Impacts of the COVID-19 pandemic on the infection prevention and control field: Findings from focus groups conducted with association for professionals in infection control & epidemiology (APIC) members in fall 2021

Moral distress among infection prevention and control professionals: A scoping review

BACKGROUND

The COVID-19 pandemic highlighted the vital role of Infection Prevention and Control Professionals (IPCPs) in safeguarding public health. Amid rapidly evolving guidelines, critical personal protective equipment shortages, and surging workloads, IPCPs encountered unprecedented moral and ethical dilemmas. However, their experiences, ethical challenges, and the resulting moral distress remain understudied.

METHODS

A scoping review following Arksey and O'Malley's methodology was conducted to examine current research on ethical challenges and moral distress among IPCPs. Searches in CINAHL, MEDLINE via OVID, Emcare, Scopus, and Korea Citation Index yielded two extracted articles.

RESULTS

Common themes included high workload, increased recognition, pressure to deliver accurate and timely information, need for peer support, and evidence-based practice. Differences in nationality, role discretion, and administrative systems led to varied experiences. District Medical Officers in Norway experienced more decision-making responsibilities and resulting ethical dilemmas in the context of broader communities and municipalities. The experiences of IPCPs were confined to their respective healthcare facilities.

CONCLUSION

There is a dearth of available research reporting the moral distress experienced by IPCPs whilst there is a plethora for those seen as "frontline" workers. Given the integral decision-making and implementation roles of these health professionals, and the burdens of ethical dilemmas they experienced in pandemic preparedness and response, further research is imperative to inform strategies to build moral resilience in the future.

SHEA/APIC/IDSA/PIDS multisociety position paper: Raising the bar: necessary resources and structure for effective healthcare facility infection prevention and control programs

The Society for Healthcare Epidemiology of America, the Association of Professionals in Infection Control and Epidemiology, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society represent the core expertise regarding healthcare infection prevention and infectious diseases and have written multisociety statement for healthcare facility leaders, regulatory agencies, payors, and patients to strengthen requirements and expectations around facility infection prevention and control (IPC) programs. Based on a systematic literature search and formal consensus process, the authors advocate raising the expectations for facility IPC programs, moving to effective programs that are:• Foundational and influential parts of the facility's operational structure• Resourced with the correct expertise and leadership• Prioritized to address all potential infectious harmsThis document discusses the IPC program's leadership-a dyad model that includes both physician and infection preventionist leaders-its reporting structure, expertise, and competencies of its members, and the roles and accountability of partnering groups within the healthcare facility. The document outlines a process for identifying minimum IPC program medical director support. It applies to all types of healthcare settings except post-acute long-term care and focuses on resources for the IPC program. Long-term acute care hospital (LTACH) staffing and antimicrobial stewardship programs will be discussed in subsequent documents.

Infection preventionists' current and preferred training strategies and tools

BACKGROUND

Educating health care staff on infection prevention and control (IPC) is an essential role of infection preventionists (IPs), but the COVID-19 pandemic diverted resources away from IPC education.

METHODS

Association for Professionals in Infection Control and Epidemiology members were invited to complete an online survey from spring 2023 to assess current and preferred approaches and tools for training health care personnel on IPC. Vendors, retirees, APIC staff, or those not working in health care or public health were excluded.

RESULTS

In all, 2,432 IPs participated. IPs were more likely to report engaging in impromptu health care worker training (ie, just-in-time teaching and team huddles) versus planned educational activities (ie, learning modules, formal presentations, train-the-trainer, or simulation; Kruskal-Wallis = 288, P < .001). IPs' top preferred teaching methodologies included simulation or interactive activity, and their lowest preferred approach was independent learning modules. IPC training apps were frequently requested technology.

DISCUSSION

IPs ranked simulation as their top preferred teaching method; however, simulation was one of the least frequently used approaches. IP education should include strategies for delivering effective impromptu training and how to develop and implement interactive simulation-based education.

CONCLUSIONS

The expressed needs and preferences of IPs should be considered when developing IPC-related teaching and training tools.

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.

A narrative review of how infection preventionist (IP) staffing and outcome metrics are assessed by health care organizations and factors to consider

BACKGROUND

Infection Preventionist to date are experiencing staffing shortages, the purpose of this narrative review is to understand how heath care organizations track staffing and outcome metrics in relation to Infection Preventionists.

METHODS

Databases utilized included MEDLINE, PubMed, EMBASE, Web of Science, and Google Scholar.

RESULTS

The initial search included 668 studies. After excluding duplicates, the title and abstract review yielded 50 articles. After screening full texts, 37 studies met the inclusion criteria. Significant variability exists within infection prevention staffing metrics. Common metrics to account for IP staffing levels include the ratio of IPs per facility and IPs per inpatient bed. Frequently tracked outcomes in relation to infection preventionists include Catheter-associated urinary tract infections and central line bloodstream infection incidence rates and standardized infection ratios, as well as Clostridioides difficile incidence rates. Metrics and outcomes from included studies are available in our supporting tables.

CONCLUSIONS

This review highlights the need for a new IP staffing model that focuses on a granular assessment of each program and care setting. Additional studies can then be conducted to examine how ideal staffing impacts outcome metrics.