From Earthquakes to Rural Shortages: How Geography Shapes Infection Prevention

Geography plays a decisive role in how hospitals staff their infection prevention and control (IPC) departments, with research showing sharp differences between urban, rural, and regionally regulated facilities.

In their discussion with Infection Control Today^® (ICT^®), study authors shared their insights on how regional disparities exist in infection prevention staffing and discussed strategies to address these differences.

The authors are Brenna Doran, PhD, MA, who specializes in hospital epidemiology and infection prevention at the University of California, San Francisco, and is a coach and consultant in infection prevention; Jessica Swain, MBA, MLT, director of infection prevention and control at Dartmouth Health in Lebanon, New Hampshire; and Shanina Knighton, PhD, RN, CIC, an associate professor at Case Western Reserve University School of Nursing and senior nurse scientist at MetroHealth System in Cleveland, Ohio.

“It’s known historically, and the literature supports it, that urban hospitals have more resources compared to rural ones,” Swain explained. Hospitals in high-volume areas or those facing unique health challenges often require larger IP [infection preventionist] teams. But many rural facilities struggle to meet these demands."

To close these gaps, experts suggest creative solutions. “Thinking through strategies like, how do you use telehealth to be able to support, what regional collaborations can take place, and how do we make sure targeted funding is implemented in those areas in order to be able to address what those staffing needs may be,” Knighton said.

Hospital size and satellite facilities also impact workload. “Our academic medical center, for instance, has a number of offsite ambulatory spaces that our IPs have to cover… that does increase the amount of area that the IPs have to cover, and the knowledge that they have to have in order to cover those areas,” Swain said.

Regional regulatory pressures further complicate staffing. Doran, a California-based IP, noted, “California… has the most regulatory requirements. For example, all healthcare buildings have to be earthquake compliant by 2030. It’s generally less expensive to build an entirely new hospital than renovate, so those of us in California are pretty much universally involved in a lot of construction and design.”

Whether preparing for earthquakes in California or hurricanes in the South, hospitals must adapt IP staffing models to their unique regional risks because infection prevention cannot be one-size-fits-all.

This is the fourth installment of this interview. The first can be found here. The second can be found here. The third can be found here.

Reference

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. doi:10.1016/j.ajic.2025.03.012