The Infection Preventionist in Long-Term Care : With Whom Will You Fill the Role ?
The IP position involves many different roles .
They include leader , critical thinker , communicator , educator and collaborator .
These roles often intersect and combine throughout the
IP ’ s day .
Each of these roles are necessary to the IP being successful in this position .
By Cindy Fronning , RN , GERO-BC , IP-BC , AS-BC , RAC-CT , CDONA , FACDONA
In
2016 the new Rules of Participation were issued . There were many changes with three different start dates : Nov . 28 , 2016 ; Nov . 28 , 2017 ; and Nov . 28 , 2019 . In November 2019 , the new rule for infection preventionists ( IPs ) became effective . It stated that :
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● The facility must designate one or more individuals as the IP who is responsible for the facility ’ s infection prevention and control ( IP & C ) program
● The IP works at least part time at the facility
● The IP has completed specialized training in infection prevention and control
● The IP must be a member of the QA & A committee and report to this committee regularly
There has been no additional guidance since the rule was finalized ; however , there is promise of interpretations , but none have been forthcoming as of now . We do have the Infection Prevention , Control & Immunization survey task tool ( CMS-20054 ) last revised in May 2021 that describes what the surveyors will be looking for . Unfortunately , not all long-term care facilities acted on this directive and were found in surveys to be in non-compliance by either not having an IP or the individual lacked the specialized training that was needed to be compliant .
Prior to November 2019 , an article , “ CMS Deadline Nears , But Infection Control in Long-Term Care a Challenge ,” was posted by Relias Media . It stated , “ The IP position turned over within a year 39 percent of the time , and by two years , over half of them have left .” It went on to say that all IPs responding to the study claimed at least one additional responsibility to their IP role , and some up to four additional roles .
This study also revealed that the most common reason for the IP turnover was a turnover in directors of nursing ( DONs ), with 55 percent reporting turnover in DONs and that brought new duties and expectations . Workload was the third reason for leaving .
A study by APIC quoted in this article stated , “ Limited IP experience and turnover will pose a significant challenge for SNFs in trying to meet CMS mandates .”
Margaret Drake , author of the previous study , also presented her research at the 2019 APIC annual conference . In that presentation she stated that IPs were “ attempting to function in many leadership roles and very frequently are working on the floor as a nurse and a CNA . It is very typical for nursing leadership to go 13 to 16 days without a full day off . Typical days are 10 to 14 hours long .”
With the arrival of COVID-19 and throughout the pandemic siege we have seen the IP position turnover rate increase , so , many administrators or DONs have had to hire several nurses into this position . With that in mind , how do we keep IPs in their positions and how do we hire the right ones ?
When hiring an IP , what characteristics should the candidate possess ? To determine that , let us look at what being an IP involves .
The IP position encompasses many different roles . They include leader , critical thinker , communicator , educator and collaborator . These roles often intersect and combine throughout the IP ’ s day . Each of these roles are necessary to the IP being successful in this position .
As an effective leader , the IP administers the IP & C program through determining program priorities , responding to IP & C events and identifying and initiating performance improvement projects ( PIPs ). The IP advocates for resources for the program through interactions with administrative and clinical leadership and through the QA & A committee . The IP is accountable for the results of the program , shows integrity and has skills in organization and time management . Lastly , the IP must be able to challenge expectations and consider alternative viewpoints such as barriers to vaccinations by involving front-line staff in discussions to identify confusion and misunderstandings and attempt to educate and overcome these misconceptions .
As a critical thinker / data analyst , the IP uses the scientific evidence found in the literature and governmental guidance and translates it into practice . Performance and outcome surveillance data is used to determine IP & C activities . The IP will also use this data to shift priorities and resources when new issues arise , such as an outbreak or , as we have recently