Researchers develop formula to determine infection prevention staff needs
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Key takeaways:
- Infection preventionists spent most of their time doing off-site consultations.
- Researchers developed a formula to determine how many infection prevention staff they needed.
Infection prevention staff at Boston Children’s Hospital learned that the complexity of certain tasks is an important factor for determining staffing needs, rather than just using the number of beds.
“Reflecting the broad scope of the infection preventionist role, the Association for Professionals in Infection Control MegaSurvey 2020 found that only 14% of respondents reported having the entirety of their responsibilities devoted to infection prevention activities,” Lindsay K. Weir, MPH, CIC, lead infection preventionist at Boston Children’s Hospital, and colleagues wrote in American Journal of Infection Control.
“Our assessment appears to be one of the few published infection prevention staffing assessments to specifically address the needs of ambulatory/procedural and pediatric settings,” Weir told Healio.
Weir and colleagues evaluated how the infection control staff at their pediatric health system spent their time throughout the week and determined whether staffing levels aligned with the demand for their services. When the study was conducted in 2021, they had seven full-time infection prevention employees who traveled between 10 locations as needed.
In addition to calculating the amount of time staff spent on certain types of tasks, the researchers factored in the complexity of the tasks as well. Some complexity indicators included high-level disinfection, performing surgical procedures and performing aerosol-generating procedures.
Over the 2021 fiscal year, infection prevention staff completed 47,621 ED visits, 25,816 surgical cases, 357,992 ambulatory treatments or infusions and 691,917 ambulatory visits, the researchers wrote. Their results identified 237 unique locations and services that infection prevention employees attended, and almost 80% were not at the hospital’s main campus. Further, half of the locations and services had at least one complexity indicator, and nearly 10% had three or more. They found that 80 locations and services included aerosol-generating procedures.
According to Weir and colleagues, infection prevention staff spent 18.7 hours per week doing on-site work. In contrast, they spent 120.5 hours per week off site, most of which were consultation hours. Infection prevention employees spent the smallest proportion of off-site time (10.2 hours per week) on professional development and quality improvement.
Weir and colleagues calculated how many staff members they needed by adding the hours spent onsite and offsite, as well as the hours they spent each week on education and divided the total by 40 hours. They learned that the 181 hours infection prevention staff spent each week on ambulatory and procedural tasks required 4.5 full-time employees, but they had only two staff members dedicated to those duties at the time.
After presenting this deficit to hospital leadership, the infection prevention department was authorized to hire four more staff members.
“While every hospital and system will be different in terms of their infection prevention staffing needs, we hope that our work provides a framework for quantitatively assessing current operations and translating these findings into compelling business cases for additional staff resources,” Weir told Healio. “I hope that future infection prevention staffing research moves beyond determining baseline operational needs and moves toward developing models that maximize staff professional development and research opportunities.
“We don’t want our departments to be surviving; we want them to be thriving,” she said.
Perspective
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Ruth Carrico, PhD, DNP, APRN, CIC, FSHEA, FNAP, FAAN
Patient care in all settings continues to become more complicated and more complex. The results from this study highlighted the impact on infection prevention and control programs. Those findings were not surprising, and they underscored the critical need for expertise in the broad field of infection prevention and control. The authors identified the need for process and practice surveillance, highlighting the importance of clinical acumen. In the evaluation of procedures, collaboration with departments that ensure adequate supplies and equipment for patient and health care worker safety are also vital activities that take time, attention and specialized knowledge and competence. The study authors further stressed the integration of infection prevention and control with related functions such as quality and education.
After spending more than 30 years in the field of infection prevention and control, these findings reflected what I have experienced in the evolving revolution of this field. There are some valuable additional take-home messages that can inform those providing care in all settings where health care is delivered as well as guide research interests and activities. First, take-home messages for front-line staff emphasize the importance of infection prevention and active collaboration with infection preventionists in identifying gaps and challenges with evidence-based practices. Take-home messages for infection preventionists include the need to develop their own professional development agendas to identify practice areas where knowledge base is under-developed as well as heighten knowledge in related fields such as quality, patient safety, advanced epidemiology, supply chain and value analysis, and industrial hygiene. In addition, the findings serve as an important basis for research beyond staffing patterns. How to integrate findings from time spent performing surveillance, use and incorporation of technologies including artificial intelligence in surveillance as well as education, change management and implementation science approaches that facilitate and guide change are just a few examples of research opportunities.
The results of this study should have broad application in highlighting the changing competencies needed among the infection prevention and control community and inform future training and education at the academic and practice levels. Shining a light on the changing landscape of health care and the increasing challenges present in meeting both care and patient outcome expectations with respect to infection prevention serves the health of the public well. Now, the next step is developing firm plans of action using those findings to further integrate infection prevention and control into all levels of health care operation.
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