Infection Control Today

AUG 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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28 ICT August 2018 feature www.infectioncontroltoday.com S evere gaps in staffng and outdated coverage benchmarks point to the critical need for evaluating and updating standards for infection preventionist (IP) staffng levels, according to two new studies that explored infection prevention and control resourcing across a variety of healthcare settings. The studies were published in the American Journal of Infection Control (AJIC), the journal of the Association for Professionals in Infection Control and Epidemiology (APIC). A comprehensive staffng and coverage assessment conducted at Providence Health & Services, a large nonproft healthcare system, revealed that actual IP labor needs were 31 percent to 66 percent higher than the current benchmarks system wide. The Providence study was conducted for all physical locations within the system that required IP oversight, including 34 critical access, community, and tertiary hospitals; one rehabilitation hospital; 13 in-home care programs; 13 long-term care facilities; and 583 ambulatory locations. After aggregating system-wide needs, the assessment team concluded the new benchmark should be 1.0 IP full-time equivalent (FTE) per 69 beds, indicating a greater IP need than the previously accepted standard of 0.5-1.0 FTE per 100 beds. The new benchmark considers IP oversight for all physical locations including ambulatory, long-term care, and home care settings. As Bartles, et al. (2018) explains, "The IPC FTE needs of the system as a whole were underrepresented by 66 percent when using the lower staffng ratio benchmark of 0.5 FTE per 100 beds and by 31 percent when using the higher staffng ratio benchmark of 1.0 FTE per 100 beds. When aggregated across the organization, the comprehensive review results yielded a new benchmark of 1.0 IPC FTE per 69 beds for the enterprise, including all care settings requiring IPC oversight." "The study shows how important it is to conduct thorough needs assessments before determining staffng models for any given organization," says Rebecca Bartles, MPH, CIC, FAPIC, the study's lead author. "While a one-size-fts-all model can't necessarily account for differences across systems, there would be immense value in large healthcare systems pooling together quantitative needs assessment data for analysis." The study was key due to a lack of data in the existing evidence. As Bartles, et al. (2018) observe, "The current resources available to assist an IPC leader in determining appropriate staffing are largely based on surveys of historical IPC program staffng within the United States and Canada. When diving deeper, the actual demand for IPC services is signifcantly higher than even the highest staffng ratio benchmark, revealing a gap of which most IPs are acutely aware. All available peer-reviewed literature presents staffng as a ratio of IPs to inpatient beds, which does not take into account the complex nature of the work and the varying degree of acuity and risk in different care settings. Because of the lack of a quantitative methodology in the literature for determining IP staffng needs based on actual services required, many healthcare organizations are still staffng to an antiquated, insuffcient standard, with many staffed below even this mark." The results revealed that the actual percentage of time IPs spent conducting sur veillance activities – which include monitoring health outcomes, analyzing processes of care, and working to improve those processes based on the outcomes – took an average of 51 percent of current working hours. All IPs interviewed agreed that although most of their time was spent on surveillance and reporting, the most valuable use of their time is conducting environmental rounding and engaging in caregiver education activities. As Bartles, et al. (2018) note, "The categories of rounding, education, and professional development are where the greatest gaps appear between current and ideal practice. All IPs interviewed agreed that although most of their time was spent on surveillance and reporting, the most valuable use of their time is conducting environmental rounding and caregiver education activities. All group participants agreed that having an IPC presence on each inpatient unit at least fve days per week, even for as few as 5 to 10 minutes, was of great value to the program." The researchers continue, "During the staffng model development process, many regions determined that a percentage of surveillance activities could be accomplished by a lesser-skilled individual, leaving additional time for the IP to interact in patient-care areas. Some regions chose to add support positions to support the work of the IPC team, including project managers, data analysts, and admin- istrative support. Other facilities determined that their needs would best be met by having their IPC staff specialize in a single-care setting, including acute care, ambulatory care, long-term care, or in-home care. Still, other facilities determined that having their IPC staff focused on a particular service line New Studies Illustrate the Need for Rigorous Review of Infection Preventionist Staffng Models Across Healthcare Systems feature

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