APIC's MegaSurvey Chronicles the Profession's Progress, Future Direction

By Kelly M. Pyrek

The perspectives of more than 4,000 infection preventionists (IPs) have been captured by the Association of Professionals in Infection Control and Epidemiology (APIC) in its MegaSurvey conducted in 2015 to chronicle the progress that the profession is making in developing strategies to support comprehensive infection prevention practice.

"The MegaSurvey was a culmination of the efforts of many individuals on the Research Committee and the MegaSurvey task force under the leadership of the board of directors and our CEO, with the goal of deriving a better understanding of the current state of infection prevention," says Timothy Landers, PhD, RN, CNP, CIC, chair of the APIC Research Committee and associate professor at the Ohio State University College of Nursing. "We will use the MegaSurvey data to help guide the future-oriented growth of the profession and how we can get the infection prevention profession to where it needs to be."

APIC undertook the MegaSurvey to create a baseline of data to answer critical questions related to practice and competencies, organizational structure and staffing, compensation, and the demographics of IPs. As Landers, et al. (2017) write, "The APIC Strategic Plan 2020 identified key goals for the organization in patient safety, implementation science, IP competency, advocacy, and data standardization. Despite in-creasing recognition of the importance of infection prevention, relatively little is known about contemporary IP practice. To provide resources to support IPs and identify future directions for infection prevention, it is critical to understand IPs' practice environments, demographic characteristics, organizations in which they work, and the relative importance of different domains of their practice."

“Infection preventionists are the backbone of efforts to prevent infections in healthcare settings,” says Landers. “To provide resources to support IPs and identify future directions for infection prevention, APIC felt it was critical to understand IPs’ current practice environments.”

Results from the APIC MegaSurvey will allow for a better understanding of IP roles and responsibilities by facility type, years of experience, professional development, and current position, and will provide insight into opportunities for professional development. 

Landers and colleagues found that all the practice domains of the APIC Competency Model for the Infection Preventionist were rated as “important” or “very important” to supervisors or managers of IPs. Surveillance and investigation accounted for the most time in an IP's typical day, followed by prevention and control of transmission, identification of infection, and management and communication.

“The APIC MegaSurvey data establishes a benchmark for practice and compensation data, and suggests directions for future growth of the IP role,” says Landers. “Forthcoming articles, developed by the APIC Research Committee, will provide in-depth analyses of the data to frame IP practice for the coming years.” Landers continues, "The first paper, published in AJIC, presented the overall methodology and findings. We have five other groups of authors who are presenting further analysis of the MegaSurvey data, and one of the specific areas of focus is on validating the competency model to see if it is currently reflecting contemporary IP practice. I think it is holding up well. There are some domains that IPs tend to focus on more than others but overall, the competency model seems to be a good description of the IP role. We want IPs to have the biggest impact in protecting patients and healthcare workers and keeping them safe from infections. While it's about professional development and skill sets, it's also about the value that the IP brings to the healthcare organization, too."

APIC has established a number of goals for itself and its members, including:
- Demonstrate and support effective infection prevention and control as a key component of patient safety.
- Promote and facilitate the development and implementation of scientific research to prevent infection.
- Define, develop, strengthen and sustain competencies of the IP across the career span and support board certification in infection prevention and control to obtain widespread adoption.
- Influence and facilitate legislative, accreditation, and regulatory agenda for infection prevention with consumers, policy makers, healthcare leaders and personnel across the care continuum.
- Promote and advocate for standardized, quality and comparable healthcare-associated infection data.

As Landers, et al. (2017) write, "Infection preventionists are the backbone of efforts to prevent infections in healthcare settings. IPs are responsible for a wide range of activities, including identifying outbreaks, implementing preventive measures, monitoring compliance, and developing organizational capacity in response to infection-related issues."

"One of the biggest takeaway messages from the MegaSurvey was that the profession is experiencing a natural maturation of the discipline in various areas evolution of the IP role in management, communication and research," Landers says. "One of the things the education commit-tee and practice guidance committee will be looking at is where should we be investing in terms of the capacity of members."

The MegaSurvey found that respondents reported surveillance and investigation as the most frequent activities by IPs, accounting for approximately 25.4 percent of infection prevention efforts.

"The surveillance component seems to be taking on more importance, so we'll be looking at that in greater detail," Landers says. "I think it is becoming increasingly clear that IPs need to be actively engaged in research and quality improvement activities as well as their core activities. Our research groups will examine what we need to do to promote or increase the capacity in those domains."

According to Landers, one of the upcoming articles that will be of most interest to IPs will address staffing levels, organization and support of infection prevention and control programs. The MegaSurvey revealed that among all participants, the average salary was $76,933 (median, $75,000; range, $25,000-$225,000). The researchers found that individuals with current CIC certification had higher base compensation than those without current CIC certification ($85,911 vs $68,817). The factors most frequently reported by participants as the criteria for compensation included experience (54.6 percent), performance measures (41.0%), highest degree earned (38.8 percent), and CIC certification (31.5 percent).

As Landers, et al. (2017) write, "A forthcoming article will address IP satisfaction with compensation and the factors associated with satisfaction with compensation. The goal of this article will be to provide an overview of IP compensation based on current practice setting, experience, and other factors. This is important because it will help organizations plan compensation packages that are more conducive to future recruitment strategies, encouraging retention of IPs as well as increased productivity (metrics-based performance) and higher levels of satisfaction."

"The MegaSurvey has helped us benchmark compensation," Landers confirms. "Our detailed compensation report, available in the APIC Store, breaks down IP salaries by region, by background, etc. to help provide benchmark data that will be helpful to healthcare organizations. In the survey we found that the average IP comes to the role with 15 years of prior healthcare experience so I think using the data from the MegaSurvey to increase visibility of IPs can help us recruit people. I teach in a college of nursing so I'm aware of the importance of getting the profession in front of nursing students. In addition to receiving their clinical instruction it's our hope that we can get them exposed to the infection prevention and control discipline earlier in their careers, which could help us grow the profession."

Additional articles stemming from the MegaSurvey findings will cover IP compensation, expansion of the IP workforce to include professionals with non-clinical backgrounds, roles and responsibilities of IPs working outside of the acute-care setting, and strategies to support certification. With regard to CIC certification, the MegaSurvey found that 37.7 percent reported that they planned to sit for certification in the future and 8.3 percent were unsure about future certification. Specifically, 19 percent of participants planned to sit for CIC during the next 12 months, and 18.7 percent reported that they planned to pursue certification in the future. Among all participants, 8.3 percent were unsure if they would be pursuing certification, and 5.2 percent of respondents reported that they were not considering certification.

Landers and colleagues report that the issue of staffing levels is perhaps among the most urgent and common concerns expressed by IPs. They say that variations in staffing levels, organizational structure, and support of infection prevention and control (IPC) programs will be explored in another article. As they explain, "That article will describe the current staffing levels, organization, and support of IPC programs across different types of practice settings to examine the relationship between organizational structure, staffing, and resources for IPC and facility characteristics. This information will be useful also in terms of benchmarking and developing business cases for additional staffing and re-sources."

One of the more intriguing findings of the MegaSurvey is that although approximately two-thirds of IPs work in the acute care/inpatient set-ting, one-third work with long-term care facilities, outpatient settings, ambulatory care or other settings. Landers says an upcoming article will describe the current roles and responsibilities of IPs outside of the inpatient setting, including examining the implementation of infection prevention and control as well as and surveillance policies and practices in the ambulatory care setting and to describe the current spectrum of roles and responsibilities of IPs working in this environment. Landers says differences in staffing, resources and support for infection prevention and control will be explored, as will types of roles and responsibilities across different types of ambulatory care settings, and their implications for new and creative ways to meet the needs of IPs working to prevent infections in non-acute care settings. As Landers, et al. (2017) write, "To date, there is a paucity of research from these types of settings of the IP role in the implementation of IPC activities and the resources dedicated to IPC. Better understanding of the resources available and best practices related to IPC in ambulatory care is needed to improve practice."

Landers indicates that APIC will continue to conduct MegaSurvey types of assessments to determine future directions. "The plan is to periodically revisit this and look at the growth of the profession," Landers says. "One of the most exciting things about the MegaSurvey is that it is not a stagnant snapshot but something we can use to plan APIC's priorities and activities that can really make a difference for us as a profession."

As Landers, et al. (2017) note further, "To achieve APIC's mission, a standardized level of IP competency with future-oriented growth and influence on infection prevention, control, and patient safety, a thoughtful, diligent approach to the current and desired future state is required. It is hoped that these analyses will provide the platform from which we can demonstrate infection prevention as the key element of patient safety on our road to 2020 and beyond."

Reference: Landers T, Davis J, Crist K and Malik C. APIC MegaSurvey: Methodology and overview.  Am J Infect Control. Feb. 2017.