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

Staffing paradigm for infection prevention and control in the era of antimicrobial resistance: The Veterans Health Administration experience

Antimicrobial resistance and other emerging health care complexities continue to challenge infection prevention and control resources. The Veterans Health Administration developed a comprehensive prevention approach to address multidrug-resistant organisms (MDROs), including a unique staffing model to complement infection preventionists. In particular, the MDRO Prevention Coordinator was established to support MDRO prevention initiatives. Alternative staffing models, including to support pathogen-specific needs in an era of antimicrobial resistance, are vital for adaptable and sustainable infection prevention and control programs.

Evaluation of Certification Board of Infection Control and Epidemiology, Inc Certification in Infection Control (CIC) examination rates

BACKGROUND

Infection prevention professionals develop through training and certification practices, with the Certified in Infection Control and Epidemiology (CIC) exam being the industry standard for infection prevention and control expertise.

METHODS

This study conducted a secondary analysis of Certification Board of Infection Control and Epidemiology, Inc exam scores from 2013 to 2022. Reliability coefficients, Spearman-Brown coefficients, and Standard Error Measurement averages were calculated for the CIC exam's eight objective areas from 2016 to 2022.

RESULTS

Over the past decade, pass rates varied from 57.30% to 85.40%, with a mean of 69.7%. The number of exam participants ranged from 574 to 1,392. Despite the variability, the highest reliability, Spearman-Brown, and Standard Error Measurement averages were consistently observed in areas such as identifying infectious disease processes, surveillance, epidemiological investigation, and controlling transmission of infectious agents.

CONCLUSIONS

As more facilities push for certification, the number of CIC exam takers has increased. However, the evolving nature of infection prevention and the lack of a standardized training track contribute to variations in reliability coefficients across the exam's objective areas.

Enhancing infection preventionist certification success through a structured training program

BACKGROUND

Certification in infection control (CIC) is a standardized indicator of the knowledge and competencies essential for effective infection prevention practice. Evidence measuring success of training programs for certfication in infection control is limited.

METHODS

From 2017 through 2023, 51 novice infection preventionists (IPs) were enrolled in a training program that combined didactic learning, application of knowledge in practice, and mentorship from advanced-practice and near-peer IPs. Participants were tracked through completion of certification examination and pass rates were compared with rates for 2023 CIC candidates.

RESULTS

All participants engaged in the training program attempted the CIC examination. The training group had a pass rate of 98%. This is 27% higher than the most recent rate published by Certification Board of Infection Control and Epidemiology (CBIC) of 71%.

DISCUSSION

Participants were significantly more likely to pass the CIC exam on the first try, showing that a supported, competency-based training program can be successful in supporting novice IPs in certification success.

CONCLUSIONS

Building foundational knowledge on key concepts in infection prevention and control and enhancing learning through supervised, direct application of skills improves CIC certification exam pass rates and supports progression of early career IPs to more independent practice.

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.

Making a difference: APIC chapters introducing public health graduate students to the infection prevention profession

Health care workforce recruitment into the field of infection prevention and control (IPC) is imperative to address attrition and maintain safe patient care. Association for Professionals in Infection Control (APIC) Badger Chapter in Wisconsin strategically aligned with their state's academic master of public health program to introduce students to the IP profession and offered scholarships to Wisconsin's annual infection prevention and control conference. Four scholarships were awarded from 2021 to 2022. Student feedback of the experience was positive and resulted in 2 participants becoming employed IPs.

Ten pillars for the expansion of health system infection prevention capacity

The COVID-19 pandemic has accelerated changes in health care across the nation. Particularly, infection prevention programs have been subjected to pressures and increased responsibilities with no expansion in support. In addition, there is a rapid trend for health systems to merge to ensure long term sustainability. Based on our experience leading infection prevention at one of the largest health systems in the United States, we outline how systems can provide and increase capacity to optimize and enhance the hospital level infection prevention programs and outcomes. In this commentary, "Ten Pillars for the Expansion of Health System Infection Prevention Capacity" we offer 10 categories of what we have found to establish a successful and functioning infection prevention program. The pillars to support the infection prevention programs focus on structure, processes, empowerment, and partnerships, and the elements and strategies that comprise them.

Optimizing the Relationship Between Perioperative Personnel and Infection Preventionists to Reduce Surgical Site Infections

Prevention of surgical site infections (SSIs) is a critical aspect of ensuring positive patient outcomes. One of the challenges of SSI prevention is the communication barrier between perioperative staff members and infection preventionists (IPs), which may lead to frontline staff members who are primarily responsible for infection prevention being unaware of pertinent hospital SSI data. To overcome this challenge, IPs and perioperative staff members should develop a partnership that facilitates the sharing of feedback on SSI case review data and effective key performance indicators. A partnership also can help engage perioperative staff members in quality improvement efforts and increase collaboration with IPs. Perioperative leaders should identify effective methods to improve data transparency, SSI case reviews, audit and feedback programs, and education for perioperative team members. A strong perioperative-IP partnership and increased sharing of data in accessible formats may improve engagement and interest in SSI prevention.

State of infection prevention and control in nonacute care US settings: 2020 APIC MegaSurvey

BACKGROUND

Strengthening infection prevention and control programs in nonacute care settings is a national priority. Efforts require thorough and ongoing appraisal of organizational structures, human resources including personnel training and competencies, system challenges and adaptive strategies implemented. Assessment of those in infection preventionist (IP) roles outside of the acute care setting is necessary to capture ongoing changes and challenges in the IP profession.

METHODS

This cross-sectional study utilized data derived from the 2020 APIC MegaSurvey and applied descriptive and bivariate analyses to describe the state of infection prevention and control programs and personnel across nonacute clinical settings in the United States.

RESULTS

Of 1,991 respondents, 57% of frontline IPs or administration/director IPs (1,051) indicated working in 1 or more nonacute care clinical settings. Of these, 33% (343) worked exclusively in only 1 type of nonacute care setting. Consistent with findings from the 2015 APIC MegaSurvey, IPs employed in nonacute care settings are a homogenous group with 88% of respondents indicating they are white, non-Hispanic (88%), female (94%), with nursing as their primary discipline (95%). A notable change in the proportion of time spent on health care-associated infection (HAI) activities in general was found, with a 31% decrease in reported time spent compared to respondents from the 2015 survey. Nearly half (47%) of respondents reported an annual salary of $50,000-$80,000; only 35% of respondents reported they were satisfied with their overall compensation. More than half (57%) of respondents reported having 5 or less years' experience in IPC and the majority, 82% reported they expected to be working in the IP profession in the next 5 years.

CONCLUSIONS

The majority of IPs in nonacute care settings also worked in acute care. Of those who exclusively worked in nonacute care settings, they were predominately female, white, and had an educational background in nursing. A decrease in time spent on HAI activities was noted compared to respondents in 2015. Although the 2020 APIC MegaSurvey captured information previously not assessed in 2015, further studies are necessary to more robustly characterize the IP profession in nonacute care settings. Enhancements to current resources and services provided by APIC may serve to fill gaps in nonacute care settings related to gaining experience in research, general expertise, advocacy, and diversity.

Early prediction of central line associated bloodstream infection using machine learning

BACKGROUND

Central line-associated bloodstream infections (CLABSIs) are associated with significant morbidity, mortality, and increased healthcare costs. Despite the high prevalence of CLABSIs in the U.S., there are currently no tools to stratify a patient's risk of developing an infection as the result of central line placement. To this end, we have developed and validated a machine learning algorithm (MLA) that can predict a patient's likelihood of developing CLABSI using only electronic health record data in order to provide clinical decision support.

METHODS

We created three machine learning models to retrospectively analyze electronic health record data from 27,619 patient encounters. The models were trained and validated using an 80:20 split for the train and test data. Patients designated as having a central line procedure based on International Statistical Classification of Diseases and Related Health Problems 10 codes were included.

RESULTS

XGBoost was the highest performing MLA out of the three models, obtaining an AUROC of 0.762 for CLABSI risk prediction at 48 hours after the recorded time for central line placement.

CONCLUSIONS

Our results demonstrate that MLAs may be effective clinical decision support tools for assessment of CLABSI risk and should be explored further for this purpose.

Learning environments, reliability enhancing work practices, employee engagement, and safety climate in VA cardiac catheterization laboratories

OBJECTIVE

To characterize the relationship between learning environments (the educational approaches, cultural context, and settings in which teaching and learning happen) and reliability enhancing work practices (hiring, training, decision making) with employee engagement, retention, and safety climate.

DATA SOURCE

We collected data using the Learning Environment and High Reliability Practices Survey (LEHRs) from 231 physicians, nurses, and technicians at 67 Veterans Affairs cardiac catheterization laboratories who care for high-risk Veterans.

STUDY DESIGN

The association between the average LEHRs score and employee job satisfaction, burnout, intent to leave, turnover, and safety climate were modeled in separate linear mixed effect models adjusting for other covariates.

DATA COLLECTION

Participants responded to a web-only survey from August through September 2020.

PRINCIPAL FINDINGS

There was a significant association between higher average LEHRs scores and (1) higher job satisfaction (2) lower burnout, (3) lower intent to leave, (4) lower cath lab turnover in the previous 12 months, and (5) higher perceived safety climate.

CONCLUSIONS

Learning environments and use of reliability enhancing work practices are potential new avenues to support satisfaction and safety climate while lowering burnout, intent to leave, and turnover in a diverse US health care workforce that serves a vulnerable and marginalized population.