The Case for Dedicated Infection Preventionists

The role is more critical than ever, and facilities that can’t afford one should take steps to compensate for the gap.

Surgical leaders often wear the infection preventionist (IP) hat for their ASC by necessity. While juggling numerous responsibilities, they do their best to put together an infection control program that outlines specific risks, methods of data collection and prevention strategies.

All accreditation agencies require ASCs to have someone identified as an infection preventionist. Not all who have this title are certified in that discipline, however, and many don’t have all the training they need to optimally perform the job. With the increasing complexity of new technologies in the OR and more stringent post-pandemic infection control requirements, facilities would be wise to consider a dedicated, full-time infection preventionist.

Outpatient Surgery Magazine spoke with two such experts — Michelle Schmitz, BS, CIC, and Benjamin D. Galvan, MLS(ASCP), CIC, CPH — about the importance of having a dedicated infection preventionist at your ASC and, for those on limited budgets, how an ASC can best accomplish a successful IP program without one.

The value of specialization

A staff member whose only function is to handle Infection Prevention and Control (IPC) issues is preferable to designating IP duties to someone who already serves in another function, according to Mr. Galvan, director of infection prevention at two HCA Florida Healthcare hospitals in Tampa.

“Infection preventionists are there to solely evaluate and manage their local IP programs,” he says. “Without a dedicated IP, a facility may not be able to truly assess what opportunities they have from a prevention standpoint, which is more important than ever as regulatory requirements become more stringent as they relate to IPC program requirements and activities.”

A full-time person can better handle the scope of the job, which is far broader than healthcare-acquired infection prevention and surveillance, notes Ms. Schmitz, clinical infection control practitioner at University of Wisconsin Health in Madison.

A dedicated employee could perform dozens of tasks, including consultation on product selection, shortages and recalls; how to clean and disinfect the environment; how to sterilize instrumentation; and how to perform construction safely within facilities. IPs also work on issues such as sharps safety, personal protective equipment, additional safety for immunocompromised staff and patients, quality improvement work, communicable disease exposure risk, informatics, antimicrobial stewardship, manufacturer instructions for use and policies and procedures.

“It would be very difficult to ask one individual to tackle all that and take on another job role at the same time,” says Ms. Schmitz. “There just aren’t enough hours in the day, and the focus would be spread so thin that some practices would suffer as a result, leading to an unsafe and potentially dangerous environment for staff and patients.”

Make infection prevention a top priority

Despite the requirement to have an infection control program, few ASCs have dedicated IPs. A primary reason for that is likely not understanding the wide array of components a complete IPC program should include, according to Ms. Schmitz and Mr. Galvan. Ms. Schmitz adds some leadership might not assign a high enough value to infection prevention, and Mr. Galvan says some facilities wrongly think that it’s enough to simply develop an infection prevention plan.

“It’s relatively simple to develop an IPC program on paper, but without someone who truly understands infection prevention tracking performance and evaluating the effectiveness of the program, it’s hard to say whether or not it is truly being implemented,” he says.

Cross-train only if you must

SHEDDING LIGHT A dedicated infection preventionist can advise staff on the latest technologies, such as UV disinfection systems.

Many facilities have decided they simply cannot afford a dedicated person to fill the role on a full-time basis. When that’s the case, exploring the dual-role position is an option. Doing so successfully can depend on the size of the facility and the training level of the person who might be assigned the additional workload.

“Infection prevention work couples nicely with clinical nurse specialists, or those who perform quality and safety, regulatory or employee health tasks,” says Ms. Schmitz. “Many times, the lines are blurred between these roles and individuals in these positions work together collaboratively to achieve a safe work and healthcare experience for all.”

“If there is a cost-related deterrence to having a full time IP, facilities could certainly integrate core IPC practices into another role,” adds Mr. Galvan. “However, it may be more difficult to fully understand what those core functions entail.” IP consulting firms are available to provide services that can meet the needs of ASCs while also respecting their cost limitations, he adds.

Getting up to speed

The good news is that training programs abound for surgical center employees to learn all about the best and latest infection prevention practices. The Association for Professionals in Infection Control and Epidemiology (APIC) offers online and in-person training sessions and conferences. APIC also has local chapters in every state that provide additional training and support to help members achieve certification. State public health agencies can provide additional training and often hold conferences related to infection prevention work, says Ms. Schmitz.

The National Health and Safety Network (NHSN), funded by the Centers for Disease Control and Prevention, offers multiple online training sessions on surveillance of hospital acquired infections. The CDC’s Project Firstline (osmag.net/3GUANCc) offers free education to frontline healthcare workers on essential concepts of infection control in health care, adds Mr. Galvan.

In addition, AORN’s ASC Academy offers the comprehensive “Infection Prevention Online Course”. The Society of Healthcare Epidemiology of America (SHEA) operates several conferences which provide individual knowledge in infectious diseases and the Certification Board of Infection Control and Epidemiology (CBIC) offers three certifications — a-IPC, CIC and LTP-CIC — depending on an individual’s level of expertise, education and experience in the field.

The pandemic effect

Before COVID-19, infection preventionists were viewed through a very narrow lens, essentially seen as mere data collectors who enforced regulatory compliance, says Ms. Schmitt. The pandemic widened that view, but more work can be done to shed light on all that an IP does do as an integral member of a larger team who collaborates with all its members.

“Infection preventionists use evidence-based medicine while following regulatory guidance to ensure the safety of patients, visitors and employees from hospital acquired infection, communicable disease, construction contaminants and other hazardous materials,” she says.

Mr. Galvan believes IPs are sought out more now for their expertise after their work was in the spotlight during the COVID response. “The pandemic highlighted the importance of infection preventionists and how much of a need there is to spread knowledge about core infection control practices with frontline healthcare workers,” he says. “We’ve seen the global effect the pandemic had on healthcare-associated infection rates, particularly in the COVID-19 population, and as a result we must continue to appreciate the value that infection preventionists bring to healthcare settings.”

Whether ASCs have full-time dedicated IPs or train another team member to adopt the role, a qualified person will identify pathways to infection and understand how to interrupt those pathways by leveraging evidence-based best practices, professional guidelines and subject matter expertise, says Mr. Galvan. OSM