infection prevention
By Sue Barnes , RN , CIC , FAPIC
The Imperative of a Physician Partner for Every Infection Prevention Program
The Society for Healthcare Epidemiology of America
( SHEA ) whitepaper from 2015 states , “ To effectively serve in these various roles , the physician partner for infection prevention programs requires formal support to protect time and effort for training activities and professional development .” 9
There are currently tremendous improvement opportunities in the United States relative to the prevention of healthcare-associated infections ( HAIs ), and the resulting patient harm and organizational cost . The Centers for Disease Control and Prevention ( CDC ) estimates that HAIs account for approximately 1.7 million infections and 99,000 associated deaths each year . 1 Prevention of HAIs can result in savings of between $ 1,000 and $ 40,000 per patient depending on the specific infection and healthcare setting . 2 Many variables affect the success of an infection prevention program including the strong partnership between this department and an infectious diseases ( ID ) physician . 3 , 4
In many U . S . hospitals , an ID physician serves as the chairperson or co-chairperson of the infection prevention committee and may also assist the infection prevention department as an advisor and partner . Where it exists , this role is often not compensated . 5 , 6 “ Administrative time ” is sometimes granted , but this time may or may not be spent in activities supporting the infection prevention program . The same ID physician is typically responsible for the antibiotic stewardship program ( ASP ) as well as clinical patient care , including ID consults , which are each separate and apart from the infection prevention program .
In a 2015 study assessing physician resourcing for ASP and infection prevention , the researchers reported an average staffing level for the combined programs of 1.21 / 100 beds . 7 Five years later , in a study by Stone still in press , only 49 percent of the hospitals reported the presence of a physician partner for the infection prevention program , and most ( 71 percent ) were only part-time . 8
The Society for Healthcare Epidemiology of America ( SHEA ) whitepaper from 2015 states , “ To effectively serve in these various roles , the physician partner for infection prevention programs requires formal support to protect time and effort for training activities and professional development .” 9 However , in the absence of a regulatory mandate this does not happen universally . There is currently no requirement by the Centers for Medicare and Medicaid Services ( CMS ) or The Joint Commission ( TJC ) for a physician partner for infection prevention programs , at the local and / or corporate level .
Unfortunately , even when there is an ID physician designated to assist the infection prevention program , there is no guarantee that the physician has had the
• appropriate training regarding prevention and control of HAIs , including outbreak investigation . There is currently no regulatory requirement for training of these physicians , and no process for certification . The Infectious Diseases Society of America ( IDSA ) offers an online course , though references the Association for Professionals in Infection Control and Epidemiology ( APIC ) guidelines for specifics . 10 SHEA also offers an online course , although it covers only the basics . 11 Neither provides certification .
Similarly , to date there is no standard role description for the physician partner for infection prevention programs in the U . S . However , there have been commentary and guidelines published . For example , the 2015 SHEA whitepaper proposes that the competencies required for this position should include :
● Data management and surveillance
● Leadership
● Microbiology and laboratory diagnostics
● Outbreak investigation
● Prevention and control of healthcare associated infections
● Quality improvement science
● Training and teaching methods and principles 9
These competencies translate to a myriad of responsibilities which vary greatly from hospital to hospital , even within the same integrated delivery network ( IDN ). In addition to the core responsibilities of the ID physician ( i . e ., clinical patient care , antibiotic stewardship , ID consults ), functions supporting the infection prevention department commonly include one or more of the following :
● Meet regularly with the infection prevention team to review ongoing issues / opportunity areas / work plan status
● Co-chair the Infection Prevention and Control Committee
● Co-lead annual infection prevention work plan development based on results of risk analysis
● Partner with the infection prevention team on key performance improvement projects
● Interface with physicians to ensure compliance with products and practices supporting the infection prevention program ( e . g ., hand hygiene , isolation and personal protective equipment ( PPE ) use , disinfection and sterilization , line insertion , surgical prep )