Study on Infection Prevention Programs Find Urgent Need for Increased Staffing

How many infection preventionists should hospitals employ? Hospitals spend a lot of time looking at nursing ratios for patients and ensuring enough staff are on the units, but what about the infection prevention program? There have been only a handful of studies to truly address the staffing of infection prevention and control programs (IPC) within health care facilities and as the duties become more diverse, such analyses are critical to reinforcing support.

The 2014 Ebola cluster in Dallas, Texas, underscored the importance of infection prevention practices and preparedness in health care, which adds another layer of complexities to health care programs. Infection preventionists (IPs) who make up the back-bone of these teams are responsible for a range of duties that include surveillance and investigation of health care-associated infections, environment of care rounding, national reporting for quality metrics, isolation rounding, communicable disease reporting, and more. As the threat of emerging infectious diseases and hospital preparedness has become a hot topic, this has also been added to the list of IP duties.

A previous study from 2002, found that infection control staffing was recommended as 1 full-time employee (FTE) IP for every 250 acute care beds; however, the authors recommended that should be changed to 0.8 to 1.0 IP for every 100 occupied acute care beds. Although this was a welcome update, it has become increasingly obvious to infection control program staff and their IPs, that the scope of practice is expanding.

Now, a new study sought to address this through a comprehensive quantitative needs assessment regarding the number of IPs needed to build an effective infection prevention program.

For the study, the research team evaluated a large, nonprofilt health care system that included 34 hospitals, and nearly 600 physician clinic and other outpatient services, which is divided across 9 regions. To truly understand the needs of each hospital, the investigators spent an entire day, on-site in each region to meet with key stakeholders (including those outside the infection prevention team, such as the chief nursing officer and chief medical officer), among other actions. They then compiled all data collected via survey and addressed the IPC duties at the locations that required an IP to be physically present (ie, performing isolation rounding, environment of care rounding, etc.) and its frequency.

The investigators then worked to develop a staffing model by looking at, “the total IPC FTE needs identified during the quantitative assessment [and comparing it] with the current IPC FTE status within the region. Gaps were highlighted based on care setting, and each regional team determined where and how the needed IPC resources should be applied. A model of an ideal program was created for each region based on the discussion and gaps identified.”

Following this analysis, the investigators established high and low benchmarks for IPC FTE needs based off the literature review (number of FTEs calculated using literature review of 0.5 FTE per 100 beds versus 1.0 FTE per 100 beds), and also the calculated actual FTE need using the quantitative assessment method.

For those of us in the infection prevention industry, the results weren’t surprising. The calculated FTE needs based on the quantitative assessment was seriously higher. If one considers that surveillance alone accounts for over 50% of the IP’s daily time, it’s not surprising that the needs aren’t being met. The researchers found that when aggregated across the system, a new benchmark was established: 1.0 FTE IP per 69 beds for true infection prevention oversight.

Although there is a desperate need for more research to establish adequate IP staffing in infection prevention programs, this study represents an updated model and benchmark for programs to utilize. At its core, investing in infection prevention is investing in patient and health care worker safety, something we are all striving to improve.