used recruitment strategies.

CONCLUSIONS

The results provide a summary of practices for IP recruitment and hiring that can inform local and national initiatives to increase the number and professional diversity of IPs.

A strategy for expanding infection prevention resources to support organizational growth

BACKGROUND

The field of infection prevention is rapidly evolving and becoming increasingly complex, as resource-intensive responses to device-associated outbreaks, global epidemics, and regulatory requirements continue to grow. This increasing complexity coupled with changing health care systems present important challenges to infection prevention staffing and resources. We describe the development of a novel infection prevention and control (IPC) staffing structure that includes both infection preventionists (IPs) and role-specific support staff to meet the evolving IPC needs and challenges of an expanding health care network.

METHODS

The IPC department at Children's Hospital of Philadelphia underwent iterative modifications to its staffing structure between 2014 and 2018, including the development of revised job descriptions and promotional criteria, career ladders, and supporting roles. Data on key infection prevention activities, including rounding frequency and performance of audits and observations, growth metrics and infection data was evaluated for trends before and after departmental restructuring. An overall health care associated infection (HAI) index was calculated based on existing surveillance data and used to monitor patient outcomes over time. In addition, departmental employee engagement was assessed via a standard survey instrument to evaluate improvements in teamwork and professional growth opportunities over time.

RESULTS

Between 2014 and 2018, the number of unique job descriptions for IPs and support staff increased from 4 to 9, creating a 3-tier career ladder for IPs and increasing full time equivalents from 8.2 to 11.6. Additional support roles included a Hand Hygiene Program Manager, Infection Prevention Associates and a Clinical Practice Analyst; these roles, along with increased IP staffing, expanded the education and consultative range of the department, as measured by a 33% increase in environmental rounding and a 7-fold increase in performance of isolation audits. Team diversity also expanded, changing from a team with predominantly nursing backgrounds, to one with an equal distribution of nursing, public health, and laboratory scientists. Results from serial engagement surveys showed an increase in teamwork and professional growth by 7.4% and 5.4%, respectively. Over this time period, the total HAI index decreased by 23%, while patient days, central line days, and ventilator days increased each year, and there was a statistically significant reduction in rates of harm across 5 key HAI indicators.

CONCLUSIONS

Role diversity and varying professional backgrounds within IPC programs offer a complement of strengths and increase capacity to support patient care activities, improving patient outcomes. This strategy leads to a more cost-effective, robust IPC program that supports the growing needs and evolving challenges of the field.

Development of a competency profile for professionals involved in infectious disease preparedness and response in the air transport public health sector

BACKGROUND

Recent infectious disease outbreaks highlight the importance of competent professionals with expertise on public health preparedness and response at airports. The availability of a competency profile for this workforce supports efficient education and training. Although competency profiles for infectious disease control professionals are available, none addresses the complex airport environment. Therefore, the main aim of this study is to develop a competency profile for professionals involved in infectious disease preparedness and response at airports in order to stimulate and direct further education and training.

METHODS

We developed the competency profile through the following steps: 1) extraction of competencies from relevant literature, 2) assessment of the profile in a national RAND modified Delphi study with an interdisciplinary expert group (n = 9) and 3) assessment of the profile in an international RAND modified Delphi study with an airport infectious disease management panel of ten European countries (n = 10).

RESULTS

We systematically studied two competency profiles on infectious disease control and three air transport guidelines on event management, and extracted 61 relevant competencies for airports. The two RAND modified Delphi procedures further refined the profile, mainly by specifying a competency's target group, the organizational level it should be present on, and the exact actions that should be mastered. The final profile, consisting of 59 competencies, covers the whole process from infectious disease preparedness, through the response phase and the recovery at airports.

CONCLUSION

We designed a profile to support training and exercising the multidisciplinary group of professionals in infectious disease management in the airport setting, and which is ready for use in practice. The many adaptations and adjustments that were needed to develop this profile out of existing profiles and air transport guidelines suggest that other setting-specific profiles in infectious disease control are desirable.

Nurses as antimicrobial stewards: Recognition, confidence, and organizational factors across nine hospitals

BACKGROUND

There are national calls to engage nurses as antimicrobial stewards, but it is unknown how patient safety culture influences nurses' antimicrobial stewardship (AS) involvement.

METHODS

Cross-sectional survey to determine bedside nurses' recognition and performance confidence in AS. Nine hospitals ranged in size from 42 to 562 beds serving pediatric and adult populations in 2 different metropolitan areas. Composite scores for nursing practices, performance confidence, and organizational factors were developed and correlated. Analysis of variance (ANOVA) with Tukey HSD post-hoc tests and nonparametric (Kruskal-Wallis) tests with Bonferroni adjusted P values for multiple comparisons were used to evaluate differences by clinical unit and years of clinical experience. Free text comments were categorized by theme.

RESULTS

A total of 558 nurses participated (13% response rate). A significant positive association r_s = 0.454, P < .001 was found between nurses' beliefs about nursing practices that contribute to AS processes and their confidence to perform. Ninety one nurses provided comments with 50 statements indicating the primary barrier to stewardship were organizational factors including perceived lack of a safety culture.

CONCLUSIONS

Nurses identified a professional role in AS processes, though safety culture inhibited their involvement. These findings can help enhance the inclusion of nurses in AS efforts.

Value of certification in infection prevention and control

The Certification Board of Infection Control and Epidemiology conducted a marketing research study to determine the perceived value of the certification in infection prevention and control among infection prevention professionals and other stakeholders. Four thematic categories were identified: certification process and standards; professionalism, competency, and career growth; patient care, safety, infection prevention and control; and regulatory compliance. Respondents stated that certification demonstrated professional competency, increased career growth, improved regulatory compliance, was important in influencing legislation, and improved the practice of infection prevention and control. Opportunities were to reevaluate eligibility criteria and examination difficulty; demonstrate how certification increases financial compensation and organizational recognition; and offer recertification through continuing education based on the study findings, strategic recommendations and next steps were incorporated into the strategic plan. This article is an overview and summarizes the study findings.

Urine lipoarabinomannan (LAM) and antimicrobial usage in seriously-ill HIV-infected patients with sputum smear-negative pulmonary tuberculosis

Background

Based on current WHO guidelines, hospitalized tuberculosis (TB) and HIV co-infected patients with CD4 count <100 cells/mm³ who are urine lipoarabinomannan (LAM) positive should be initiated on TB treatment. This recommendation is conditional, and data are limited in sputum smear-negative patients from TB endemic countries where the LAM test is largely inaccessible. Other potential benefits of LAM, including reduction in antibiotic usage have, hitherto, not been explored.

Methods

We consecutively enrolled newly-admitted seriously-ill HIV-infected patients (n=187) with suspected TB from three hospitals in KwaZulu-Natal, South Africa. All patients were empirically treated for TB as per the WHO 2007 smear-negative TB algorithm (patients untreated for TB were not recruited). Bio-banked urine, donated prior to anti-TB treatment, was tested for TB-infection using a commercially available LAM-ELISA test. TB sputum and blood cultures were performed.

Results

Data from 156 patients containing CD4 count, urine-LAM, sputum and blood culture results were analysed. Mean age was 37 years, median CD4-count was 75 cells/mm³ [interquartile range (IQR), 34-169 cells/mm³], 54/156 (34.6%) were sputum culture-positive, 12/54 (22.2%) blood-culture positive, and 53/156 (34.0%) LAM-positive. Thus, LAM sensitivity was 55.6% (30/54). The study design did not allow for calculation of specificity. Urine-LAM positivity was associated with low CD4 count (P=0.002). Ninety-point-six percent (48/53) of LAM-positive patients received antibiotics [15/48 (31.3%), 23/48 (47.9%) and 10/48 (20.8%) received one, two or three different antibiotics respectively], while the duration of antibiotic therapy was more than 5 days in 26 of 46 (56.5%) patients.

Conclusions

Urine LAM testing in sputum smear-negative severely-ill hospitalized patients with TB-HIV co-infection and advanced immunosuppression, offered an immediate rule-in diagnosis in one-third of empirically treated patients. Moreover, LAM, by providing a rapid alternative diagnosis, could potentially reduce antibiotic overusage in such patients thereby reducing health-care costs and facilitating antibiotic stewardship.

Switching from expectorated to induced sputum cultures for tuberculosis diagnosis reduces cost without increasing risk

Active pulmonary tuberculosis testing with 3 expectorated sputa can increase isolation days and expenditures compared with 1 induced sputum. Six-month retrospective and prospective chart reviews were conducted, and a screening algorithm was phased into 2 hospital sites. With induced sputum testing, isolation decreased from 7 to 4 days (interquartile range, 4-3, P = .0135), and there was a cost savings of $7,275 per case, with no added harm.

International responses to the 2015 APIC MegaSurvey

The prevention of health care-associated infections is an international concern. Infection preventionists across the world play a key role in assessing, planning, implementing, and evaluating infection control policies. In 2015, the APIC launched the MegaSurvey to establish the state of the infection preventionist workforce. This brief report will describe and compare responses from the United States, Canada, and "other" countries to establish a professional baseline and set an agenda for future international collaborations.

Dissemination and implementation science for infection prevention: A primer

Dissemination and implementation science (D&I) is a rapidly growing area of investigation. Although many evidence-based guidelines for infection prevention are available, not all are systematically implemented into clinical practice. This evidence-to-practice gap has been linked to poor health outcomes. D&I science bridges the gap between research and everyday practice by providing a knowledge base about how health information, interventions, and new clinical practices and policies are translated for use in specific settings. D&I science can expedite and sustain the successful integration of evidence into practice to improve care delivery, population health, and health outcomes. This article offers an introductory overview of D&I and addresses issues such as variation in terminology, finding and appraising evidence, theories and models, implementation strategies, and the future of D&I. Examples from the infection prevention literature are presented throughout.

Impact of infectious exposures and outbreaks on nurse and infection preventionist workload

BACKGROUND

Staff nurse and infection preventionist (IP) workload increases in response to exposures and outbreaks. Understanding the time burden associated with responding to specific pathogens may improve resource allocation. The purpose of this study was to evaluate workload increases reported by nurses and IPs in response to common exposures and outbreaks.

METHODS

Surveys were distributed to nurses in a New York hospital network and to IPs who attended the 2018 Association for Professionals in Infection Control and Epidemiology annual conference or to IPs who were members of local Association for Professionals in Infection Control and Epidemiology chapters. Respondents were asked to rate their daily workload increase and to rank their most time-consuming activities in response to exposure and outbreak scenarios.

RESULTS

A total of 150 nurses and 228 IPs responded. Among the nurses, >60-minute workload increases were reported for Clostridium difficile (76%), lice or scabies (46%), and influenza (45%). Among the IPs, >60-minute increases were reported for mumps or measles (66%), tuberculosis (64%), and C difficile (50%). Among the nurses, isolation precautions, patient and family education, and staffing changes were the most frequently reported time-consuming activities. Among the IPs, chart review, exposure list compiling, and preventive measures for exposures were the most frequently reported time-consuming activities.

CONCLUSIONS

Organisms that are easier to treat and more difficult to spread, such as scabies or lice, can contribute substantially to nursing workload. Notably, three-quarters of the nurses and one-half of the IPs reported that C difficile adds >1 hour to their daily workload.

Skills for generalist and specialist nurses working in the prevention and control of infections in Brazil

Objective

to define the competencies for the prevention and control of healthcare-related infections that should be developed by the generalist nurse and the specialist nurse in infection control in Brazil.

Method

the Delphi technique, developed in four rounds, was used. Thirty-one nurses and eight physicians participated in the study, with expertise in infection prevention and control. Data were collected using open-ended questionnaires, whose answers were treated using the content analysis technique. Structured instruments were used to evaluate the importance of each competency using a Likert scale. Data were analyzed and presented in a descriptive way, use of median and coefficient of variation.

Results

the competences were organized in 4 core, 14 generic and 17 specific, with name and description of each competency.

Conclusion

the definition of competencies for the prevention and control of healthcare-related infections is the first step to begin the rethinking of the teaching and learning process in the initial training of nurses. The data found in the present study may help to restructure education and support permanent education programs in health.

The master of public health graduate as infection preventionist:Navigating the changing landscape of infection prevention

Infection prevention is a rapidly changing field with regulatory requirements and emerging global public health threats. Infection preventionists (IPs) must use advanced epidemiologic skills for health care-associated infection investigation and prevention. A potential talent pool for IPs is the Master of Public Health graduate. Those hiring IPs should consider master of public health graduates as candidates who can help drive the future of this profession.

Infection preventionists' challenges in psychiatric clinical settings

BACKGROUND

Infection preventionists (IPs) play an important role in preventing health care-associated infections in a health care system. However, the limitations of the clinical setting and the unique characteristics of psychiatric patients could be barriers to effective infection prevention. The purpose of this study was to understand how IPs perceived their challenges and how these challenges negatively affect their infection prevention work in psychiatric clinical settings.

METHODS

A descriptive, qualitative research approach was used in this study. Thirteen Taiwanese psychiatric IPs were interviewed in semistructured interviews. Data were transcribed and then analyzed by thematic analysis.

RESULTS

This analysis identified 6 themes: (1) lack of preservice training in psychiatric infection control, (2) insufficient staffing in practice, (3) working within environmental limits, (4) patient noncompliance, (5) undervaluation of the importance of infection control by professionals, and (6) involvement of hospital administrators.

CONCLUSIONS

The implementation of effective infection prevention in psychiatric clinical settings may be strongly related to the factors of sufficient training and IP staffing while relying on collaboration among patients and clinical professionals and on the full support of administrators.

The success of strategic planning in health care organizations of Iran

Purpose Although strategic planning promised to boost organizational performance, many health care managers found it difficult to implement it successfully. The purpose of this paper is to investigate the success of strategic planning in health care organizations of Iran. Design/methodology/approach This descriptive and cross-sectional study was conducted in 2016 using a valid and reliable questionnaire completed by 99 health care managers in Tehran province, Iran. Findings Strategic planning was positively related to organizational performance including employees' and patients' satisfaction and organizational productivity. However, strategic planning was moderately successful in enhancing organizational performance of Iranian health care organizations (score of 2.84 out of 5). The most and least success was observed in the planning and employee management constructs of organizational performance. Process management, organizational culture and customer management constructs had the most effect on the success of strategic plans in health care organizations. Practical implications Strategic planning is effective and provides a clear focused direction for health care organizations. Understanding the success factors of strategic planning would enable managers to develop more effective methods for developing, implementing and evaluating strategic plans in health care organizations. Originality/value This paper highlights the relationship between strategic planning and organizational performance and offers suggestions on how to develop and implement strategic plans to achieve higher organizational performance.

Creation of a competency-based professional development program for infection preventionists guided by the APIC Competency Model: steps in the process

BACKGROUND

Infection Preventionists have varying levels of educational preparation. Many have no prior experience in IP. The diversity makes design of professional development programs challenging. Recent surveys suggest that only about half of practicing IPs are board certified. There is an urgent need to employ competent IP's to drive improvement in patient outcomes.

METHODS

This is a project that utilized the APIC Competency Model to create a professional development program characterizing three career stages. Methods included a review of literature on professional development; a survey of IP competence; an assessment of job descriptions and performance evaluations; and a crosswalk of IP competencies.

RESULTS

The professional development program includes competency - based IP job descriptions and performance evaluations for each career stage; a professional portfolio; and a toolkit for supervisors.

DISCUSSION

Participants agreed that application of the model resulted in tools which are more closely aligned with current roles for IPs; and increased satisfaction and motivation with the new program.

CONCLUSION

Competent and knowledgeable IP's are crucial to optimizing efficacy of IPC programs. A professional development program has the potential to guide staff orientation, improve satisfaction and retention, improve patient outcomes and promote a positive trajectory in advancing practice.

Factors affecting strategic plan implementation using interpretive structural modeling (ISM)

Purpose Strategic planning is the best tool for managers seeking an informed presence and participation in the market without surrendering to changes. Strategic planning enables managers to achieve their organizational goals and objectives. Hospital goals, such as improving service quality and increasing patient satisfaction cannot be achieved if agreed strategies are not implemented. The purpose of this paper is to investigate the factors affecting strategic plan implementation in one teaching hospital using interpretive structural modeling (ISM). Design/methodology/approach The authors used a descriptive study involving experts and senior managers; 16 were selected as the study sample using a purposive sampling method. Data were collected using a questionnaire designed and prepared based on previous studies. Data were analyzed using ISM. Findings Five main factors affected strategic plan implementation. Although all five variables and factors are top level, "senior manager awareness and participation in the strategic planning process" and "creating and maintaining team participation in the strategic planning process" had maximum drive power. "Organizational structure effects on the strategic planning process" and "Organizational culture effects on the strategic planning process" had maximum dependence power. Practical implications Identifying factors affecting strategic plan implementation is a basis for healthcare quality improvement by analyzing the relationship among factors and overcoming the barriers. Originality/value The authors used ISM to analyze the relationship between factors affecting strategic plan implementation.

Revisiting the Association for Professionals in Infection Control and Epidemiology Competency Model for the Infection Preventionist: An evolving conceptual framework

This article reviews 2 models of skill acquisition, 1 from nursing and the other from aviation, and compares them to the Association for Professionals in Infection Control and Epidemiology Competency Model for the Infection Preventionist (IP). The authors explore the mental activity associated with competence and provide usable examples for IPs to further assess their own competence, and competence of IPs in their charge. This was done for the purpose of advancing and expanding upon the career stages within the field of infection prevention. Further, we suggest a mechanism for expansion of the current Association for Professionals in Infection Control and Epidemiology Competency Model for the IP, as well as explore career stages and the evolution of professional practice self-assessment and recertification. The authors believe an expansion would better match the needs of current and future IPs in terms of career development and competency.

Factors affecting annual compensation and professional development support for infection preventionists: Implications for recruitment and retention

BACKGROUND

Factors affecting annual compensation and professional development support have been studied for various healthcare professions. However, there is little understanding of these factors for infection preventionists (IPs).

METHODS

Using secondary data from the Association for Professionals in Infection Control and Epidemiology 2015 MegaSurvey, we designed a descriptive, correlational study to describe IP annual compensation and professional development support. We tested for associations between demographic variables and annual compensation and investigated for predictors of higher annual compensation.

RESULTS

Median salary for IPs was $75,000. IPs who indicated that their compensation was based on industry benchmarks reported a median salary of $85,000 (P < .001). IPs with advanced degrees reported a median salary of $90,000. IPs with bachelor's degrees or lower reported a median salary of $50,000 (P < .001). IPs with CIC® reported a median salary of $85,000. IPs without CIC® reported a median salary of $65,000 (P < .001).

CONCLUSION

This study can be used to develop recruitment and retention guidelines that lead to a well-educated, well-compensated, and competent IP workforce.

Predictors of certification in infection prevention and control among infection preventionists: APIC MegaSurvey findings

BACKGROUND

The 2015 APIC MegaSurvey was completed by 4,078 members to assess infection prevention practices. This study's purpose was to examine MegaSurvey results to relate infection preventionist (IP) certification status with demographic characteristics, organizational structure, compensation benefits, and practice and competency factors.

METHODS

Descriptive statistics were used to examine population characteristics and certification status. Bivariate logistic regression was performed to evaluate relationships between independent variables and certification status. Variables demonstrating statistical significance (P <.05) were included in multivariable logistic regression analyses.

RESULTS

Forty-seven percent of survey respondents had their CIC. IPs were less likely certified if their educational attainment was less than a bachelor's degree, they were aged 18-45 years, they worked in rural facilities, they had <16 years' experience in health care before becoming an IP, and the percentage of job dedicated to infection prevention was <75%. However, certification was associated with CIC benefit paid fully by employer, self-rating as proficient and expert-advanced, and surveillance and epidemiologic investigation competency obtained via professional development and training.

CONCLUSIONS

CIC attainment was associated with IP characteristics. Additional research should focus on identifying strategies to increase certification among noncertified IPs because CIC is a measure of proficiency that should be a goal for all IPs.

Health care system leaders' perspectives on infection preventionist and registered nurse engagement in antibiotic stewardship

BACKGROUND

Infection preventionists (IPs) and registered nurses (RNs) have an important role to play in antibiotic stewardship programs (ASPs). Recent articles highlight their potential roles in practice, research, education, and policy; however, little is known about their actual ASP engagement. Leaders often have early knowledge of emerging trends and evolving health care worker roles.

METHODS

A survey was developed using the Centers for Disease Control and Prevention's Core Elements of Hospital Antibiotic Stewardship Programs to assess health care system infection prevention and control leaders' perceptions of IP and RN engagement in hospital ASPs.

RESULTS

Thirty-five leaders representing all regions of the United States completed the survey. Their organizations tended to have significant ASP leadership support, but lacked ASP policies indicating IP and RN roles and responsibilities. IPs were more likely than RNs to be members of the ASP team and have greater ASP knowledge. Neither discipline was conducting patient education related to proper use of antibiotics, but this was identified as a future ASP role. The 2017 Joint Commission Antimicrobial Stewardship Standard was accelerating ASP implementation.

CONCLUSIONS

IPs and RNs are well-positioned to assume greater roles in ASPs, especially in educating patients about the safe and proper use of antibiotics. However, their roles must be clearly identified, defined, and quantified. In so doing, knowledge and skill gaps can be identified and specific educational programs developed to advance their successful engagement in ASPs.

Promoting appropriate urine culture management to improve health care outcomes and the accuracy of catheter-associated urinary tract infections

Published literature indicates that the unjustified ordering or improper collection of urine for urinalysis or culture from either catheterized patients or those without indwelling devices, or misinterpretation of positive results, often leads to adverse health care events, including increased financial burdens, overreporting of mandated catheter-associated urinary tract infection events, overtreatment of patients with antimicrobial agents, selection of multidrug-resistant organisms, and Clostridium difficile infection. Moreover, national guidelines that provide evidence-based direction on core processes that form the basis for subsequent clinical therapy decisions or surveillance interpretations; that is, the appropriate ordering and collection of urine for laboratory testing and the treatment of patients with symptomatic urinary tract infection, are not widely known or lack adherence. This article provides published evidence on the influence of inappropriate ordering of urine specimens and subsequent treatment of asymptomatic bacteriuria and associated adverse effects; reviews research on bacterial contamination and preservation; and delineates best practices in the collection, handling, and testing of urine specimens for culture or for biochemical analysis in both catheterized and noncatheterized patients. The goal is to provide infection preventionists (IPs) with a cohesive evidence-based framework that will assist them in facilitating the implementation of a urine culture management program that reduces patient harms, enhances the accuracy of catheter-associated urinary tract infection surveillance, improves antibiotic stewardship, and reduces costs.

The Project Protect Infection Prevention Fellowship: A model for advancing infection prevention competency, quality improvement, and patient safety

BACKGROUND

The Centers for Disease Control and Prevention 2016 Healthcare-Associated Infections (HAI) Progress Report documented no change in catheter-associated urinary tract infections (CAUTIs) between 2009 and 2014. There is a need for investment in additional efforts to reduce HAIs, specifically CAUTI. Quality improvement fellowships are 1 approach to expand the capacity of dedicated leaders and infection prevention champions.

METHODS

The fellowship used a model that expanded collaboration among disciplines and focused on partnership by recruiting a diverse cohort of fellows and by providing 1-on-1 mentoring to enhance leadership development. The curriculum supported the Association for Professionals in Infection Control and Prevention Competency Model in 2 domains: leadership and performance improvement and implementation science.

RESULTS

The fellowship was successful. The fellows and mentors had self-reported high level of satisfaction, fellows' knowledge increased, and they demonstrated leadership, quality improvement, and implementation science competency within the completed capstone projects.

CONCLUSIONS

A model encompassing diverse educational topics, discussions, workshops, and mentorship can serve as a template for developing infection prevention champions. Although this project focused on CAUTI, this template can be used in a variety of settings and applied to a range of other HAIs and performance improvement projects.

Pharmacist perceptions of competency: Identifying priority areas for a competency program development at an academic medical center

BACKGROUND

Competency-based education models can serve as valuable resources for providing quality continuing education and professional development in healthcare. However, competency development programs can be stifled by scarce stakeholder involvement and insufficient recognition of resource challenges. Engaging pharmacists in program development can inform program design and prioritization of needs.

OBJECTIVE

To describe a process to assess pharmacist perceptions about competency development and to inform program design by identifying high priority topic areas based on perceived value, confidence in abilities, and frequency of use by pharmacists.

METHODS

Pharmacists at a large academic medical center were surveyed to examine opinions regarding competency development and identify perceived departmental value, personal confidence, and frequency of use for nine competency topic areas. Responses were aggregated to create scores for each of the three criteria related to the nine topics. Priority areas were topics with the highest relative scores in perceived value and frequency of use and lowest relative scores in confidence compared to the other areas.

RESULTS

Survey responses were collected from 105 pharmacists (78.9% response rate). A majority indicated that competency assessment is a shared responsibility between the organization and individual pharmacists. Therapeutic knowledge was identified as the competency requiring the most immediate attention as it was perceived to have the highest departmental value and highest frequency of use, yet participants indicated low confidence regarding the topic.

CONCLUSIONS

Competency development is a critical aspect of ensuring pharmacists are prepared for the rapidly evolving needs of the healthcare system. Organizations play an important role in identifying and developing pharmacist competencies aligned with institutional and individual needs. This study suggests that pharmacists and leaders at an academic medical center identified a shared responsibility for competency development. The process described here may provide a model for other medical centers with similar competency development needs.

Building a Successful Infection Prevention Program: Key Components, Processes, and Economics

Infection control is the discipline responsible for preventing health care-associated infections (HAIs) and has grown from an anonymous field, to a highly visible, multidisciplinary field of incredible importance. There has been increasing focus on prevention rather than control of HAIs. Infection prevention programs (IPPs) have enormous scope that spans multiple disciplines. Infection control and the prevention and elimination of HAIs can no longer be compartmentalized. This article discusses the structure and responsibilities of an IPP, the regulatory pressures and opportunities that these programs face, and how to build and manage a successful program.

Infection prevention workforce: Potential benefits to educational diversity

BACKGROUND

Nurses have historically occupied the infection preventionist (IP) role. As the knowledge and skills needed to advance the field expand, professionals from public health and the laboratory sciences have become IPs. Our study describes the characteristics of current IPs and assesses for relationships between background, certification, experience, and type of work performed.

METHODS

The data were drawn from an existing dataset collected in the conduct of the Association for Professionals in Infection Control and Epidemiology (APIC) MegaSurvey. Descriptive statistics were computed. Associations were calculated using χ² or Cochran-Mantel-Haenszel tests. Characteristics of IPs were stratified by work-related activities to allow for comparisons between groups.

RESULTS

Of the 13,050 active APIC members, 4,079 participated in the survey (31% response rate). The primary job activity for nurses (97.9%; n = 2,434) was preventing and controlling the transmission of infectious agents or health care-associated infections, for laboratory scientists (97.5%; n = 307) it was the interpretation of surveillance data, and for public health professionals (96.1%; n = 136) it was management and communication: feedback.

CONCLUSIONS

Infection control departments would benefit from hiring IPs with diverse education and training to address the expanding roles and responsibilities of IPs. This may facilitate the implementation of novel and innovative processes that will impact patient care.

Understanding the current state of infection preventionists through competency, role, and activity self-assessment

BACKGROUND

The Association for Professionals in Infection Control and Epidemiology (APIC) MegaSurvey, administered in 2015, was completed by approximately 4,079 APIC members. The survey sought to gain a better understanding the current state of 4 components of infection prevention practice: demographic characteristics, compensation, organizational structure, and practice and competency.

METHODS

The data for this analysis come from the APIC MegaSurvey Practice and Competency domain. Descriptive statistics and χ² analyses were conducted to examine differences in infection preventionist (IP) competency, roles, and activity self-assessments.

RESULTS

The majority of IPs self-assessed their competency as Proficient compared with Novice or Expert for each of the 8 IP core competency activities. Forty percent of IPs self-rated their competency as Expert in the Preventing/Controlling the Transmission of Infectious Agents/HAIs component. IPs reported Novice competency in Employee/Occupational Health (29%); Cleaning, Sterilization, Disinfection, and Asepsis (23%); and Education and Research categories (22%). Differences in self-rated competency among IPs by discipline type (public health, nurse, and laboratory) were identified.

CONCLUSIONS

Differences in self-rated competency were identified for each of the 8 IP core competency activities. IPs report using various resource types to gain competency. Future research is needed to identify opportunities to increase competency levels in the weakest-rated competency activities.

APIC MegaSurvey: Methodology and overview

BACKGROUND

Infection preventionists (IPs) play key roles in preventing health care-associated infections and ensuring quality of care. To develop strategies to support comprehensive infection prevention practice, it is critical to understand key aspects of their practice.

METHODS

A task force of expert IPs, staff representatives from the Association for Professionals in Infection Control and Epidemiology (APIC), and survey designers developed and pilot tested a survey addressing 4 components of infection prevention practice: demographic characteristics, compensation, organizational structure, and practice and competency.

RESULTS

During mid- to late-2015, 4,078 APIC members (response rate 31%) participated in the study. Results indicated that all of the practice domains of the APIC Competency Model for the Infection Preventionist were rated as "important" or "very important" to supervisors or managers of IPs. Surveillance and investigation accounted for the most time in an IPs typical day, followed by prevention and control of transmission, identification of infection, and management and communication.

DISCUSSION

Future analyses will examine the validity of the APIC Competency Model for the Infection Preventionist; factors related to professional development, including addressing the needs of IPs who may be ready for certification; and current compensation of IPs.

CONCLUSIONS

The results of the APIC MegaSurvey can be used to guide development of programs and initiatives for the future of infection prevention.

Exploring the context for effective clinical governance in infection control

BACKGROUND

Effective clinical governance is necessary to support improvements in infection control. Historically, the focus has been on ensuring that infection control practice and policy is based on evidence, and that there is use of surveillance and auditing for self-regulation and performance feedback. There has been less exploration of how contextual and organizational factors mediate an infection preventionists (IP's) ability to engage with evidence-based practice and enact good clinical governance.

METHODS

A cross sectional Web-based survey of IPs in Australia and New Zealand was undertaken. Questions focused on engagement in evidence-based practice and perceptions about the context, culture, and leadership within the infection control team and organization. Responses were mapped against dimensions of Scally and Donaldson's clinical governance framework.

RESULTS

Three hundred surveys were returned. IPs appear well equipped at an individual level to undertake evidence-based practice. The most serious set of perceived challenges to good clinical governance related to a lack of leadership or active resistance to infection control within the organization. Additional challenges included lack of information technology solutions and poor access to specialist expertise and financial resources.

CONCLUSIONS

Focusing on strengthening contextual factors at the organizational level that otherwise undermine capacity to implement evidence-based practice is key to sustaining current infection control successes and promoting further practice improvements.

Korean infection control nurses' knowledge and awareness of infection control against Ebola virus disease

AIM

To assess the level of knowledge and awareness of Ebola virus disease infection control among infection control nurses and to identify a correlation between these factors.

METHODS

The data were collected from 125 infection control nurses by using a self-report questionnaire. The data were collected on sociodemographic and hospital characteristics, as well as the level of knowledge and awareness of Ebola virus disease infection control.

RESULTS

The respondents' mean level of knowledge (correct-answer rate) was 87.7% and their mean level of awareness was 3.86 (1 = "not important at all" to 4 = "very important"). Knowledge of Ebola virus disease infection control was significantly higher among those nurses who had received some Ebola virus disease education. There was a significant positive correlation between the level of knowledge and the level of awareness.

CONCLUSION

The development of effective education and training systems is necessary to improve infection control nurses' knowledge and awareness of Ebola virus disease infection control. Moreover, each hospital should build effective and systematic Ebola virus disease infection control strategies.

APIC professional and practice standards

Professional and practice standards for IPs have existed since 2008. The expanding, evolving, and increasingly critical role of the profession demanded they be updated. The standards emphasize flexibility and applicability across a multitude of domains and settings and provide the profession with a rigorous, well-defined set of expectations, competencies, and practices. The result is a succinct set of precepts that encapsulates the field of IPC in the present and foreseeable future.