Credentialing, diversity, and professional recognition-foundations for an Australian infection control career path

Credentialling in Australia for infection prevention and control: Philosophy, principles and practice

Infection prevention and control programs are vital to ensuring the health and wellbeing of healthcare consumers and staff. Infection control professionals who lead these programs are uniquely positioned with the knowledge, skills and attributes to direct effective infection control practices and policies within their healthcare setting. As with many specialisations, these individuals may choose to undertake a credentialling process, where their expertise and competence are evaluated and formally recognised by a professional body. Globally, there is growing evidence that credentialling improves the standard of practice of infection control professionals, and achieves beneficial outcomes for staff, patients and the broader healthcare systems in which they operate. In Australia, credentialling is a relatively new endeavour emerging in the mid 1990s with the rapidly evolving profile of the infection control professional. In this paper, we detail the history and evolution of credentialling of the infection control professionals in Australia. We also appraise the current three-tier credentialling framework, including its underlying philosophy, how it distinguishes between 'competence' and 'capability', the mechanisms it provides for career development, and its adaptation in response to critical contemporary developments in the field of infection control in Australia, including the expanding diversity of contemporary practice.

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.

Developing a model to assess optimum infection control workforce in acute care settings

BACKGROUND

Little research has been completed to assess the numbers of infection prevention and control personnel employed or optimal size and composition of infection control teams.

METHODS

Acute national health hospital organizations in England were requested to provide information about the numbers of infection prevention and control personnel employed and weekly hours contributed by each occupational group under the United Kingdom's Freedom of Information legislation. The relationship between capacity of the infection prevention and control workforce, size of the inpatient population, and routinely collected surveillance data for health care-associated infection were explored.

RESULTS

There were 137 (85%) National Health Service (NHS) hospital organizations that responded. The number of infection prevention and control nurses ranged from 1-16 per organization. A total of 46 (33.6%) reported that they received no clinical microbiology sessions, and for 11 (8%) input was inadequate. An antibiotic pharmacist was reported to be employed in 107 (78.1%) organizations. Few infection prevention and control teams reported receiving the following: 1. managerial support, 2. being represented on committees where decisions about resource allocation were made, or 3. assistance with administration.

CONCLUSION

Despite the priority that infection prevention and control have received in the United Kingdom over the last 10 years, many infection prevention and control teams appear underresourced.

Factors influencing the self-perceived practice levels of professional standard competency among infection control nurses in Korea

BACKGROUND

This study investigated the self-perceived infection control (IC) knowledge and practice levels of professional standards competency (PSC) among Korean infection control nurses (ICNs) to identify factors that may influence PSC.

METHODS

Using a self-reporting questionnaire method, we collected data from a total of 104 ICNs.

RESULTS

The average self-perceived IC knowledge level was 3.1 ± 0.8, with hand hygiene scoring the highest at 3.7 ± 0.8. The total proportion of responders who did not meet the expected standard in 4 future-oriented domains was 51.7%. Of the 4 domains, technology had the highest number of respondents meeting the desired standard (57%). There were significant differences in self-perceived levels of PSC in relation to ICN specialist certification and continuing education (eg, extra coursework, conference attendance) in the field. Self-perceived practice levels of PSC also were significantly correlated with age, years of total clinical experience, years of ICN experience, hospital bed count, and IC knowledge. Predictors of self-perceived practice levels of PSC were knowledge and years of ICN experience.

CONCLUSION

Educational programs are needed to promote knowledge and competency, the lack of which was recognized by the ICNs. Also, various efforts are needed to prevent turnover of ICNs with a high level of competency.

Incidence density and relative risk of nosocomial infection in Taiwan's Only Children's Hospital, 1999-2003

We report on 2,688 nosocomial infection episodes involving 3,238 pathogens in Taiwan's only children's hospital. The mean annual incidence density was 4.06 cases per 1,000 patient-days. The relative risk was highest in intensive care units, oncology wards, and neonatal observation wards. Very young, low-birth-weight, critically ill, and oncology patients were most at risk.

Hospital infection control in Australia

Australia is a large country divided into six states and two territories, each of which has infection control programmes. This paper looks at the organization of infection control in Australia, as well as describing the national bodies involved and recent state initiatives in infection control.

Variation in administrators' and clinicians' attitudes toward critical elements of an infection control program and the role of the infection control practitioner in New South Wales, Australia

BACKGROUND

Debate remains over the core activities of infection control (IC) programs. Differences in stakeholder opinions must be considered if consensus panel guidelines and recommendations are to be broadly applied. This article describes a survey of administrators and clinicians employed in hospitals in New South Wales, Australia. Respondents self-reported their levels of agreement with affirmative statements regarding the role of the infection control practitioner (ICP) and the essential requirements and infrastructure of IC programs.

METHOD

The study population included administrators and clinicians in each public, private, and freestanding day hospital in New South Wales. Respondents reported the intensity of their agreement with 16 affirmative statements relating to IC program infrastructure and resources and the ICP's role and responsibilities.

RESULTS

The overall response rate was 62.1% (587/945). Clinicians (349/587) and administrators (238/587) accounted for 59.5% and 40.5% of the response rate, respectively. Overall, administrators and clinicians reported greatest levels of agreement for those elements not requiring additional resources.

CONCLUSION

The extent of divergence between administrators and clinicians is not so great that it can not be resolved. Our findings demonstrate the degree of administrator support that clinicians can expect for each element. We advocate better communication between clinicians and administrators in conjunction with objective strategic planning. Our findings provide a guide for ICPs to either establish or negotiate the core components of their IC program.

Educating the infection control team - past, present and future. A British prespective

This review sets out to explore how education and training provisions for members of the Infection Control Team (ICT) have developed alongside their roles and in response to changes in the British National Health Service. It focuses on the Consultant in Communicable Disease Control, the Infection Control Doctor and the Infection Control Nurse in the United Kingdom, but also briefly considers approaches adopted by other countries. Future developments should include maximizing information technology for delivering teaching materials, shared learning and improvements to pre-registration curricula for both doctors and nurses.

Methodologies used in surveillance of surgical wound infections and bacteremia in Australian hospitals

BACKGROUND

The prevalence of nosocomial infection in Australian hospitals is estimated to be between 5.5% and 6.3%. Since 1989, infection control professionals (ICPs) in hospitals accredited by the Australian Council on Health Care Standards (ACHS) have been encouraged to collect nosocomial infection data according to ACHS methodology.

METHOD

In 1996, we surveyed members of the Australian Infection Control Association to examine the time spent on surveillance, the practice of surveillance of all hospital infections (hospital-wide surveillance), case-finding methods, case definitions, and reporting routinely used by ICPs in acute care hospitals. We also examined the ICPs' education and experience in infection control (IC).

RESULTS

The survey was completed and returned by 65% (644 of 993) of Australian Infection Control Association members. Of the ICPs who completed the survey, 47.8% (308 of 644; 95% CI, 43.9%-51.7%) met the criteria for inclusion, because they coordinated an IC program in an acute care or surgical hospital and performed surveillance for either surgical wound infection, intravascular device-related bacteremia, or non-device-related bacteremia. Of the ICPs who reported their facility's accreditation status, 93.5% participated in ACHS system. Most (97.6%) ICPs had completed hospital-based general registered nurse training. Only 1.9% (6 of 308) of ICPs reported completion of continuing education relating to hospital epidemiology. The number of years of IC experience ranged from zero to 35 years, with a median of 4 years. ICPs spent a substantial proportion of their total weekly IC time on surveillance irrespective of ACHS accreditation; 19.5 hours in ACHS hospitals and 15.6 hours in non-ACHS hospitals (P =.33). More than three quarters (76.0%) of ICPs performed hospital-wide surveillance. The case-finding methods, definitions of infections, and reporting formats varied greatly. The definition most commonly applied by ICPs (6.8%; 95% CI, 4.1%-10.4%) to define surgical wound infection was infection within 30 days after the operative procedure, plus purulent drainage, plus isolation of organisms from a culture from the incision site, plus diagnosis by a medical officer. A 5-item definition of a patient being asymptomatic, plus afebrile on admission, plus infection occurring at least 48 hours after admission, plus the patient having a fever of >38 degrees C, plus a recognized culture from one or more bottles was used by 15.7% (95% CI, 11.3%-21.0%) of ICPs to define a case of bacteremia.

CONCLUSION

Surveillance is the core business of Australian ICPs and consumes a substantial proportion of their time. The importance of surveillance, the epidemiologic limitations of the current ACHS system, and the nonstandard methods we report indicate that improved methodology is required for case finding and reporting of nosocomial infections. Australian ICPs should complete training in the principles of surveillance and epidemiology. With this training, ICPs can work collaboratively with other health care professionals to develop epidemiologically sound, local, nosocomial surveillance systems and lobby for a voluntary, national, standardized, risk-adjusted system of targeted nosocomial surveillance.