Infection Preventionist Role Needs to Be Spotlighted

Lisa Waldowski, DNP, RN, CIC, of Kaiser Permanente: “There will always be a role for infection preventionists. I don’t worry about job security, so to speak. There are so many elements within infection prevention and control.”

When the COVID-19 pandemic ends, where will infection preventionists (IPs) find themselves in the health care system? One of the goals for infection prevention and control should be to educate young people who want a career in health care about what being an infection preventionist entails, says Lisa Waldowski, DNP, RN, CIC, a regional director in infection prevention and control for Kaiser, Permanente. “It’s definitely something for someone who is seeking a lot of different experiences, and wants that type of excitement, and knowing that it’s not going to be the same-old same-old each and every day,” says Waldowski, who is a member of Infection Control Today®’s Editorial Advisory Board. “It’s just such a growing field and I hope that we can support one another along the way.” It’s important to grow a new crop of infection preventionists in a profession in which 40% of the members are due to retire in the next 10 years. However, demographic challenges aren’t the only ones facing IPs, Waldowski tells ICT® in wide-ranging discussion, in which she also talks about the importance of certification and the educational obligations of IPs.

Infection Control Today®: Did the pandemic move the needle at all in terms of mandating that infection preventionists have to be certified?

Lisa Waldowski, DNP, RN, CIC: I don’t think I can completely support that I’ve seen that reflective across the country. I do have some insight on that having consulted for many years prior to taking the job that I currently am in. And I think that that’s a great move, a great incentive. I think that there may even be more scrutiny or looking at infection prevention certification prior to even getting in the field to broaden that reach and help support getting

certified. I think many infection preventionists that have been in the role—and they come from many different backgrounds, public health, nursing, lab—that to level that playing field, and to have that certification is an important step in infection prevention. But I also see that that also would need in tandem to have leadership and organizations support getting that test taken and pay for it, allow for education to ensue to take the exam. And that becomes a challenge. And that’s not something that’s standardized across the country.

ICT®: You’re the regional director of infection prevention and control for one region of Kaiser Permanente. You do some hiring. Do you look for a CIC after somebody’s name when they’re going for an infection preventionist job?

Waldowski: Yes, I do. But again, based on organizations and what they put through human resources in their job description, you will commonly see certification as a preferred element and not a required element. Although I am seeing that change, or verbiage to say within two years upon hire, acquiring your CIC certification. It would certainly be a stronger requirement to put that verbiage in a job description that you have to have it before you’re even considered for hire. And that’s not a standardized element that I see across the country.

ICT®: Some experts have told me that I can be hired by a hospital tomorrow, and they can tell me: “You’re our Infection preventionist.” Is that really the case? Was it the case before the pandemic? Has it changed at all because of the pandemic? Or is that an exaggeration?

Waldowski: That’s not far off. I’ve been in health care over 30 years. And when I first got into infection prevention and control, oftentimes this was the reality. I’m not exaggerating or making this up. If I was on workman’s compensation, they could put you into infection prevention and control as a nurse in this environment. That location at least required you to be a nurse at that point in time. And I see various backgrounds I think, because like many roles in health care—shortages, people retiring, burnout, many reasons—that there are not enough infection preventionists to do the good work that is required to keep an organization safe. Given the fact that from a regulatory standpoint, everything essentially has to be integrated into infection prevention and control. We’re in high demand, but the backgrounds that constitutes that role are varied from an LPN all the way up to doctorally prepared infection preventionist. Some certified, some not. In response to your question, yes, I can see many organizations: “Oh, you’re interested? Great. You’re hired.” There is that still to this day in health care going on.

ICT®: Have you noticed—or do you know—whether nursing programs have started to include infection prevention more in their training for nurses?

Waldowski: I think that there’s still an opportunity. I don’t see it strictly standardized or stood out. And I would also offer that it shouldn’t just be nursing. It should be in medical professions. We would not struggle as much as we do with infection prevention and control implementation, if there was a more standardized representation and effort within our education system to become a nurse, to become a physician in any of the roles in public health and others that ended up going into this role. Many wonderful working opportunities I’ve had with professionals in infection prevention and control have also included from other countries internationally, those that have relocated to the United States. And they’re physicians that ended up becoming infection preventionists and such. I think that the role needs to be clearly supported. And that content, which should be everybody’s content, should be taught in their training and education prior to working as a physician, as a nurse. Because we struggle with basic concepts—like hand hygiene, and aseptic technique, and PPE use—that should be something that everybody is taught in their respective professional programs.

ICT®: As you know, the Centers for Disease Control and Prevention last year launched Project Firstline, the $180 million program to teach basic principles of infection prevention to anybody on health care’s frontlines. Now, if everybody knew basic principles of infection prevention on the frontlines, where would that leave the infection preventionist? There are still some things that infection preventionists—and only infection preventionists—can do and monitor. Is that a fair assumption?

Waldowski: Yes, it’s a specialty. You certainly need to be aware that there’s some basic information that covers all areas. I think that we can be taught something, but to sustain that is another piece. Whether you call it process improvement, or whether you call it high reliability. Whatever you want to term it, that you can be taught these concepts but implementing them and sustaining them is entirely different. There will always be a role for infection preventionists. I don’t worry about job security, so to speak. There are so many elements within infection prevention and control. And I think that that word prevention is something we continually strive to work toward. I still think we’re in that mode of putting out fires. And obviously, with your original comments about COVID-19, I think that really currently has highlighted some of our opportunities within health care with infection prevention and control activities that were very glaringly apparent and that we could do better.

ICT®: One of the jobs of an infection preventionist is to monitor staff. To make sure that they’re following infection prevention guidelines and also to make sure that they’re not infected. How has that role changed? Or has it changed through the course of the pandemic? Is staff more knowledgeable now and monitoring has to be done less?

Waldowski: I think that with the broad spectrum of infection prevention and control, often that word “employee” as opposed to “patient” … employee typically partners that role in that issue with employee health. And that has become hopefully a stronger link or an opportunity to build stronger relationships working with employee health with what we’ve been faced with COVID-19. The infection preventionist—even though there’s that working relationship with employee health—is typically more in efforts to prevent infection and transmission with patients and to include employees obviously, as well. But that transmission between patients. There’s certainly room for growth and working with the employee and understanding because there’s been, for example, the PPE education and [how is was] used during the COVID 19 pandemic. That has run the gamut of what we typically as infection preventionists would strive to constantly enforce following the manufacturer’s instructions for use for single patient use items. And as you well know, we broke all those rules during shortages during the pandemic, and who knows more to come as to being able to extend use and things that we would never have done during, quote, pre-COVID times. I think it’s been a constant learning opportunity and keeping people updated with the latest and greatest information as to how to safely protect themselves. If we’re talking about employees with PPE use as a perfect example. And then the confusion of when you’re not at work and now I’m just a, quote, regular person in the community. And that’s had different instructions than what I am told to do in health care. I think they’ve constantly needed to work together, infection prevention with employee health, and other key stakeholders in this, to get it right to make sure employees are safe doing the good work they do in their environments.

ICT®: Are you hearing more interest among young people who are talking about possibly going into the health care field of maybe thinking about becoming an infection preventionist? If you do, how do you sell it to them? What do you say it involves?

Waldowski:That’s a loaded question. I think that there have been some ups and downs with infection prevention being at the table during COVID-19. I don’t think there are enough of us to have made such visible impression during COVID-19 that could really change the tide across the board. A lot of us ended up having to do a lot of things behind the scenes to help strengthen our COVID-19 response. And getting out and about in being patient facing or being out on floors and units and clinics may have not been awarded or afforded to us because there was so much that had to go on with answering phone calls, answering emails, being at meetings, doing the surveillance.

ICT®: Is there anything that I neglected to ask you that you think is pertinent and that you want your fellow infection preventionists and other health care professionals to know?

Waldowski: I think it’s important that while we do have an opportunity during COVID-19 that has put the [spotlight on] infection prevention and control practices to support one another in advocating for more resources, whether that be, as mentioned earlier, pursuing certification and having that supported by your organization to obtain such and offer the appropriate education to study for that exam to be successful. And I think that the other piece is so critical that as we see across many professions an aging profession that is close to retirement, to support and build that capacity when we are ready to retire. That we’ve built a strong team, or we’ve supported infection preventionists in that role, and not just blindsided them: “Here’s the job and just kind of learn as you go.” Because it is such a vast specialty and covers so much involvement within an organization, whether it be a hospital acute care setting, or an ambulatory setting, home care … it’s very vast. It’s overwhelming for a novice that has just embarked upon this profession that we need to not eat are young, but we need to build capacity and enthusiasm to even go into this profession. And then mentor and grow those infection preventionists to stay in this profession that’s very exciting, very dynamic, very “go to work and don’t know what you're going to get that day.” It’s definitely something for someone who is seeking a lot of different experiences and wants that type of excitement and knowing that it’s not going to be the same-old same-old each and every day. It’s just such a growing field and I hope that we can support one another along the way.

This interview has been edited for clarity and length.