Abstract
Description
Infection prevention is a team within health care facilities and systems whose members are vital to reducing and mitigating patient harm secondary to infectious disease. Infection preventionists are subject matter experts who reside in the quality department and are responsible for multiple areas beyond infectious disease spread. They assist nursing teams, employee health programs, and epidemiologists in decreasing the spread of illness. They are widely under-recognized, though they have a significant impact on the overall stability of the health care system and the communities they serve.
Keywords: infectious disease, communicable diseases, cross infection, infection control, infection prevention, hospitals
Introduction
Health care-associated infections result in increased human suffering, deaths, prolonged hospital stays, and inflation of health care costs, with global estimates as high as 0.14% and increasing by 0.06% each year.1 In response, hospital-based infection prevention and control (IPC) programs have been created to perform surveillance activities, apply epidemiologic principles, and identify risk factors for health care-associated infections (HAIs). These evidence-based programs focus on harm reduction and elimination as well as the prevention of avoidable infections in patients and health care workers. A robust IPC program steered by seasoned leaders is at the heart of every successful reduction in health care-associated outcomes. HCA Healthcare, a frontrunner in IPC programs for large health care systems, validates the idea that reducing device-associated infections (such as central line-associated bloodstream infection [CLABSI], catheter-associated urinary tract infection [CAUTI], and Clostridioides difficile) can occur due to a solid, effective structure. Moreover, strategic partnerships with key stakeholders, such as nurses, physicians, and other clinical and operational teams, as well as unwavering support from leadership are critical components for success. The HCA Healthcare infection prevention program uses 3 foundational domains to reduce HAIs and minimize risks to infectious disease harm: (1) a solid, effective structure, (2) strategic partnerships, and (3) education and research.
A resilient IPC program provides a solid foundation, which includes a meaningful ratio of infection preventionists (IPs) correlated with the facility’s complexity. The program must also have a standard approach to education, a robust data abstraction program or process, and the necessary tools and guidance to allow IPs to be confident and physically present as they round on floors and speak to patients, colleagues, and key stakeholders.
Infection Prevention Program Structure
Recognizing the unique nature of each facility, a well-functioning IPC program must have a staffing model that can realistically accommodate the scope of the nurses and other IP team members’ jobs. Although IPC staffing comes in many forms,2 the number of IPs for the organization must match the type of patient population and facility structure and size using a recommended equation.3 Beyond reducing HAIs, the program also aims to control clusters or outbreaks, maintain the facility’s integrity within accreditation bodies’ regulations, as well as uphold practices in surgical services, construction sites, and other high-risk areas within the hospital. The program also assists with employee health by reducing exposure among staff, and it collaborates closely with the emergency response team for expertise in risk mitigation. Having an experienced infectious disease physician as department chair allows field expertise and leverage for his or her physician peers for crucial engagement.
Key Leadership
HCA Healthcare has over 186 hospitals within its system.4 Therefore, it is vital to have IPC leadership at each of its 15 divisions to allow for an organized strategy and maintain effective communication during an outbreak. Adding these leaders creates a dialogue between corporate headquarters and the facility and allows for guidance to be routed to the front line quickly. With a solid groundwork of IPC expertise, knowledge, and practice, HCA Healthcare has maintained and continues to improve infection outcomes, even throughout the COVID-19 pandemic. (When adjusting for COVID-19 discharges, target HAIs declined.)5 The division leaders of IPC are seasoned, certified IPs who have a span of control of 9 to 20 hospitals within their realms and are accountable for outcomes and strategies for their respective areas.
Education
Allowing for a standardized education program ensures a foundational base for IPC practices and knowledge. Creating an IPC university for the health care system, along with a standardized onboarding process for new IPs, would provide education on leading practices and allow for effective networking amongst peers.6,7 The university would match the Association for Professionals in Infection Control and Epidemiology (APIC) certification content7 and go into detail with each element, including examples from current leaders. Experienced leaders would act as faculty and would provide pragmatic solutions to current challenges. In addition, the university would have ongoing education for IPs of all experience levels to keep them abreast of specialty service expansions and novel pathogens.
Infection Prevention Personnel: Priorities and Tools for Success
Data abstraction for health care-associated infections acts as a deliberate and separate function to complement surveillance. Infection preventionists with this skill set are experts in National Healthcare Safety Network (NHSN) definitions,8 proficient in medical terminology, and knowledgeable in electronic health record navigation.8 Depending on the facility or system size and scope, these full-time employees may be dedicated extensions of the IPC program. Having these HAI abstraction experts work on data abstraction full-time allows the IPC team members to spend more time on the floor with colleagues, patients, and the clinical team as well as conduct rounds through high-risk areas. A centralized abstraction program can be a practical yet novel approach to furthering the strength of the IPC program.9
For novice IPs, a consistent reminder ensures balance in their work spent on activities for the highest productivity of their efforts. Borrowing guidance from the banking industry, the “50/30/20 rule” advises IPs on how to split their time on each domain.10 For example, 50% of their time should be spent rounding on units with patients and stakeholders and in high-risk areas, such as the sterile processing department and isolation rooms. Thirty percent should be spent on administrative tasks, such as continuous surveillance from an IPC platform or tool, preparation of agendas for upcoming IPC meetings, and updating meaningful data to share with leadership and other stakeholders. A common element that IPC teams tend to neglect is their professional development. The final 20% of their time should be spent staying abreast of scholarship, journals, or innovative developments in IPC that allow them to stay current with industry trends.
Tools for the IPC team are vital to operations and effective workflows. Having real-time information makes a difference between effective interventions and ineffective processes. For instance, having a dashboard allows the IPC team and other clinical leaders to visualize and understand the highest risk of HAIs and prioritize daily efforts. Other informative tools were developed by IPC leaders to allow real-time visibility of patients, units, or facilities, where opportunities for interventions can prevent harm.11 It is important to note that no matter how a dashboard or tool is created, it must be scalable and validated.
Research is the final domain where IPC experts can leverage their experience, education, and professional knowledge to provide new evidence for the field. Partnering with external entities, such as other health care systems or universities, grants incredible opportunities to conduct research trials and quality improvement efforts. Integrating evidence-based IPC practices into clinical trials, advancing innovations in infectious disease, and validating clinical treatment protocols for HAI reduction are a few examples of published research where IPC teams are front and center, highlighting the field’s important contributions to scholarship. 12,13 Studies in these areas continue to shape practice through large national publications and provide an outlet to showcase the importance of IPC as a vital part of health care.
IPC team members are the silent but powerful entities that shape harm reduction for patients, communities, and the individual organization’s clinical program. Infection preventionists are experienced and educated experts who contribute heavily, often behind the scenes, to patient care by reducing the risk of infection in the overall health care environment. Having a solid partnership with this team is integral to the success of any health care organization’s operational and clinical health.
Funding Statement
This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity.
Footnotes
Conflicts of Interest: The author declares she has no conflicts of interest.
The author is an employee of HCA Healthcare Clinical Services Group, an organization affiliated with the journal’s publisher.
This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.
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