The CDC recommends that healthcare organizations have an IP & C program that is sustainable . Today , in many organizations , IP programs are insufficient and unsustainable , and when COVID was at its peak , some hospitals continued surveillance , but many others didn ’ t because they were overwhelmed , understaffed and underresourced .”
Steed agrees , noting that , “ We must continue to champion scientific advancement in infection prevention and control practice . An example of that is the desire to have – when faced with emerging pathogens that are aerosol generating , airborne droplet transmitted – one mask that could effectively fit anyone ’ s face , protect the provider , and not require fit testing . One of the most frustrating experiences during the pandemic was that people would put on a surgical mask and not don it correctly . How can we develop a mask that you put it on , and you don ’ t have to do much to it to make it fit except for just press it around your nose make sure it ’ s in the right place . That sounds simple , but it ’ s not . I would love to see that so you didn ’ t have to worry about all the complication of N95s and fit testing , and of course , during the supply chain challenges , there were shortages of PPE and protocols went out the window because no one could afford the time it took to fit test .”
An additional conundrum that Steed points to is balancing increasing workloads in a shrinking workforce that may have a suboptimal infrastructure .
“ The CDC recommends that healthcare organizations have an IP & C program that is sustainable ,” she says . “ Today , in many organizations , IP programs are insufficient and unsustainable , and when COVID was at its peak , some hospitals continued surveillance , but many others didn ’ t because they were overwhelmed , understaffed and under-resourced . CDC ’ s clear message to healthcare leaders is you must examine your infection prevention and control program and figure out how to make it more robust and sustainable through things like pandemics , emerging pathogens and other challenges . Some people say the CDC is criticizing them , but remember , infection prevention is the business of the healthcare organization , but we can only do as much as we can in a 24-hour day . This is important messaging to corporate healthcare leaders – we must wake them up .”
Many IPs maintain that without adequate staffing , they cannot continue to meet the demands which a post-COVID world are placing on their institutions , which are already stretched thin .
“ There must be more research on staffing ,” Steed confirms . “ The problem is , staffing ratios are not regulated . However , corporate healthcare leaders won ’ t like regulation . That ’ s exactly what is happening for long-term care , where CDC suggests that if
you ’ ve got more than 100 long-term care beds , you need a full-time IP . Now , if you look at acute-care facilities , they haven ’ t caught up . This issue needs to be prioritized and researched further .”
Stone , et al . ( 2009 ) were among the first to analyze staffing and structure of hospital-based infection prevention and control programs . They sent a Webbased survey to 441 hospitals that participate in the National Healthcare Safety Network . The response rate was 66 percent ( n = 289 ); data were examined on 821 professionals . Infection preventionist staffing was significantly negatively related to bed size , with higher staffing in smaller hospitals . Median staffing was one IP per 167 beds . Forty-seven percent of IPs were certified , and 24 percent had less than two years of experience .
Furthermore , researchers have found that how IPs spend their “ time varies significantly from hospital to hospital and is driven in part by regulations , by the priorities of hospital administration and supervisors of IP , and by the strengths and interests of the IP .”
In 1969 , the CDC recommended one FTE per 250 occupied beds in acute care . APIC ’ s Delphi Project suggested one IP for every 100 occupied beds in acute care . Bartles , et al . ( 2018 ) found that infection prevention FTE needs of the system as a whole were under-represented by 66 percent when using the lower staffing ratio benchmark of 0.5 FTE per 100 beds‐ 37.435 versus actual 108.40 ; also under-represented by 31 percent when using the higher staffing ratio benchmark of 1.0 FTE per 100 beds – 74.82 versus actual 108.40 . 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 infection prevention oversight .
While the staffing issue remains a challenge that APIC and others are attempting to address , the chronic , perennial problems that IP & C programs are tasked to solve – such as hand hygiene compliance , proper donning and doffing of PPE , etc . – remain as competing priorities .
“ Those chronic issues are always there , they always need attention , time , money and effort put toward them ,” Pettis confirms . “ I think that is probably the main reason so many people in infection prevention are thinking about retiring . In infection prevention , you ’ re never quite there , you ’ re never done , and we now have lost so much ground in terms of HAI prevention because of the pandemic . We must reclaim that lost territory but there are so many plates spinning already . So as IPs , we must keep our wits about us , keep our heads on straight and constantly conduct risk assessments so we can prioritize . I think it ’ s easy to use the pandemic as an excuse not to do everything that we should . It ’ s too easy to fall back and say , ‘ well , you know that ’ s why we ’ re not able to do that right now .’ But even if the IP can keep those plates spinning , they are likely asked to do even more , and they look