Pediatric Healthcare Facilities Need More Staff Dedicated to Infection Prevention
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Tencic and Roche ( 2023 ) sought to describe nurses ’ perceptions of the impact of nurse-patient ratios on IP & C by using a questionnaire with items drawn from pertinent research . Data were collected from 51 nurses on 12 units in a large tertiary referral hospital where a minimum 1:4 patient ratio had been recently introduced . More than half had experienced a 1:4 ratio on their most recent shift . Nurses in this group indicated that they could complete infection control-related care in a timely manner , were more likely to provide infection control-related patient education and had more time to communicate with the treating team about infection control matters . As the researchers note , “ The link between nursing workload and patient safety is well-established . High nurse workload has been associated with missed infection control practices and healthcare-acquired infections . Approaches such as nurse – patient ratios provide a mechanism to sustain appropriate staffing and to strengthen infection control practices .”
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Clifford , et al . ( 2022 ) sought to quantitatively evaluate relationships between infection preventionists ( IPs ) staffing levels , nursing hours , and rates of 10 types of healthcare-associated infections ( HAIs ) covering 1.6 million patient days of surveillance . The researchers found that IP staffing levels fluctuated from ≤2 IP FTE ( critically low ) to 7-8 IP FTE ( recommended levels ). Periods of highest catheter-associated urinary tract infection SIRs , hospital-onset Clostridioides difficile and carbapenemresistant Enterobacteriaceae infection rates , along with 4 of 5 types of surgical site SIRs coincided with the periods of lowest IP staffing levels and the absence of certified IPs and a healthcare epidemiologist . Central-line-associated bloodstream infections increased amid lower nursing levels despite the increased presence of an IP and a hospital epidemiologist . Of 10 HAIs , the researchers found that eight had the highest incidences during periods of lowest IP staffing and experience . Some HAI rates varied inversely with levels of IP staffing and experience and others appeared to be more influenced by nursing levels or other confounders .
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Wundavalli , et al . ( 2020 ) found that the World Health Organization ’ s Workload Indicators of Staffing Need
Pediatric Healthcare Facilities Need More Staff Dedicated to Infection Prevention
new paper published mid-October
A in the American Journal of Infection Control describes efforts at a major children ’ s hospital to assess and fulfill its staffing needs for infection prevention and control , highlighting the challenges of allocating sufficient resources to this important role . Infection preventionists ( IPs ) at Boston Children ’ s Hospital found that conventional methods for calculating the number of staff for these roles do not accurately reflect the current needs of healthcare systems or the specific needs of a pediatric patient population , and that a new approach is required to ensure patient safety .
While infection prevention is widely regarded as critical for hospitals and other healthcare facilities , properly staffing these roles has long been a challenge , in part because IPs are expected to take on many responsibilities that are not directly associated with infection prevention and control . In a survey conducted by the Association for Professionals in Infection Control and Epidemiology ( APIC ) in 2020 , just 14 percent of respondents said that their work was fully focused on infection prevention activities . Most respondents were also expected to perform quality improvement , education , and regulatory compliance work in addition to their infection prevention responsibilities .
The conventional approach to calculating IP staffing needs is based on the number of inpatient beds at a hospital , but this method does not take into account key trends in healthcare such as increased outpatient procedures , shorter durations of hospital stays , and more focus on ambulatory services . The need for IPs is likely to be significantly higher than an inpatient-bedonly calculation would suggest .
In their new paper , IPs described a detailed assessment of the infection prevention and control needs at Boston Children ’ s Hospital , which includes more than 40 different clinical departments and handles more than 47,000 emergency department visits and more than 690,000 ambulatory visits annually , based on data for fiscal year 2021 . At the time , hospital IPs were responsible for supporting the main hospital campus , four satellite campuses , four doctor ’ s offices , and a community health center . The needs assessment focused on time devoted to on-site and off-site responsibilities , as well as an evaluation of ambulatory location complexity .
The complexity variables studied show that work performed by IPs is highly complex , with half of all services evaluated found to have at least one complexity indicator and many having two or more . Based on the estimate of how much time was needed to perform all required tasks , the team found that the hospital was operating at an IP deficit . Their calculation called for 4.5 full-time IPs for the ambulatory and procedural departments , and only two full-time IPs were already on staff in these locations . This finding was presented to hospital leadership , along with a business case for adding more infection prevention and control resources . Approval for new hires was granted , and four additional full-time IPs were added to the staff to increase support for the ambulatory and procedural departments and to add new infection prevention and control and quality improvement capabilities . Beyond highlighting staff shortages , the detailed assessment also allowed department leadership to understand how staff IPs were spending their time and to re-prioritize those responsibilities as needed .
“ Our work highlights the complexity and scope of infection prevention and control needs in pediatric ambulatory and procedural settings , areas for which little published infection prevention staffing data exist ,” says Lindsay Weir , MPH , CIC , lead infection preventionist at Boston Children ’ s Hospital and first author of the paper . “ We hope that our work helps other infection prevention programs advocate for the critical resources they require to meet the expanding needs of their ambulatory and procedural services . “
Additional details from the study include :
• Complexity variables included factors such as using endoscopes or similar devices , and performing high-level disinfection or sterilization , surgical procedures , and aerosol-generating procedures , among others .
• Complexity was calculated for 237 locations and services , with nearly 80 % outside the main hospital campus .
• IPs reported spending the most time on providing consultations , and the least time on professional development and quality improvement projects .
• The assessment focused on the hospital ’ s current needs , but the authors point out that by the time the analysis was finished , a new satellite location had been opened and plans for a new satellite campus were already underway .
Reference : Weir L , Ormsby JA , Vaughan-Malloy AM and Chandonnet C . Determining Infection Prevention Staffing Needs for the Pediatric Ambulatory and Procedural Care Setting . Am J Infect Control . Oct . 17 , 2024 . https :// doi . org / 10.1016 / j . ajic . 2024.08.011
november 2024 • www . healthcarehygienemagazine . com •
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