From Concept to Impact: A Collaborative Journey in Infection Prevention Staffing

Brenna and Jessica meeting to discuss this research idea

(AI image by Brayden Unger)

Part 1: The Spark: Unmasking the Hidden Workload

The field of infection prevention has always been dynamic, but the past few years have brought unprecedented challenges to the forefront, particularly regarding staffing and workload. In this inaugural piece of our 6-part series for Infection Control Today^®, we, Brenna Doran and Jessica Swain, will take you behind the scenes of our journey to quantify the evolving landscape of infection preventionists (IPs). This is the story of how a shared frustration ignited a collaborative research effort, leading to an impactful article, a comprehensive research manuscript, and even a podcast, all aimed at shedding light on the critical issue of IP staffing in modern health care.

Inception of the Idea: When Frustration Fuels Research

Our personal inspiration for delving into the demanding world of IP workloads stemmed from a place of shared experience and mounting frustration. As infection prevention system directors, we frequently found ourselves lamenting the myriad challenges posed by our current staffing levels. The conversations often revolved around how our dedicated teams managed to accomplish their extensive work, a feat that often felt herculean. It became clear to both of us that existing staffing recommendations were grossly inadequate and failed to account for the breadth and depth of what was being asked of us daily.

The struggle is real: How do you justify the need for additional full-time equivalents (FTEs) when the work prioritized for you already consumes more hours than there are in a standard workweek? We felt the weight of this disconnect daily, as we championed the efforts of our teams while simultaneously grappling with the systemic under-resourcing of our infection prevention programs.

The COVID-19 pandemic, while highlighting the critical role of IPs, also exacerbated these issues, pushing many IPs to work well beyond normal hours, including evenings, weekends, and holidays, simply to keep patients and staff safe. This emergent work piled onto an already extensive list of standard duties, from regulatory preparedness and construction risk assessments to surveillance of health care-associated infections (HAIs) and continuous committee work. This personal experience of trying to keep up with the demands while feeling perpetually understaffed was the initial spark.

The "Aha!" Moment: From Regional Lament to National Crisis

What began as a lament between 2 colleagues soon culminated in a profound "aha!" moment. Through our ongoing conversations, we recognized that the critical issue of inadequate IP staffing transcended our individual regions and states; it was, in fact, a national challenge. The increasing demands placed on IPs, while presenting both similar and distinct facets across different organizations, universally led to unmanageable workloads.

The existing body of literature, we observed, simply wasn't adequately addressing the increased expertise IPs were expected to provide, nor the expanded scope of work they were responsible for. We realized that if 2 IPC leaders, deeply embedded in the field, were experiencing such acute staffing pressures and feeling unheard, then countless other IPs across the country were likely facing similar, if not identical, struggles. This revelation transformed our shared frustrations into a collective understanding: our common experience needed national input from other IPs and empirical data to truly illustrate IPs current state.

The pandemic had unmistakably brought to light the impact of insufficient IP staffing, particularly in long-term care facilities, which suffered disproportionately from COVID-19-related mortality and morbidity due in part to inadequately staffed infection prevention programs. However, even as the need for IPs soared, hospitals faced severe financial strains, with many operating with negative financial margins and experiencing higher labor expenses and lower patient volumes.¹ This created a tricky dynamic: Hospitals were required by regulation to have IP programs, but these programs were not revenue-generating, making it difficult to justify additional staffing despite their proven ability to reduce healthcare-associated infections and generate cost savings. This growing disconnect between the essential nature of IP work and the financial realities of health care organizations cemented our belief that this was a critical issue demanding investigation.

Diverse Perspectives, Shared Purpose: Shaping the Study's Direction

Our collaboration brought together different perspectives and roles, which ultimately enriched the direction and scope of our study. We engaged in passionate discussions about the practical realities of how our respective teams approached their work and what the organizational expectations were for their involvement. This wasn't just about the "what," but also the "how" – how the work was done in our organizations, and equally important, how that work was supported, and by whom.

We expanded our discussions to include how the field of infection prevention has evolved over time, sharing insights into how we approached the work in prior organizations. We also actively connected with a range of colleagues and peers working in various IP roles to gather additional, diverse insights. This broad outreach allowed us to paint a more comprehensive picture of the challenges and nuances faced by IPs across different settings and career stages. We took all the valuable information we had gleaned from these conversations and meticulously considered what a national-level study might look like. Our goal was to design research that was both inclusive of diverse IP experiences and representative of what the average IP was truly experiencing within their organization, ensuring the study reflected the real-world demands and complexities of the role.

Key Questions from the Outset: Guiding Our Initial Inquiry

From the very beginning, our primary goal was clear: to understand how infection prevention departments are staffed to meet the complex needs and expectations of their organizations. We specifically wanted to investigate how all organizations, regardless of size or complexity, address the fundamental core infection prevention work. This includes critical duties like surveillance of HAIs, outbreak management, policy development, education, and regulatory compliance.

Beyond this core, we were deeply curious about how infection prevention programs adapt their approaches as their organizations grow in size and complexity. For instance, in a smaller, less complex organization, a solo IP might function as a generalist, handling a broad spectrum of responsibilities. But how do larger, more intricate academic facilities with their broader scope of services, higher patient acuity, and greater service complexity meet these expanded needs through a team of IPs? Do these teams specialize, and if so, how is that specialization structured within the department?

We also examined whether IPs concurrently work in other roles, such as employee health. This question was critical to understanding the true workload and potential for role diffusion within organizations. Finally, a key inquiry was to understand how other organizational departments support the infection prevention program. This explored the concept of "insourcing" and "outsourcing" of IP functions, shedding light on the collaborative dynamics and resource sharing within healthcare institutions. These core questions formed the bedrock of our initial inquiry, setting the stage for a research endeavor that would ultimately unveil the hidden workload of IPs across the nation.

Conclusion: Volunteering to Create the Path Forward

The start of this journey, in the summer of 2023, led us to volunteer to write an article for the Prevention Strategist magazine. As editorial panel members, our conversations made it clear we weren't alone in our questions or in the relentless struggle to keep pace with an ever-growing workload. We offered to write an article because we suspected many of you are experiencing the same pressures. While we still needed to figure out how we were going to collect the voices of other IPs, and narrow down the questions we had, we were energized and excited.