Credentialing, competence and certification: Infection Prevention and Control as a specialty

Protecting the public and assuring patient safety is a major driver in the regulation of healthcare providers and professions. Initial registration, and more recently periodic revalidation of many healthcare professions, provides one mechanism of such assurance. However, higher professional training and the development of specialist knowledge, skills and expertise may not result in a qualification that is registered or recorded by regulatory bodies, credentialing of such qualifications instead falling to professional organisations including medical colleges. The IPS vision/mission is at the centre of the Society’s commitment to the education of practitioners and the protection of patients being treated and cared for in healthcare settings.

In 2011, the Society’s five-year strategic plan (Storr et al., 2011) included a commitment to add value to its membership by building on the outcome competencies for practitioners in infection prevention and control (Burnett et al., 2011) by exploring accreditation of education and professional development. In addition, the prospect of creating ‘Fellows’ of the Society was identified as an aspiration. Over the span of the 2011–2016 plan, accreditation in the form of CPD points has been implemented in the annual international conference, specialist symposia and at Branch level by the Trent and East of England branches. The aspiration of establishing a framework and process for IPS members to seek recognition for their specialist expertise, through certification, similar to that pursued by colleagues in North America (Certification Board for Infection Control and Epidemiology [CBIC]) and Australasia (Australian College of Infection Prevention and Control [ACIPC] Credentialing Programme), has also been explored and discussed by the IPS Board and Consultative Committee, and the new IPS strategic plan (2017–2020) commits to move beyond a focus on competence to one that also offers credentialing.

In 2015, as part of the implementation of the UK Antimicrobial Resistance Strategy, the Centre for Workforce Intelligence undertook a review of the infection prevention and control (IPC) workforce which was defined as nursing working in the specialty. The review took the form of interviews with 19 senior IPC nurses, a horizon scanning workshop (or focus group) with ten healthcare professionals and the analysis of workforce data. Although the review missed the opportunity to examine the workforce in the wider IPC team, it identified that this needed to be undertaken in the future and highlighted the need to improve the quality of IPC workforce data. Authors commented that there was no consistency in person specifications for the IPC nurse role, no recognised IPC qualification, and that teams and service delivery models across different healthcare settings were variable. Clearly there are some anomalies in these findings. Role descriptions are based on Agenda for Change and are therefore consistent within the framework, but the banding for different roles, particularly that of the team leader, is variable and many higher band posts have been reassessed in the past six years. The reviewers’ conclusion that no core competencies existed for IPC nurses was misinformed. The work to develop the outcome competencies for practitioners in infection prevention and control (Burnett et al., 2011) was led by IPS, funded by the Department of Health and involved all four UK government leads for IPC. Skills for Health supported the development process and the resulting framework was ‘a milestone in the evolution of infection prevention and control practice in the UK’. Finally, while the ENB 329, Foundation in Infection Control Nursing disappeared in 2002 when the NMC was established, it has been replaced by level 7 higher education (HEI) programmes in infection prevention and control across the UK, many of which map their content and outcomes to the above competencies. Over the past two years, the Education and Professional Development Committee (EPDC) has undertaken a review and revision of the competencies and a scoping of specialist IPC education. The competencies are currently out for consultation and will be closely aligned with the credentialing framework and the work on recommended content and outcomes for specialist IPC courses within the HEI sector will follow.

The terms credentialing, competency and certification are often used interchangeably. The International Council of Nurses has adopted the board definition offered by Styles and Affara (1997):

‘Credentialing is a term applied to processes used to designate that an individual, programme, institution or product have met established standards set by an agent (governmental or non-governmental) recognised as qualified to carry out this task. The standards may be minimal and mandatory or above the minimum and voluntary. … Credentials are marks or “stamps” of quality and achievement communicating to employers, payers, and consumers what to expect from a “credentialed” nurse, specialist, course or programme of study, institution of higher education, hospital or health service, or healthcare product, technology, or device. Credentials may be periodically renewed as a means of assuring continued quality and they may be withdrawn when standards of competence or behaviour are no longer met.’

In the field of IPC, the term certification is used in Europe and North America, while colleagues in Australia use the term credentialing, to refer specialist knowledge, skills and experience meeting defined education and practice standards or competencies. The most established process for certification is operated by CBIC in North America. Originally set up in 1981 by Association of Professionals in Infection Control and Epidemiology (APIC), CBIC offers an internationally recognised, examination-based certification and re-certification programme that results from regular practice evaluations to ensure that the process keeps pace with change (Goldrick, 2012). The recently launched ACIPC model of credentialing builds upon the original Australian Infection Control Association process; it has three levels that each have prerequisite ACIPC membership, knowledge, attitudinal and practice requirements (ACIPC, 2016). The three levels of credentialing are: Primary Credentialed Practitioner; Advanced Credentialed Practitioner; and Expert Credentialed Practitioner. In Europe, over the past eight years several collaborative projects involving DG SANCO, the European Centre for Disease Control (ECDC), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the Health Protection Agency (now Public Health England), have been working towards the European Council Directive for the harmonisation of IPC education and training (Directive 2011/24/EU European Parliament and Council) (Table 1). The impact of the recent UK referendum on EU membership on our participation in these initiatives is uncertain.

Table 1.

European Initiatives to Harmonise Infection Prevention and Control Training.

European entity	Project	Focus
DG SANCO	Improving Patient Safety in Europe (IPSE)	Training needs analysis and core curriculum (IPSE, 2009)
ECDC	Training in Infection Control in Europe (TRICE)	Training needs analysis (ECDC, 2013)
ECDC	Implementation of a training strategy for infection control in Europe (TRICE-IS)	Development of a taxonomy and wiki platform to share education materials
ESCMID	European Committee on Infection Control	Establishing a European (board) Certificate for IPC professionals (Zingg et al., 2015)

Credentialing offers several benefits and can be used to build personal and professional capacity by expanding upon the skills and knowledge of existing IPC practitioners and attracting new practitioners, thereby increasing the number of people with the IPC knowledge and skills. Over the next 12 months a credentialing sub-group of the EPDC, which represents the Society’s current membership profile, will develop a framework and process for credentialing IPC expertise. The ACIPC model (2016) will provide a template for our ideas as it fits with IPC professional education in the UK and is consistent with developments in the EU. Consultation with the IPS Consultative Committee will be ongoing throughout the development process and a wider consultation with all members will be undertaken in September 2017 with the aim of completing the work for the beginning of 2018. The IPS Board strongly believe that providing a credentialing framework for members will provide recognition of higher professional training and raise the profile of IPC as a specialty; provide assurance for employers that the IPC service is lead, managed and delivered by a capable workforce; and offer assurance for health consumers’ that the care provided by health professionals in an organisation is safe, effective and efficient. This is an exciting point in the further development of the Society and we look forward to sharing our progress with you over the next 12 months.