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. 2026 Jun 19;35(11):4648–4661. doi: 10.1111/jocn.70410

Core Competencies of Nurses Working in Hospital Infection Prevention and Control: A Scoping Review and Cluster Analysis

Ge Bai 1,2,✉, Andreas Efstathiades 1, Yanli Wang 2, Ruifang Liu 2
PMCID: PMC13629277  PMID: 42319202

ABSTRACT

Background

Infection prevention and control (IPC) nursing plays a central role in implementing IPC standards and preventing healthcare‐associated infections. However, a unified core competency framework for IPC nursing roles has yet to be clearly defined.

Aim

This study aimed to identify and synthesise the core competencies required for IPC nurses, including infection control nurses (ICNs) and infection control link nurses (ICLNs). It also examined how these competencies differ according to role responsibilities and explored patterns of association among competency domains.

Design

A scoping review with cluster analysis.

Methods

This scoping review followed a five‐stage methodological framework, including identifying the research questions, identifying relevant sources, selecting sources, charting the data and collating, summarising and reporting the results. Based on this process, we conducted high‐frequency term analysis and cluster analysis to identify the core competency structure.

Results

This review included 18 sources, from which 40 high‐frequency terms were extracted and nine core competency domains were identified. Cluster analysis grouped these domains into three clusters: system‐supporting and developmental competencies, IPC in clinical practice and microbiology and surveillance. When compared with the World Health Organization framework, these domains showed overall alignment while also revealing additional domains of importance, such as research competence and personal quality. ICNs placed greater emphasis on surveillance, leadership, education and programme management, whereas ICLNs focused more on clinical practice and communication.

Conclusion

This study systematically mapped IPC nursing competencies into nine domains and three functional clusters, distinguishing role‐specific profiles for ICNs and ICLNs. The findings can inform role‐specific competency framework development and more targeted IPC education and workforce preparation.

Highlights

  • This scoping review synthesised competency evidence for ICNs and ICLNs.

  • Three competency clusters were identified: system‐supporting and development, IPC clinical practice and microbiology and surveillance.

  • The findings support the development of role‐specific competency frameworks, assessment tools and training programmes for infection control nursing roles.

Implications for Practice

Findings from this study suggest that strengthening analytical, clinical, and system‐level IPC competencies may enhance the effectiveness of infection prevention efforts in daily practice. Targeted competency development appears feasible, though further research is needed to design and evaluate integrated interventions.

Impact

The findings suggest that IPC competencies should be developed with attention to the distinct requirements of analytical, clinical, and system‐level work. Healthcare organizations may enhance IPC performance by providing targeted training in surveillance, supporting frontline implementation, and strengthening mechanisms that connect managerial activities with bedside practice. Integrating these strategies may help improve the consistency and impact of infection prevention efforts.

Reporting Method

PRISMA‐ScR.

Keywords: clinical competence, infection control, nursing staff, professional role, scoping review

Keypoints

  • What does this paper contribute to the wider global clinical community?
    • ○
      This study synthesizes evidence from multiple countries and provides a comprehensive view of IPC nursing competencies that are relevant across diverse healthcare systems. It identifies core competency domains, compares them with WHO frameworks, and highlights additional domains that extend beyond existing global guidance, thereby offering a broader and more practice‐oriented understanding of IPC nursing requirements.
    • ○
      By distinguishing the competency needs associated with ICN and ICLN roles and demonstrating how nine domains cluster into three functional groups, this study provides a clearer structure for defining IPC nursing roles and guiding workforce development. These findings support clinicians, educators, and healthcare leaders in strengthening role clarity, competency‐based training, and system‐level IPC capacity worldwide.

1. Introduction

Healthcare‐associated infections (HAIs) are a major public health challenge worldwide. HAIs result in additional illness and deaths, increased length of stay and medical care costs. This poses a substantial burden on the healthcare systems (Dekker et al. 2023; Perry 2005). As stated by the World Health Organization (WHO 2023), approximately 15% of patients experience these infections within the hospital setting across low‐ and middle‐income countries; in high‐income countries, the rate is 7%. Effective infection prevention and control (IPC) teams play an important role in preventing HAIs (Hale et al. 2015).

In healthcare systems, IPC is a multidisciplinary effort and nurses play an important role in carrying out IPC measures (Massaroli et al. 2019). Within the IPC teams, two specialised nursing roles are central to implementation: infection control nurses (ICNs) and infection control link nurses (ICLNs). They work together to implement IPC measures into practice. In this study, both are referred to as IPC nurses. ICNs are full‐time professionals with formal training and qualifications. Their work includes infection surveillance, outbreak response and IPC training (West 2021). ICLNs are clinical nurses who take on IPC duties part‐time after receiving training. They act as a link between clinical units and the IPC team. This helps ensure that infection control standards are followed across departments (Thandar et al. 2021). Together, IPC nurses form an essential component of IPC programs (Wu et al. 2024).

As healthcare systems continue to grow in complexity, the roles of ICNs and ICLNs have expanded beyond the routine execution of IPC policies. They are increasingly expected to promote the implementation of best practices and contribute to education and capacity development in IPC (Dekker et al. 2022; West 2021). The successful functioning of IPC programs requires clear delineation of the roles and competencies of these two groups. Unclear role competencies may lead to overlapping responsibilities or fragmented IPC activities, which may hamper program performance. Systematic identification and comparison of the core competency profiles of IPC nurses thus represent an essential step towards improving role clarity and the efficiency of IPC teamwork. This requirement has become even more important in the post‐COVID‐19 context, as building sustainable IPC capacity remains a key priority for healthcare systems worldwide (Pace 2023).

Within the nursing field, core competency is normally considered the integration of knowledge, skills, values and attitudes that enable a nurse to practice safe and effective care (American Association of Colleges of Nursing 2008). This definition reflects the multi‐dimensional nature of nursing practice. In the IPC context, the WHO (2020) describes core competencies as the knowledge, skills, situational judgement, critical thinking and reflective capacity required by infection prevention and control professionals (ICPs) to implement strategies to prevent infections and limit the development of antimicrobial resistance. The WHO framework outlines five core competency domains: leadership and programme management, microbiology and surveillance, IPC in clinical practice, education and quality, patient safety and occupational health. The framework stresses technical ability, systems thinking and continuous improvement, offering a clear standard for the required competencies.

Although the WHO (2020) has issued a global competency framework for ICPs, the specific competency requirements for IPC nurses are not yet well described in the existing literature. Current research and guidelines focus mainly on ICPs and ICNs. The competency structure of the ICLNs is relatively unexplored (European Center for Disease Prevention and Control 2013; WHO 2020). Some researchers have assessed the role of link nurses in implementing IPC practice within healthcare institutions, but they have not clearly defined the competency dimensions required for this role (Dekker et al. 2020; Fitria et al. 2023; Ward 2016). In addition, the competency expectations for IPC nurses vary considerably across countries and regions, suggesting that no unified global consensus has yet been established. Existing reviews often discuss the roles of ICNs and ICLNs separately and rarely compare their competencies within a single conceptual framework (Hale et al. 2015; Peter et al. 2018). Therefore, we needed to clarify the core competency profiles of both ICNs and ICLNs and to evaluate how well these align with the WHO global framework.

To address these gaps, this study employed a combined methodology of scoping review and cluster analysis to systematically examine the core competencies of IPC nurses. The scoping review was conducted to comprehensively map and synthesise relevant global research, thereby clarifying the distribution and characteristics of these core competency elements. Cluster analysis was used to identify latent patterns and relationships within the extracted competency data (Miguel et al. 2024). This quantitative method helps move beyond descriptive lists by examining how competency elements are structurally related. By comparing the findings derived from this combined approach with the competency standards established by the WHO, this study aims to clarify the competency requirements for IPC nurses. The results are intended to provide a scientific basis for competency‐based training, education and evaluation.

1.1. Aims

The purpose of this study is to systematically identify and synthesise the core competencies required for IPC nurses. The specific objectives are to:

  • Identify and summarise core competency domains as reported in the literature on IPC nurses.

  • Compare these domains with the WHO framework and identify domains of convergence and divergence.

  • Identify similarities and differences in the emphasis placed on competencies between ICNs and ICLNs.

  • Investigate patterns of association among competency domains within IPC nursing practice.

2. Methods

2.1. Design

A scoping review was conducted to identify and summarise the existing literature on the competencies of IPC nurses. The review consisted of five steps, following the framework proposed by Arksey and O'Malley (2005), as refined by Levac et al. (2010) and in accordance with guidance from the Joanna Briggs Institute and Peters et al. (2020, 2021). The PRISMA‐ScR checklist was applied (see File S1) (Tricco et al. 2018). In addition, a quantitative analytical component was added to complement qualitative synthesis. Specifically, manual coding produced a structured set of competency items and domains, which then served as input for term frequency analysis and hierarchical clustering. This design allowed qualitative coding to define the construct space and quantitative analysis to examine patterns of association among domains. The study was registered with the Open Science Framework (DOI: 10.17605/OSF.IO/NU7H4).

2.2. Stage 1: Identifying the Research Questions

The review was guided by four questions:

  1. What core competencies of IPC nurses have been reported in existing research and guidelines?

  2. How do these competencies fit with the WHO framework and what domains of convergence, divergence or additional emphasis can be identified?

  3. How does the emphasis on competencies differ between ICNs and ICLNs?

  4. What patterns of association exist among the identified competency domains?

2.3. Stage 2: Identifying Relevant Studies

To obtain comprehensive evidence on the core competencies of IPC nurses, we searched nine databases: PubMed, MEDLINE, Cochrane Library, EBSCOhost, CINAHL, CNKI, Wanfang Data, VIP and CBM. Grey literature was also searched on the websites of national and international IPC professional organisations and through supplementary searches in Google Scholar. The search covered the period from database inception to June 20, 2024. No restrictions were placed on study type. The search strategy combined Medical Subject Headings and free‐text terms. Core terms included “infection prevention and control,” “nurse,” “link nurse,” “core competency,” “competence,” and “responsibility.” Boolean operators and truncation were adjusted according to the requirements of each database to improve search sensitivity. Detailed search strategies for each database are provided in File S2. The results were manually checked to ensure completeness. The reference lists of included sources were also reviewed to identify additional eligible sources.

2.4. Stage 3: Study Selection

The inclusion criteria were sources that: (a) involved IPC nurses, including ICNs and/or ICLNs; (b) were conducted in healthcare settings; (c) examined competencies, skills, roles or IPC‐related responsibilities of IPC nurses; (d) were empirical studies using qualitative, quantitative or mixed‐methods designs or were relevant guidelines, standards or consensus statements; and (e) were published in English or Chinese.

The excluded criteria were: (a) reviews, commentaries, editorials, opinion papers, case reports, protocols, conference abstracts, proceedings or other non‐full‐text publications; (b) studies irrelevant to IPC competencies for nurses; and (c) superseded guidance documents and standards.

All search results obtained from database searches and grey literature were organised using EndNote X9 (Clarivate Analytics) to remove duplicates. The screening involved three stages. Initially, one researcher screened all titles using the selection criteria and selected studies that were deemed potentially relevant or uncertain. Subsequently, two researchers independently assessed abstracts and keywords. Any disagreements were resolved through consensus or by a third researcher. Finally, two researchers independently assessed the full texts of potentially eligible studies, while consulting a third reviewer whenever consensus could not be reached.

2.5. Stage 4: Charting the Data

A standardised data‐charting form was used to summarise each study, including author, publication year, country, study design, participant type and core competency elements. The competencies were identified to relate to each of the five domains identified by WHO and those not identified within WHO domains were noted within separate domains. The form was piloted on five studies to ensure clarity. Two reviewers independently extracted and cross‐checked data, resolving disagreements through discussion or consultation with a third reviewer. Final data were approved by all authors.

2.6. Stage 5: Collating, Summarizing and Reporting the Results

The data were synthesised using both qualitative and quantitative approaches to summarise information and to establish the structural relationships between and among core competencies.

2.6.1. Qualitative Synthesis

A qualitative content analysis was performed by two researchers using NVivo 11 Plus (QSR International) software. The competency items were identified and coded directly or paraphrased to enhance clarity, after which they were categorised according to their corresponding domains. The rules that governed coding were developed by team consensus. Similar items were combined, confusing language reduced to clarity and new codes introduced only after items could no longer fit into any domains devised by WHO. Each competency item was assigned to one primary domain.

2.6.2. Integration of Qualitative and Quantitative Data

The results obtained from qualitative coding included a list of items corresponding to domains across core competencies, which were homogenised and standardised to avoid redundant expressions such as those including similar terminology. Items on this list were also mapped to unique domains and appropriately labelled according to role indications within their source. The dataset thus generated provides a platform to derive results on domain distribution and domains' relations via cluster and term frequency analysis.

2.6.3. Frequency Analysis

Term frequency analysis was based on Chen et al. (2024) and aligned with the WHO framework. All competency items were standardised into terms and grouped by domain and IPC nurse role. Based on this criterion, 108 distinct terms were included in the final analysis (File S3). Word frequencies were calculated using Weici Yun software (https://fenci.weiciyun.com/). High‐frequency terms were identified using the formula proposed by Pao (1978) n=1+1+8I1/2, where n represents the threshold distinguishing high‐ and low‐frequency terms and I 1 is the number of terms appearing once. Frequencies were summarised within competency domains to examine patterns of emphasis across ICNs and ICLNs. The results were further visualised using a heatmap of the frequencies of high‐frequency terms across competency domains and IPC nurse roles.

2.6.4. Cluster Analysis

A competency domain‐by‐term frequency matrix was constructed using high‐frequency term counts for cluster analysis. Hierarchical agglomerative cluster analysis was conducted in SPSS 27.0 (IBM Corp.) using squared Euclidean distance as the dissimilarity measure and Ward's method as the linkage method. The number of clusters was determined by examining the dendrogram, the agglomeration schedule and the conceptual interpretability of the cluster solution. Cluster solutions were interpreted in relation to the qualitative domain definitions and the WHO framework.

3. Results

A total of 4394 records were identified through the database and grey literature searches. After duplicates were removed and titles and abstracts were screened, 52 sources were considered potentially relevant. Following full‐text review, 18 studies met the inclusion criteria. The screening process and reasons for exclusion are presented in Figure 1.

FIGURE 1.

FIGURE 1

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Flow diagram of source identification and selection. [Colour figure can be viewed at wileyonlinelibrary.com]

3.1. Characteristics of Included Sources

A total of 18 sources published between 2008 and 2023 were included, comprising eight peerreviewed papers, seven professional standards or frameworks and three theses. The sources came from China (n = 8), the United States (n = 2), the United Kingdom (n = 2), Hong Kong, China (n = 2), the European Union (n = 1), Canada (n = 1), Brazil (n = 1) and the global WHO framework. Five sources used qualitative designs, 10 adopted mixed methods and three were standards‐based or guideline documents.

When mapped to the WHO framework, all sources covered at least three domains, but only three (European Center for Disease Prevention and Control 2013; Infection Prevention Society 2020; WHO 2020) were fully aligned. Thirteen sources showed partial alignment, typically covering three to five domains. IPC in clinical practice (domain 3) and quality, patient safety and occupational health (domain 5) were most frequently represented, whereas leadership and IPC program management (domain 1) and microbiology and surveillance (domain 2) were less frequently addressed.

Several sources reported additional competencies beyond the WHO domains, especially research competence and personal qualities. Communication, collaboration and personal qualities were also highlighted across sources. Details are summarised in Table 1.

TABLE 1.

Characteristics of included sources (n = 18).

Author (year) Country/region Study design Participants Main competency domains
Carrico et al. (2008) USA Mixed methods research ICPs 2, 3, 5
CBIC (2012) USA Not mentioned ICPs 1, 2, 3, 4, 5 + communication
Chan (2012) Hong Kong, China Mixed methods research ICNs 1, 2, 3, 4, 5 + collaboration, infection control‐related knowledge
Chen (2019) China Mixed methods research ICPs 2, 3, 5 + personal qualities
Chen et al. (2023) China Qualitative research ICNs 1, 2, 3, 5 + research competence, personal qualities
ECDC (2013) European Union Qualitative research ICPs 1, 2, 3, 5
Ipac Canada (2022) Canada Qualitative research ICPs 1, 2, 3, 4, 5 + communication
IPS (2020) UK Qualitative research ICPs 1, 2, 3, 4, 5
Li (2022) China Mixed methods research ICNs 2, 3, 4, 5 + research competence, personal qualities, communication and collaboration, infection control‐related knowledge
Li et al. (2023) China Mixed methods research ICNs 2, 3, 4, 5 + infection control‐related knowledge
Massaroli et al. (2019) Brazil Mixed methods research ICNs 3, 4, 5 + personal qualities, communication
Nursing Council of Hong Kong (2021) Hong Kong, China Not mentioned ICNs 3, 4, 5 + personal qualities, research competence
RCN (2021) UK Qualitative research ICLNs 3, 4, 5 + communication
WHO (2020) Global Not mentioned ICPs 1, 2, 3, 4, 5
Wu et al. (2024) China Mixed methods research ICLNs 2, 3, 4, 5 + infection control‐related knowledge
Yang et al. (2023) China Mixed methods research ICPs 1, 2, 3, 4, 5 + research competence
Zhang et al. (2017) China Mixed methods research ICPs 2, 3, 5
Zhang et al. (2023) China Mixed methods research ICPs 2, 3, 5 + personal qualities
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Abbreviations: CBIC = Certification Board of Infection Control and Epidemiology; ECDC = European Center for Disease Prevention and Control; ICLNs = infection control link nurses; ICNs = infection control nurses; ICPs = infection control professionals; Ipac = Infection prevention and control; IPC = infection prevention and control; RCN = Royal College of Nursing; WHO = World Health Organization. WHO IPC core competency domains: 1 = leadership and IPC program management; 2 = microbiology and surveillance; 3 = IPC in clinical practice; 4 = education; 5 = quality, patient safety and occupational health.

3.2. Classification of Core Competency Domains

Core competencies were first classified according to the five domains of the WHO framework. During manual coding, several sources described competencies that extended beyond the WHO framework. After team discussions, the competencies were reorganised into nine categories (see Figure 2), integrating both the WHO‐defined domains and additional domains derived from the literature. The WHO‐based domains reflect the technical and managerial foundation of IPC work, whereas the additional domains, including infection control‐related knowledge, communication and collaboration, research competence and personal qualities, represent emerging and developmental dimensions that expand the scope of IPC nursing competence. Together, these nine domains form a comprehensive framework that links practice, leadership, education and personal growth, providing the structural basis for the subsequent frequency and cluster analyses.

FIGURE 2.

FIGURE 2

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Diagram of the nine core competency domains identified for infection prevention and control nurses, showing domains aligned with the WHO framework and domains further identified in this review. IPC = infection prevention and control; WHO = World Health Organization. [Colour figure can be viewed at wileyonlinelibrary.com]

3.3. Distribution and Functional Patterns of Core Competencies

A total of 41 high‐frequency terms were identified and mapped to nine core competency domains. The most common terms included monitoring (n = 68), IPC training (n = 38) and team collaboration (n = 32). In contrast, terms such as emergency response (n = 7) and patient safety (n = 6) appeared less often.

When these terms were grouped by competency domain, a somewhat different pattern emerged. The domains most frequently represented were IPC in clinical practice (n = 64) and infection control‐related knowledge (n = 57). Communication and collaboration (n = 48) and education (n = 43) appeared at moderate levels once related terms were combined. Microbiology and surveillance (n = 27), personal qualities (n = 26) and quality and patient safety and occupational health (n = 25) showed lower levels of representation, while research competence (n = 20) and leadership and IPC program management (n = 6) were the least emphasised.

The heatmap (Figure 3) shows the distribution of the 41 high‐frequency terms across the nine competency domains and also provides a comparison of term frequencies between the overall dataset, ICNs and ICLNs. Within the IPC nursing workforce, ICNs and ICLNs show different patterns of emphasis that reflect their functional roles. Studies on ICNs often highlight IPC (n = 30), monitoring (n = 16), training (n = 15), IPC risk assessment (n = 15), policy implementation (n = 15). In contrast, studies on ICLNs more frequently report monitoring (n = 14), training (n = 12), quality improvement (n = 11) and communication (n = 11).

FIGURE 3.

FIGURE 3

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Heatmap of high‐frequency terms across IPC competency domains and IPC nurse roles. The heatmap displays term frequencies. Red indicates higher frequency in the corresponding competency domain, whereas blue indicates lower frequency. Abbreviations: A = IPC in clinical practice; B = education; C = leadership and IPC program management; D = microbiology and surveillance; E = quality, patient safety and occupational health; F = infection control‐related knowledge; G = communication and collaboration; H = personal qualities; HAI = healthcare‐associated infection; I = research competence; ICLNs = infection control link nurses; ICNs = infection control nurses; IPC = infection prevention and control. [Colour figure can be viewed at wileyonlinelibrary.com]

3.4. Cluster Analysis of Core Competency Domains

Figure 4 presents the hierarchical clustering of the nine core competency domains as a dendrogram. A three‐cluster solution was retained. Inspection of the dendrogram showed a clear separation of clusters at a rescaled distance of approximately 15. Cluster 1 included research competence, personal qualities, communication and collaboration, education, leadership and IPC program management, infection control‐related knowledge and quality, patient safety and occupational health. Cluster 2 included IPC in clinical practice. Cluster 3 included microbiology and surveillance. Detailed descriptions of the nine core competency domains are presented in File S4.

FIGURE 4.

FIGURE 4

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Dendrogram of hierarchical cluster analysis of the nine IPC nurses' core competency domains. Clustering was performed using squared Euclidean distance and Ward's method. Shorter linkage distances in the dendrogram indicate greater similarity in term usage patterns among competency domains. IPC = infection prevention and control.

The three clusters showed a function‐oriented structure. Cluster 1 reflected system‐supporting and developmental competencies. Cluster 2 represented competencies related to IPC implementation in clinical practice. Cluster 3 captured analytic and monitoring competencies associated with microbiology and surveillance activities. Based on these findings, a conceptual framework of IPC nurse core competencies was developed (Figure 5), showing the relative position of the three clusters within the overall competency structure.

FIGURE 5.

FIGURE 5

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Conceptual model of IPC nurses' core competencies. The model illustrates the relative position and functional relationships among the three competency clusters. Arrows indicate theoretically informed functional linkages based on the WHO framework and routine IPC workflows, rather than causal relationships derived directly from the cluster analysis. IPC = infection prevention and control. [Colour figure can be viewed at wileyonlinelibrary.com]

4. Discussion

This scoping review identified nine core competency domains for IPC nurses and grouped them into three functional clusters through cluster analysis. The three clusters reflected system‐supporting and developmental competencies, IPC in clinical practice and microbiology and surveillance. The review also found that there are differences in responsibilities between ICNs and ICLNs. These findings contribute to a clear understanding of the competency structure required for IPC nurses, as well as the variations in these competencies across different roles.

4.1. Interpretation of Findings in Relation to WHO Framework and Existing Evidence

The nine competency domains identified in this review demonstrate substantial alignment with the WHO framework, particularly in domains related to IPC implementation, microbiology and surveillance, leadership, education and patient safety. These results show that the expectations on ICPs across the globe are currently covered by the IPC nursing practice definitions. The themes identified include monitoring, risk management, standard precautions and outbreak response, which correspond to the competencies identified by WHO to enable safe infection prevention. This provides an indication that the WHO framework is relevant to the development of IPC competency within nursing.

Our results suggest that the IPC nurse competency profile exceeds the requirements of the existing WHO framework. Specifically, competencies in communication and collaboration, personal qualities, infection control‐related knowledge and research competence emerged as distinct categories. As these competencies are not explicitly outlined as standalone elements in the WHO framework, their emergence in our findings highlights their critical relevance for nursing practice. This can be attributed to the fact that IPC nurses take up a critical role at the point of interface of different disciplines and departments (Dewi et al. 2023). These factors are particularly important to ICLNs, who work within a decentralised clinical setting (Dekker et al. 2019). They allow policy to be implemented at a practical level, training within teams and adherence at the point of care being carried out (Royal College of Nursing 2021; Sugunan et al. 2024).

Although research competence is increasingly recognised as essential for IPC nurses, current global standards do not fully reflect this shift. The WHO framework does not classify research competence as a distinct domain, revealing a mismatch between international guidance and the expanding demands of contemporary IPC practice. Recent studies have shown that the expectation of IPC nurses involves the capacity to analyse data, evaluate the efficacy of interventions, as well as the role of nurses' practice‐based research (Chen et al. 2023; Li et al. 2023; Yang et al. 2023). Furthermore, according to Keizer et al. (2019), the rapidly changing landscape of infectious diseases requires nursing professionals to adopt flexible, evidence‐based response strategies because of emerging pathogens, evolving antimicrobial resistance and shifting institutional demands. This implies that conventional IPC nurse competency profiles could potentially underappreciate the role of practice‐based research capability.

In contrast, competencies in quality management, patient safety and occupational health were cited less frequently in the literature, despite their clear definition in the WHO framework. This underrepresentation may stem from methodological limitations or from the tendency to frame these domains as organisational functions rather than individual competencies. The European Center for Disease Prevention and Control's (2013) framework exemplifies this, positioning them within institutional structures instead of as standalone competencies. Addressing this gap is critical for future research, given their fundamental importance to effective IPC programs.

On the basis of these results, we suggest that the WHO framework provides a valuable high‐level structure for understanding IPC competencies, while our review extends and operationalizes this structure for IPC nursing practice. In particular, the competency domains identified in this study highlight the importance of interpersonal, professional and practice‐development capabilities that appear especially relevant to nursing roles within IPC. Future research should continue to refine competency frameworks for IPC nurses so that they better reflect role‐specific responsibilities, practice contexts and workforce development needs.

4.2. Role Differentiation and Competency Implications for ICNs and ICLNs

ICNs and ICLNs share a set of core competencies in the IPC field; however, the systematic word‐frequency analysis in this study indicates clear differences in their competency emphases, reflecting their distinct functional roles within IPC systems. These differences are likely related to their different role positioning within healthcare organisations. ICNs usually work at the organisational or programmatic level and are more directly involved in surveillance, coordination, policy translation and system‐wide IPC improvement (Chen et al. 2023), whereas ICLNs are typically embedded within clinical units and work closer to frontline care processes (Bai et al. 2024). This difference in practice location and scope of responsibility helps explain why the two roles show different competency profiles.

The findings show that ICNs' required competencies are more strongly aligned with system‐level responsibilities, particularly in surveillance data analysis and project management. This is in line with their role of coordinating activities within multidisciplinary teams, while they are also responsible for promoting hospital‐wide initiatives on IPC through evidence‐based approaches (Sugunan et al. 2024), which is within their mandate to ensure that institutional programmes on IPC are functional (Li et al. 2023). Because ICNs often connect clinical services with hospital management and infection prevention programmes, they require stronger competencies in leadership, coordination, data interpretation and programme oversight.

In contrast, ICLNs' competencies are more closely oriented towards clinical practice, communication and quality improvement, highlighting their frontline implementation role. This is supported by available evidence showing that ICLNs play an essential role in acting as a link between care units and IPC specialist teams (Dekker et al. 2022). The functionality of ICLNs is dependent on ensuring IPC guidelines are implemented while promoting adherence to them (Ward 2016). As ICLNs usually undertake IPC responsibilities alongside routine clinical work, their role requires them to translate policies into daily practice, support colleagues in applying IPC measures and identify implementation gaps at the point of care (Isahak and Zolkefli 2022). This may explain the greater emphasis on communication, practice‐based support and locally oriented quality improvement in their competency profile.

These differentiated competency requirements have important implications for the professional development of IPC nurses. At the system level, competency frameworks and job descriptions should clearly distinguish the roles of ICNs and ICLNs to prevent the conflation of their responsibilities. This aligns with the call for role‐specific development pathways highlighted by Dekker et al. (2022). In terms of training, ICNs require advanced preparation in epidemiological methods, leadership development and system‐level change management (Sugunan et al. 2024), whereas ICLNs should focus on clinical coaching, team coordination and implementation‐focused skills (Royal College of Nursing 2021). Evaluation mechanisms should also adopt differentiated performance indicators that correspond to the distinct competency domains of each role, enabling more accurate assessment of their respective contributions to IPC practice. For ICLNs, who balance IPC responsibilities with routine clinical duties, the establishment of evaluation criteria that reflect the realities of their hybrid role has become an important and yet underdeveloped component of IPC human resource management (Wu et al. 2024).

4.3. Cluster Analysis Findings

The cluster analysis, as visualised in the dendrogram, focused on patterns of co‐occurrence of competency‐related terms in the literature to examine how IPC nurses' competencies are commonly portrayed. It should be noted that term frequency reflects the level of attention given to specific competencies in the published literature rather than their intrinsic importance in practice. This method considered lexical closeness within competency domains to analyse similarities, with the dendrogram providing a visual representation of the distance‐based grouping process. Three clusters emerged, each reflecting distinct patterns of emphasis in existing studies. These clusters should therefore be interpreted as literature‐based conceptual groupings rather than definitive competency domains.

In cluster 1, the seven competency domains identified in this study reflect a broad system‐supporting and development dimension of IPC nursing practice. These domains integrate professional knowledge with organisational coordination, communication, interpersonal qualities and evidence‐informed improvement. Their internal coherence is consistent with existing research showing that leadership depends on communication to guide teams and that education and research help transform infection control knowledge into organisational learning and continuous improvement (Juliasih et al. 2023; Newman and Ford 2021). This aggregation also reflects the expanding role of IPC nurses, who increasingly operate across clinical, managerial and programme‐level functions (Fitria et al. 2023). At the same time, the statistical separation of this cluster from clinical practice raises an important concern for organisational effectiveness. Several studies have shown that well‐developed IPC policies and committees often coexist with persistent gaps in frontline implementation (Deryabina et al. 2021; Isahak and Zolkefli 2022; Lowe et al. 2021). Lowe et al. (2021) reported that even when formal IPC structures are in place, context‐specific constraints such as workload, limited authority, competing priorities and weak safety culture may prevent policies from influencing clinical behaviour. This pattern is consistent with our findings and suggests that system‐level competencies must be enacted in ways that remain closely aligned with clinical realities to ensure meaningful improvements in infection prevention.

Cluster 2 comprised only IPC in clinical practice, representing the fundamental competence of IPC nurses, which is distinctly separable statistically from other clusters. This pattern reflects the semantic structure of existing literature, where technical procedures and clinical practices are often discussed together but rarely correlated with nontechnical aspects. Current research therefore tends to define IPC nursing as evidence‐based, measurable and auditable professional activity (Carrico et al. 2008; Li 2022). Conceptually, these competencies form the foundation of infection control and represent the minimum professional standard (Dekker et al. 2022; European Center for Disease Prevention and Control 2013; Gašpert 2025). However, this technical independence may present a practical paradox. In healthcare settings, the success of any technical action depends on system support, teamwork, communication and safety culture (Bai et al. 2024). Failures in infection prevention usually result not from a lack of knowledge but from organisational and behavioural constraints (Ward 2016). Thus, the apparent independence of clinical practice reveals the knowing—doing gap in IPC nursing, highlighting that effective infection prevention requires integrating technical skills with contextual and organisational support (Berdida 2023). IPC nurses should move beyond technical practice towards roles as clinical implementation scientists and system integrators who enable reliable, sustainable practice (Dekker et al. 2019).

Cluster 3 revolved around microbiology and surveillance, highlighting the distinct position of this competency domain within IPC practice. Terms related to pathogen characteristics, antimicrobial resistance mechanisms and surveillance indicators suggest a specialised technical competency domain within the IPC literature. These findings indicate that effective IPC participation requires nurses to acquire competencies that extend beyond routine clinical education; although not typically included in formal nursing training, such skills are essential for infection surveillance and outbreak detection (Chen et al. 2023; Royal College of Nursing 2021). The WHO (2020) also identifies surveillance as a core technical function necessary for risk prediction and targeted intervention. The distinctiveness of this competency domain further underscores the need for diverse expertise within IPC teams, as clinical experience alone does not translate into analytical proficiency (Talbot et al. 2025). This necessitates differentiated capacity building trajectories that pay particular attention to microbiology and surveillance. As stated by Lukasewicz Ferreira et al. (2024), these competencies should be recognised as core analytical skills. Through structured training specific to the role, nurses can translate surveillance data into clinical insights and management actions, promoting the integration of specialised knowledge with clinical practice and organisational processes.

Therefore, the results of the clustering analysis suggest that IPC competencies are described in the literature as three function‐oriented domains, which broadly distinguish system support, clinical execution and analytical surveillance as complementary domains of IPC practice. Because cluster analysis captures patterns of co‐occurrence rather than causal, developmental or hierarchical relationships, the framework proposed in this study should be understood as a conceptual model rather than a definitive competency structure. The directional relationships shown in the model are theoretically and practically grounded, with reference to the WHO framework and routine IPC workflows, but they are not directly inferred from the clustering results themselves. In this model, surveillance provides evidence for decisions, system support creates conditions for implementation and clinical practice is the pathway through which IPC actions produce outcomes (Aghdassi et al. 2025; Bai et al. 2024; Hale et al. 2015). From a practical perspective, this conceptual model may help nurses, educators and managers organize IPC competency development more systematically. It may support curriculum design by linking analytical, system‐level and practice‐based competencies; clarify role delineation between ICNs and ICLNs; and inform workforce planning by identifying different domains for training, supervision and capacity building. However, these potential applications should be considered alongside the methodological caveat that the model provides a conceptually informed interpretation of literature patterns rather than an empirically validated causal structure.

5. Limitations

The included studies varied in design and terminology and competency descriptions were not always consistent, which may have affected data extraction and synthesis. As a scoping review, no formal quality appraisal was performed, in line with methodological guidance and the findings therefore cannot be interpreted in terms of evidence strength. Most sources were from China, which may limit the transferability of the findings across cultural and organisational contexts. Term‐frequency analysis reflects the level of attention given to competencies in the literature rather than their practical importance. Accordingly, the use of weighting based on the frequency of terms and clustering driven by data may have contributed to greater emphasis on frequently reported competencies, while competencies that are important but reported less frequently may have appeared less prominent in the resulting pattern. Cluster analysis results were based on textual co‐occurrence rather than performance, developmental or causal data; therefore, relationships among competency domains should be interpreted cautiously. Future studies should evaluate and refine this competency structure across different health systems and professional cultures, both to confirm the stability of the identified domains and to explore whether competency patterns and role differentiation extend beyond the ICNs and ICLNs configuration described herein.

6. Conclusion

This scoping review identified nine core competency domains for IPC nurses and through cluster analysis organised them into three conceptual groups: microbiology and surveillance, IPC in clinical practice and system‐supporting and development competencies. ICNs showed a higher emphasis on surveillance, training and programme support, while ICLNs were more closely aligned with implementation and communication at the bedside. Despite these competencies being generally consistent with the WHO structure, system‐supporting and analytical skills are less developed. The above results offer a starting point to better define competency goals and aid capacity development. Further studies could work to validate this competency structure, investigate utility within differing contexts and assess how competency training affects implementation and patient outcomes.

Author Contributions

Ge Bai: conceptualisation, methodology, data curation, formal analysis, writing – original draft and funding acquisition. Andreas Efstathiades: methodology, writing – review and editing. Yanli Wang: data curation and supervision. Ruifang Liu: data curation and formal analysis.

Funding

This study was supported by the Natural Science Foundation of Inner Mongolia Autonomous Region (Grant no. 2023QN08045) and the Nursing Research Foundation of Inner Mongolia Autonomous Region Nursing Association of China (Grant no. NMKY202509).

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

File S1: Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) Checklist.

JOCN-35-4648-s001.docx (67.1KB, docx)

File S2: Full search strategies for all resources.

JOCN-35-4648-s003.docx (21.8KB, docx)

File S3: Technical terms related to IPC nurses' core competency.

JOCN-35-4648-s002.docx (20.6KB, docx)

File S4: Detailed descriptions of the nine core competency domains.

JOCN-35-4648-s004.docx (19.6KB, docx)

Data Availability Statement

The data that supports the findings of this study are available in the Supporting Information [Link], [Link], [Link], [Link] of this article.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

File S1: Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) Checklist.

JOCN-35-4648-s001.docx (67.1KB, docx)

File S2: Full search strategies for all resources.

JOCN-35-4648-s003.docx (21.8KB, docx)

File S3: Technical terms related to IPC nurses' core competency.

JOCN-35-4648-s002.docx (20.6KB, docx)

File S4: Detailed descriptions of the nine core competency domains.

JOCN-35-4648-s004.docx (19.6KB, docx)

Data Availability Statement

The data that supports the findings of this study are available in the Supporting Information [Link], [Link], [Link], [Link] of this article.

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