From Concept to Impact: Deeper Dives: Regional Variations and Staffing Models

The increasing complexity of the infection preventionist (IP) role, particularly in the years following COVID-19, has placed unprecedented strain on infection prevention programs, which are universally tasked with doing more with less. Yet this universal struggle often masks critical differences: Have you ever wondered how your department’s staffing model compares with peers in another state, or why resource allocation varies so widely across health care regions?

As 2 IP system directors, we frequently lamented how challenging it was to benchmark our growing demands against national standards, given the diverse regional and organizational approaches to resource management. This observation sparked a collaborative effort, which developed from a simple concept into a major publication in the American Journal of Infection Control (AJIC).

The Mystery of the Overburdened IP: Unpacking Regional Workload

Our survey on IP staffing confirmed a universal truth: IPs are working excessive hours nationwide. But our data unearthed a more specific, intriguing challenge: The IP workload is anything but uniform. Specifically, our findings revealed a significant gap in average weekly work hours, with IPs in the Western region logging nearly 44.9 hours a week, while those in the Northeast averaged a leaner 41.6 hours.¹ When we see regional differences like this, it’s a hint that this variation isn't simply about hospital size or complexity; it's about the underlying invisible currents that demand an IP's time. When we originally looked at the raw data and saw variations in the average number of hours, we were intrigued. We had all sorts of “maybe’s” and “I wonder…” but these ideas coalesced into a few future research topics worth exploring.

Even in our initial conversations, we marveled at the regulatory differences between Dartmouth Medical Center in New Hampshire (Northeastern US) and the University of California, San Francisco in California (Western region), where we both worked.

As an IP in California, there are more regulatory requirements for reporting hospital-acquired infections (HAIs), including the types of surgical site infections (SSIs) in National Healthcare Safety Network², than in New Hampshire. I also shared that California has a state law requiring all hospitals to meet “earthquake” criteria by 2030. ³ Because renovating existing structures to meet the requirements was extremely expensive, some facilities opted to build new towers instead of remodeling.

However, when reviewing the data as an IP in New Hampshire, I would assume that one reason for the variability in working hours between the Northeast and Western regions was the size of hospital staffed beds. However, staffed bed data from the Medicare Cost Report actually show that hospitals in the Northeast have the highest average number of beds: 177.⁴

In the northeast, there may also be more hospitals located in closer proximity to one another, allowing for shared resources and regional support networks, which has been my experience. Additionally, in larger hospitals in the northeast, IPs are likely dedicated to the infection prevention department rather than performing multiple roles, such as occupational health, quality, or emergency preparedness.

We also noted that the local infectious disease environment plays a role. A large-scale outbreak like a regional measles cluster that originated in Texas ⁵ demands immediate, intense effort, such as extensive contact tracing, communication, and support of front-line staff, and frequent communication with public health departments, which can last months. This quickly adds hours to the IP work week, fueled by event-driven pressures.

The necessity for disaster preparedness and response similarly adds a consistent strain on hours. Regions prone to specific natural disasters, such as wildfires in the West or hurricanes in the Southeast, require IPs to dedicate substantial time to proactive planning, drills, and emergency management infrastructure. This work is often federally or locally mandated. Invariably, when disasters occur, IPs are actively involved in supporting emergency response and the facility's subsequent return to normal operations.

The Ins and Outs of IP Staff Sharing

Historically, IPs with clinical backgrounds wore multiple hats, including employee health or part-time patient care. Given the expanding scope of the IP role, we questioned what the "new normal" for staff sharing looked like. The results were surprising: Only 13% of participants reported their IP departments provided support to another team, while just 20% received support from internal departments.¹ Intriguingly, this sharing occurred not at small community hospitals, as it had historically, but at large, complex medical centers.

This shift makes sense upon reflection. For simple, standalone hospitals, IPs tend to be self-sufficient. While this gives them full program ownership, it places a heavier, siloed workload entirely on their shoulders. In contrast, larger, complex systems act as collaborative hubs. They are most likely to insource support from roles such as data analysts and epidemiologists.¹

This diversified external support is a huge benefit, allowing IPs to concentrate on core infection control while building a more diversified skill set through cross-functional work. To build this crucial network and move beyond the limitations of isolated staffing, organizations must formally integrate the IP function across all hospital operations. This integrated approach, which we term the "integrated services advantage,” is the key to creating a resilient safety infrastructure.

Making Collaboration Work: Leveraging the Integrated Services Advantage

One of the most valuable lessons from our survey is that simply having a large IP team isn't enough; what matters is how well that team is supported by the rest of the hospital. We found that the largest and most complex systems are the winners, benefiting most from both giving and receiving support, thereby creating a robust safety net. This suggests that the ideal staffing model isn't a silo; it's a network.

For less-integrated organizations, the successful strategy is to formally embed the IP function throughout the organization. Instead of having IPs struggle to juggle everything, successful collaboration involves carving out specific, time-consuming tasks and assigning them to specialized partners. Critically, our data showed that IPs in complex systems received key support from data analysts, epidemiologists, and medical directors, illustrating how larger organizations insource specialized expertise to alleviate siloed workloads.This leveraging of expertise allows IPs to focus on core tasks that require their subject matter expertise.

Furthermore, the quality department (QD) offers a natural conduit for collaboration, given its deep intertwining with patient safety, regulatory, and risk. Hospitals should maximize this by establishing joint committees in which IP and QD share objectives and resources. By making IP expertise readily available to QD (outsourced) and receiving support in return (insourced), facilities can transform a fragmented workload into a cohesive safety infrastructure. Cross-training between IP and QD further reinforces this synergy, fostering shared language, goals, and accountability for patient safety.

Moreover, leadership engagement is critical to sustaining a collaborative model. Organizations where leaders routinely include IPs in operational and strategic decision-making see more consistent alignment between infection prevention priorities and institutional strategic goals. In turn, this leads to a reduction in patient harm and overall cost avoidance. As a result, the future of infection prevention lies not in expanding teams in isolation but in designing interconnected systems where expertise is exchanged freely, ensuring both efficacy and efficiency.

What We Learned: Recommendations for Future Research

What we gleaned from our discussions and the statistical analysis of the survey data is profound: The challenge of IP staffing is a complex mix of politics (regulations), geography (disease and disaster risk), and organizational collaboration. While we can propose informed hypotheses about what might be driving variation in hours worked, additional research using standardized data and metrics is needed to confirm our findings and flesh out potential causes. Our recommendations on topics for future research:

• Quantifying External Pressures: To accurately quantify the possibility of variations in regional workload variations, we recommend that studies investigate state-specific regulatory requirements, trends in infectious disease outbreak/ exposure responses, and preparedness and responses to natural disasters. Understanding external pressures will help distinguish between systemic and situational workload drivers.
• Modeling Interdepartmental Support: While our study focused on acute care facilities, our small sample size was only a snapshot into how interdepartmental support may look across the US. We recommend including a diverse range of facility types and sizes in future research to build a complete national picture.
• Formalizing Collaborative Networks: We recommend that future studies evaluate 2 aspects of collaboration: first, how IP skills are leveraged to support other departments and create new professional growth paths; and second, which external departmental skills are most valuable in supporting the IP program (eg, data analysis). This dual perspective provides invaluable insight into how organizations can leverage existing resources when adding staff isn't an option, while also developing a more diversified skill set for IPs and developing a cross-trained workforce
• Integrative IP Staffing Calculator: To move beyond static calculators, we strongly advocate research into AI-powered staffing models. These tools would use machine learning to dynamically adjust IP staffing based on real-time factors (eg, patient census, active outbreaks, and regulatory changes). This approach will allow for continuous improvement and customization to an organization's unique needs.
• Evaluating Workforce Sustainability: Finally, future research should explore how staffing models, collaboration structures, and leadership engagement influence IP job satisfaction, burnout, and retention. Sustainable workforce planning is essential to maintaining infection prevention capacity amid growing regulatory and epidemiologic demands.

Ultimately, by pursuing these future research topics and integrating data on hours worked with funded full-time equivalents (FTEs), we can provide IPs requesting additional resources with a robust, detailed case that is individualized to their facility's needs. Together, these research priorities will help the field move from anecdotal staffing benchmarks toward data-driven, adaptable models that strengthen both patient safety and workforce well-being.

References

1. Doran B, Swain J, Knighton S. Quantifying the progressing landscape of infection preventionists: a survey-based analysis of workload and resource needs. Am J Infect Control. 2025;53(6):669-677.
2. California Department of Public Health. Healthcare-associated infections (HAI) program: HAI reporting guidance for California hospitals. Published 2020. Accessed April 9, 2026. https://www.cdph.ca.gov/Programs/CHCQ/HAI/Pages/CA_SpecificReportingGuidelines.aspx
3. California Hospital Association. 2030 seismic requirements. Accessed April 9, 2026. https://calhospital.org/issues/2030-seismic-requirements/
4. Definitive Healthcare. What is the average number of beds in a U.S. hospital? Published January 15, 2025. Accessed April 9, 2026. https://www.definitivehc.com/resources/healthcare-insights/us-hospitals-average-beds
5. Measles cases and outbreaks. CDC. Published 2025. Accessed April 9, 2026. https://www.cdc.gov/measl
6. es/data-research/index.html

To read more about our publications and work on this topic:

1. "Post-COVID Learnings from an Infection Prevention Staffing Survey" Brenna Doran and Jessica Swain Prevention Strategist, Spring 2024.

This article offers key insights from a survey on infection prevention staffing in the post-COVID-19 era.

Prevention Strategist (APIQ) - Spring 2024 - Post-COVID Learnings From an Infection Prevention Staffing Survey

2. "Quantifying the Progressing Landscape of Infection Preventionists: A Survey-Based Analysis of Workload and Resource Needs" Brenna Doran, Jessica Swain, and Sarah Knighton American Journal of Infection Control, 2025.

Dive deeper into the research that quantifies the workload and resource needs of infection preventionists today.

https://www.sciencedirect.com/science/article/pii/S019665532500104X

3. "Burnout, Beds, and Budgets: The Hidden Reality of IP Staffing" (Podcast Episode No. 46) Hosted by Nikki Shore and Jessica Swain. American Journal of Infection Control: Science Into Practice Podcast, May 10, 2025.

Listen to this podcast for a candid discussion on the challenges and realities of infection prevention staffing, including burnout and budget constraints.

https://ajicscienceintopractice.org/episode/46-burnout-beds-and-budgets-the-hidden-reality-of-ip-staffing/