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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29 August 2018 ICT or activity would be the most benefcial (e.g., reprocessing, surveillance, rounding). Staffng models and needs varied widely based on size and structure of each region." Bartles, et al. (2018) acknowledge the limitations to this quantitative staffng approach: "Inherent error likely occurs when caregivers are asked to estimate the number of hours historically spent conducting a task or the amount of time it might take to conduct a future task. Additionally, there are no recent studies available that correlate increases in staffng with decreases in hospital-ac- quired infections; therefore, the threshold at which these two relate is not known. Finally, priorities for IPC services will vary at each entity. Although this assessment does not fully take into account potential changes to IPC programs in the future, the tool itself is intended to do just that. Used on a routine basis, this method will allow an organization to continue to understand their staffng needs as they evolve. In summary, it is necessary to conduct a comprehensive assessment of the composition of a healthcare organization prior to determining the IPC staffng needs for that specifc organization. Hospital size, scope, services offered, populations cared for, and type of care settings all impact the actual need for infection prevention coverage. A one-size fts all model cannot be developed because of the signifcant variation from facility to facility and system to system; however, a better proxy could be developed if enough large healthcare systems pooled together quantitative needs assessment data for analysis." A second study, analyzing infection prevention staffing and resources in U.S. acute-care hospitals based on results from the 2015 APIC MegaSurvey, exposed similar gaps. The article, by Monika Pogorzelska-Maziarz, PhD, MPH, CIC, and colleagues, drawing from 1,623 survey respondents, provided a snapshot of IP staffng and resources in acute care hospitals, fnding important differences between small and large facilities. Pogorzelska-Maziarz acknowledges the history of IP staffng ratios: "Since 1980, multiple authors have updated the IP staffng ratio recommendation using diverse methodologies. In a 2002 Delphi study conducted by O'Boyle et al, IP a staffng ratio of 1 FTE IP per 100-167 beds was recommended.7 In a 2015 systematic review of the literature conducted by Zingg, et al., the authors recommended a ratio of 1 FTE IP per 100 beds in acute care hospitals and added that an effective infection prevention program should also include a dedicated physician trained in infection control, as well as microbiological and data management support. The evolving IP staffng ratio recom- mendations were attributed to increasing job demands, expectations, and workload of infection prevention departments. To establish actual IP staffng levels and resources available to infection prevention departments, multiple state and national surveys have been conducted. In 2007, Stone et al conducted a survey of 289 U.S. hospitals participating in the National Healthcare Safety Network (NHSN). Study fndings indicated a current median staffng level of 1 IP per 167 beds, or 0.69 IP per 100 beds. A study by Krein, et al. reported a statistically signifcant increase in staffng ratios between 2005 and 2008 in non-federal acute care hospitals, from 0.67 to 0.8 IP FTE per 100 beds. This trend in higher IP staffng was also noted in a follow-up 2011 survey study by Stone et al of 975 NHSN hospitals. The survey fndings indicated that IP staffng had increased to a median staffng level of 1.2 IP per 100 beds. Although IP staffng recommendations and actual staffng levels have increased signifcantly since 1980, many think that IP staffng levels have not kept pace with the increasing responsibilities of the IP and the expanding scope of infection prevention depar tments. Because the nature of infection prevention and control in hospitals is rapidly evolving, we conducted a secondary analysis of survey data from a cross-sectional, national study to describe the current staffng levels, organization, and resources for infection prevention programs in U.S. acute care hospitals." Among the APIC MegaSurvey's fndings: • The way in which IPs spent their time differed between those that were employed by larger vs. smaller hospitals. IPs working in smaller hospitals spent a signifcantly smaller proportion of their time on surveillance and prevention and control of HAI transmission, and a larger proportion of their time on employee and occupational health, along with education and research. The way in which IPs spent their time in smaller hospitals potentially refects the additional responsibilities they may have in addition to infection control. • Overall median IP staffng was 1.25 IPs per 100 inpatient census. • Responses echoed results from other published studies, fnding that few IPs had data management or secretarial support, particularly in smaller hospitals. Being able to delegate administrative tasks frees the IP to spend more time on infection prevention-related work. "The relationship between IP staffng and rates of healthcare-associated infections has been documented," says Pogorzelska-Maziarz, PhD, MPH, CIC, FAPIC, lead author of the APIC MegaSurvey article. "This study sheds light on the fact that individual organizations should conduct routine assessments to ensure IP staffng is matching the demands of the facility, and it demonstrates the need for information-sharing among organizations." Pogorzelska-Maziarz adds, "There is ongoing discussion in the feld regarding the need to update IP staffng recommendations. This is because of the changing nature of healthcare and the growing responsibilities and expanded settings for infection prevention and control departments. Additionally, there is growing acknowledgment that infection prevention and control programs objectives, priorities, and staffng may be best established by the size and acuity of the patient population, local epidemiology, and regulatory and accreditation requirements at the local level. Consequently, a single staffng ratio may not be appropriate for all hospitals." Both studies support the view that IP staffng recommendations should be based on the care and services provided by a healthcare institution, rather than on a single ratio, which may not be appropriate for all models. "As the responsibilities of infection prevention and control departments have grown, and the settings of care requiring IP services have expanded, many IPs fnd that they lack time to conduct activities that will have the most impact on preventing health- care-associated infections, such as interacting with frontline teams in patient care areas," says 2018 APIC president Janet Haas, PhD, RN, CIC, FSHEA, FAPIC. "These studies demonstrate the critical need to reevaluate staffng models to ensure that the demand for IP services is being adequately met so that we can effectively protect patients from infections." References: Bartles R, Dickson A and Babade O. A systematic approach to quantifying infection prevention staffng and coverage needs. American Journal of Infection Control. Vol. 46, No. 5. May 2018. Pogorzelska-Maziarz M, Gilmartin H and Reese S. Infection Prevention Staffng and Resources in U.S. Acute Care Hospitals: Results from the APIC MegaSurvey. American Journal of Infection Control. Article in press: https://doi.org/10.1016/j. ajic.2018.04.202 Since 1980 , multiple authors have updated the IP stafng ratio recommendation using diverse methodologies. Ò

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