Healthcare facilities across the country, including clinics and hospitals, have been prioritizing infection prevention in recent years. Outbreaks from healthcare-associated infections (HAIs) not only extend the time a patient spends in treatment but can also have deadly consequences. The Centers for Disease Control and Prevention report about 72,000 deaths per year from HAIs. The risks aren’t limited to patient safety either – providers must also weigh the financial implications of HAI spread. The annual costs of healthcare-associated infections is in excess of $9.5 billion in the United States alone. By combatting HAIs, clinicians not only save lives and improve patient outcomes but also work to lower costs for all stakeholders involved, including the patient.
It is common practice for hospitals and larger clinics to have infection prevention teams charged with overseeing the implementation and adherence to infection control protocols. But an infection preventionist (IP) shouldn’t be viewed as an enforcer, but rather as an educator. The most effective infection prevention and control is carried out in facilities where a culture of infection control has been created. In facilities where infection control is seen as only the duty of the IP, administrators may face the challenge of having a medical staff which is unaware of their important role in the process. Each clinician and staff member has the opportunity to have a positive impact on patient safety. Part of the responsibility of an infection preventionist should be to inform all stakeholders in the facility of their role and how best they can keep patients safe.
As facilities expand then so must the infection prevention team. Larger facilities, such as hospitals, must ensure that their IP team grows in line with their organization. This is not simply a matter of numbers, but also of roles and backgrounds. Hospitals experiencing rapid growth should ensure that their IP team has the necessary numbers and skill sets to combat the increased risks associated with expansion. Failing to do so can inadvertently leave the IP team and the facility’s infection control priorities behind as the rest of the organization grows.
In a recently published study in the American Journal of Infection Control, researchers from the Children’s Hospital of Philadelphia (CHOP) measured the impact which expanding the facility’s infection prevention team had on their fight against healthcare-associated infections. CHOP administrators answered unprecedented expansion needs by revitalizing their IP team. The hospital increased the number of infection preventionists on staff to be in line with the growth they were experiencing and worked to ensure the team had a diversified background.
The researchers noted how the role of the infection preventionist has grown in recent years. This is due in part to state and federal regulations regarding HAI reporting. It is also due to the increased role of the IP as a frontline responder to public health emergencies.
“In addition, IPs have a more prominent role as frontline responders to public health emergencies related to both emerging and re-emerging infectious diseases, such as pandemic H1N1 influenza, Ebola virus disease, outbreaks of vaccine-preventable diseases (eg, measles) and rising antimicrobial resistance,” the authors wrote. “Furthermore, device-related outbreaks, such as those associated with contaminated heater-cooler units and duodenoscopes, require prompt investigation and resource-intensive responses. The latter have underscored the need for enhanced infection prevention and control (IPC) oversight and increased regulatory scrutiny of high-level disinfection and sterilization programs.”
To ensure that the IP team was diversified, CHOP created a 3-tier career ladder and drew equally from public health, nursing, and laboratory scientist backgrounds. In addition, they adopted a framework developed by the Association for Professionals in Infection Prevention and Epidemiology (APIC) that recognizes novice, proficient, and expert infection preventionists. CHOP’s career ladder for infection prevention consists of Infection Preventionist I, Infection Preventionist II, and Senior Infection Preventionist. The hospital grew their infection prevention staff from 4 to 9 and added multiple support roles, including hand hygiene program manager, infection prevention associate, and a clinical practice analyst. Changes such as these expanded the educational and consultative variety within the team and resulted in a 33% increase in environmental rounding as well as a seven-fold increase in performance of isolation audits.
“The core strategies we chose to implement were to increase staffing due to organization growth, create career ladders to recruit and retain talented IPs and to add cost-efficient supporting team roles. These strategies will allow our team to keep pace with the rapid expansion of our organization and growing complexity of the field, while continuing to promote safer patient outcomes,” noted the researchers.
Moreover, investigators developed an algorithm with the hospital for five key healthcare-associated infections. These included central line associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator associated pneumonia (VAP), and healthcare-associated viral infections. At the conclusion of the four-year study, researchers found that there was a statistically significant reduction in rates of harm across all five key infections – a 23% decrease of HAIs from 2014 to 2018.
Furthermore, the Children’s Hospital of Philadelphia’s addition of supporting roles may provide a model for other infection control teams. Their novel approach added positions which can serve as entry-level roles for future infection preventionists. At the same time, these new positions provide cost-effective support for the needs of the program, thereby increasing the infection prevention team’s effectiveness while keeping costs in check. The authors noted, “Diversifying roles and creating support staff benefits the team by increasing the productivity of the department and providing a deeper bench so that IPs can focus on broader activities requiring specific subject matter expertise.”
Overall, this study points to how diversifying infection prevention teams and allowing IPs to make greater use of their subject matter expertise can not only be cost-efficient but also conducive to increased patient safety and more effective infection control programs in the long run.
