as optional and static. Given their impact on the safety, quality and operations of healthcare facilities, the expectations for facility IP & C programs must be raised, moving to maximally effective programs that are foundational and influential parts of the facility’ s operational structure, resourced with the correct expertise and leadership, and prioritized to address all potential infectious harms.”
The position paper emphasizes that an IP & C program may be active but not fully effective. As we know, the Centers for Medicare & Medicaid Services( CMS) requires an“ active” IP & C program, but the agency does not clearly define what it considers to be an active program. Lacking these clear definitions of program effectiveness, SHEA indicates that many facilities meet minimum standards without achieving comprehensive infection prevention efforts. The whitepaper authors advocate for revised standards that promote continuously improving, data-driven IP & C programs with measurable outcomes.
The position paper attempts to make this distinction between active and effective by explaining that,“ One facility’ s IP & C program that has an infection prevention committee with policy review, reports the required HAIs to CMS, and meets regulatory expectations might be deemed as‘ active.’ However, compare that facility to the effectiveness of another, where in addition to the above, the IP & C program partners with frontline staff in proactive practice assessments to reduce HAIs and track other infectious harms. Most importantly, the second facility conducts rigorous review of all HAIs for patterns of variability in expected practices, develops action plans for improvement, and sets and communicates institutional metrics and expectations for infection prevention for all its personnel. Comparatively speaking, the first facility may be‘ active’ but not as‘ effective’ as the second.”
The difference between these two states of being may hinge upon how robust – or likely under-powered – most IP & C programs are these days. As Talbot, et al.( 2025) emphasize,“ IP & C programs remain under-resourced and under-prioritized. The resources and support that facilities provide for their IP & C programs are often extensively scrutinized and are constantly under threat. IP & C programs are under-resourced and underprioritized for a number of reasons, such as failure to add more resources to the IP & C program in the setting of facility expansion and delegation of IP & C leadership to individuals without the necessary competencies in infection prevention. These approaches reflect the perception that an adequately resourced IP & C program that is able to address all infectious harms is optional and static,
I think we cannot ignore the resource piece, especially right now given all of the financial stressors that have and will hit healthcare this year. Other than that, I think there’ s never been an explicit call and expectation to have programs staffed with trained leaders in a structure that aligns accountability.”— Tom Talbot, MD, MPH, FSHEA, FIDSA
instead of being a foundational necessity that accommodates healthcare facilities of all types and sizes. Some facilities may only focus on publicly reported HAIs or IP & C program functions that are expected by regulatory agencies instead of fully addressing the larger harms and activities that are not‘ required’ but directly impact patient and facility outcomes. This under-resourced approach fails to recognize how the work of the IP & C program is vital to the facility’ s efficiency, effectiveness, and financial stability and neglects the larger burden of preventable harms. It is time to raise the bar for IP & C programs to ensure they are adequately and appropriately resourced, led, and supported.”
Talbot addresses what he sees as some of the biggest barriers to facilities moving from active to effective.
“ I think we cannot ignore the resource piece, especially right now given all of the financial stressors that have and will hit healthcare this year,” he says.“ Other than that, I think there’ s never been an explicit call and expectation to have programs staffed with trained leaders in a structure that aligns accountability. We’ re hopeful that this paper can be used by various groups to move facilities forward.”
Continuous improvement is challenging, and Talbot offers his advice on helping IPs and others responsible for improvement processes stay motivated and inspired for the long haul.
“ Strive for the small but incremental wins,” Talbot says.“ We do not think one can go into leadership with the paper and say,‘ OK, give me all of these resources right now.’ That’ s not realistic. The hope is that this creates that dialogue and leads to plans on building up the IP & C program through prioritization and risk assessment.”
Key recommendations from the position paper include:
• Healthcare facility leaders and regulatory partners should prioritize the expectation that IP & C programs address all infectiousrissand harms as a core requirement.
• IP & C program leaders should have direct access to senior facility executives who can provide prompt support for IPC initiatives.
• Regulatory agencies and other evaluators of healthcare facility quality should assess IP & C program leadership, including resource allocation, staff competencies, and leadership structures( such as the presence of a dyad leadership model), during facility surveys.
• Adoption of a dyad leadership model to strengthen communication, collaboration, and the achievement of institutional goals. This model features two leaders from different professions sharing responsibilities: a medical director of IP & C and an infection preventionist director of IP & C. Competencies for each role are outlined in the position paper, aligning with the complexity and evolving needs of modern healthcare organizations.
The societies emphasize that“ prioritizing effective IP & C programs is critical not only for strong patient care, but also for sound financial and operational strategies that reduce preventable harms, enhance healthcare quality, and build public trust. Future initiatives will focus on providing healthcare facilities with tools and training to support the implementation of these best practices.”
Not every hospital’ s C-suite may be ready to own their part of the IP & C equation, and Talbot acknowledges the long journey ahead toward improved resourcing for programs.
“ I think every facility is different, and right now, it may be tough to get more resources. That said, we think this paper is the most comprehensive call for explicit detailed structure and resources for IP & C programs. It can be used to map out the plan to reach a maximally active and effective program.”
Reference:
Talbot TR, Baliga C, Crapanzano-Sigafoos R, et al. SHEA / APIC / IDSA / PIDS Multi-society position paper: Raising the bar: necessary resources and structure for effective healthcare facility infection prevention and control programs. Infect Control Hosp Epidemiology. Published online by Cambridge University Press April 28, 2025.
may-june 2025 • www. healthcarehygienemagazine. com •
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