There is a direct correlation between how well an infection prevention program is staffed and a facility's rate of infection.
Your reaction might be "duh," but the scientific proof was elusive — until APIC's new Center for Research, Practice, and Innovation applied a new staffing calculator. This tool, applied across nearly 400 acute care hospitals, drew a straight line between inadequate staffing and higher infection rates.
Using a similar framework as the staffing calculator, Boston Children's Hospital took into account the complexity of infection prevention work required for the best staffing regime at a pediatric hospital. After they ran the numbers, the team was allowed to hire four additional infection preventionists.
This outcome is ideal and hopefully will be a trend within the field.
The findings from these studies, published in consecutive weeks in the American Journal of Infection Control, demonstrate the need to institutionalize use of the staffing calculator.
APIC calls on hospitals to utilize the tool to assess IP staffing needs and invest in the appropriate number of staff based on the specific needs of each institution.
But that isn't enough. APIC urges CMS and standards bodies, such as The Joint Commission, to put some teeth behind it and require use of the APIC staffing calculator to determine appropriate IP staffing needs.
Here's the backstory.
When the beta version of the staffing calculator was released in December 2023, hospitals started entering their data. They included various risk factors that might increase a facility's need for infection prevention staffing, such as an organ transplant program or a burn center in which patients are highly susceptible to infection and require additional precautions. Theoretically, facilities like that would require more IP staff than those without specialty units.
Three hundred and ninety U.S. acute care hospitals entered data. The algorithm compared each facility's current staffing ratio to a standardized staffing recommendation. Hospitals with staffing levels below the recommended threshold were found to have higher standardized infection ratios for three common healthcare-associated infection types.
The conclusion was startling. The research team found that nearly 4 out of 5 hospitals that utilized the calculator reported staffing levels that were insufficient to account for the complexity of their patient population and services.
At Boston Children's Hospital, researchers factored in complexity variables during a comprehensive needs assessment, such as the use of endoscopes and high-level disinfection or sterilization at the main hospital and satellite facilities, to make the best staffing recommendations.
Both of these studies support the growing body of literature that describes what should seem obvious — for infection preventionists to be effective in their roles, they must be sufficiently staffed based on the complexity of their work environment.
Resistance from hospital management is understandable. Infection prevention departments often do not typically generate revenue and, at times, are seen as cost centers to be minimally funded in order to meet regulatory and advisory requirements.
The primary measure used by IP departments that have successfully advocated for growth is cost avoidance. However, this measure only accounts for the handful of infection types that are measured and publicly reported. It ignores what is likely the majority of HAIs (those not included in the surveillance plan), putting patients at risk and undervaluing the impact of this critical profession.
Patients rightfully expect that when they enter a healthcare facility, they will get well rather than get an infection. And certainly, no healthcare provider starts their shift with the intent of precipitating one. Regardless, HAIs remain a significant cause of patient harm.
As IPs, we create processes and protocols, establish active disease surveillance, conduct patient and caregiver education, and directly observe practice to prevent infections. IPs are also expected to maintain a level of expertise about the rapidly evolving infectious disease landscape that seems to throw us a new curveball each week.
IPs cannot depend on the voluntary compliance of hospitals to outdated staffing models based merely on the number of beds in a facility. Staffing assessments must account for both the complexity of the patient population and the services provided.
Every hospital should be required to use a comprehensive needs assessment process, like the staffing calculator, to determine the adequate number of infection preventionists needed to keep patients safe, with federal oversight ensuring at least a minimum standard.