Infection Preventionists Face Demographic Challenges

Frank Diamond

Frank Diamond has been with Infection Control Today since November 2019. He has more than 30 years of experience working for magazines, newspapers, and television news.

There are not enough infection preventionists to go around now, and trends suggest that there may even be fewer in the future. But there are ways to shore up the ranks, a study says.

For a while there during the COVID-19 pandemic, infection preventionists (IPs) were rock stars, the go-to experts in hospitals that other health care professionals looked to for advice on how to battle this devastating pandemic. They were crucial players in turning the tide against COVID-19 (knock wood).

IPs have paid the price, too. The headline on Infection Control Today®’s May cover story sums it up: “As COVID-19 Recedes, Infection Preventionists Must Still Battle Stress.”: “As COVID-19 Recedes, Infection Preventionists Must Still Battle Stress.” In it the author—Saskia v. Popescu, PHD, MPH, MA, CIC, a member of ICT®’s Editorial Advisory Board—writes: “Most people do not know about IPs but we are always there. We work to ensure education and training, support our fellow [health care workers], review supply chain challenges, try to prevent health care–associated infections (HAIs), ensure adequate personal protective equipment, and perform myriad other duties in our job descriptions. Helping respond to COVID-19 has been up to IPs.”

Since IPs more than proved their worth during the pandemic, health care organizations need to take steps to bolster their ranks, argues a study in the American Journal of Infection Control (APIC). If that doesn’t happen then come the next pandemic, health care professionals might look for advice and find that no one is there to give it.

“The retention and development of employed IPs should be a priority to increase staff tenure (i.e., length of employment), engagement, and to decrease turnover,” the AJIC study states. “Some turnover cannot be controlled, such as the anticipated retirement of nearly 40% of current U.S. IPs. However, other causes of turnover, such as burnout, poor work environments, and a lack of professional opportunities can be influenced. Retention of current staff is critical as many open IP positions stay vacant for months, suggesting there may not be enough IPs to fill the current need.”

One of the authors of the study—Heather Gilmartin, PhD, NP, CIC, of Denver/Seattle Center of Innovation for Veteran-centered and Value Driven Care at the VA Eastern Colorado Healthcare System, tells ICT® that this “silver tsunami of baby boomer retirements has been discussed for years. I believe retiring IPs will be successfully replaced in organizations that invest in training and mentoring the next generation. These organizations should look for professionals with diverse backgrounds (e.g. nursing, public health, laboratory sciences) to broaden the applicant pool. It will take work, but it will happen.”

Investigators used data gathered in a survey of 522 members of the Association for Professionals in Infection Control and Epidemiology (APIC) taken in 2019.

They were asked:

  • What is the average length of employment for current IPs in your organization?
  • Why have IPs separated from your organization?
  • How many IPs in the organization have retired in the last 5 years or are planning to retire?
  • What strategies are used to retain and develop IPs in your organization?

Investigators found that 67% (294) of the respondents had worked in their current position for 4 years or more, while 52% (230) said that 1 or 2 members of their infection control department would retire in the next five years. Four hundred and forty-five of the respondents explained why IPs left their health care organizations. The reasons cited were:

  • Personal reasons—222 (49%)
  • Professional advancement—153 (34.4%)
  • Increases in workloads—127 (28.5%)
  • Work-life balance problems—125 (28.1%)
  • Relationships with colleagues or supervisors—102 (22.9%)
  • Financial reasons—81 (18.2%)
  • Internal support issues—79 (17.8%)
  • Getting fired—56 (12.6%)

But the respondents also said that there were ways that health care organizations can have a better chance of improving IP retention. They included:

  • Continuing education support—353 (79.3%)
  • Certification support—322 (72.4%)
  • Professional conference support—308 (69.2%)
  • Flexible schedules—288 (64.7%)
  • Tuition reimbursement—258 (58%)
  • Competitive salaries—229 (51.4%)
  • Mentoring for new IPs—(194%)

That the data were collected before the COVID-19 pandemic might be salient; perhaps young health care professionals might consider IP as a career. But there needs to be a clear career path, the study states. For instance, APIC suggests 3 levels, novice (fewer than 2 years experience), proficient (3 to 5 years experience), and expert (over 5 years experience).

“Another program created by Smathers et al. includes redesigned job descriptions, clear promotional criteria, and creation of supporting roles to serve as entry level positions for future IPs,” the study states. “These two programs provide roadmaps for career development to enhance retention of IPs. In addition, organizations should consider strategies to create healthy work environments that support high quality relationships and team cohesiveness.”

The Smathers mentioned above is Sarah Smathers, MPH, CIC, FAPIC, the system director for infection prevention and control at the Children’s Hospital of Philadelphia (CHOP). Smathers is also one of the coauthors of the AJIC study. In an interview last October with ICT®, Smathers outlined one of the methods she used to recruit new IPs.

She said that she “reached out to Drexel University and I asked if they would be interested in developing a certificate program and their master’s department at their Dornsife School of Public Health. And I worked with their team there to develop a curriculum.”

ICT® asked Smathers recently what effect COVID-19 might have had on the course.

“It was exciting to see increased enrollment in the course that I teach at the Dornsife School of Public Health,” she said in an email exchange. “It was already designed to be an all online course, so we didn’t need to transition students, but we did allow more flexibility to students around assignments and due dates, understanding that the pandemic was presenting challenges for students in their personal and work lives. There were also barriers in providing students with internship opportunities as most hospitals were restricting students onsite. To overcome this, our department launched a 100% remote learning experience in infection prevention.”

The AJIC study concludes by addressing the problem of burnout, that Popescu wrote about.

“Specific strategies to promote work-life balance include engaging staff in hospital decision making committees, supporting self-care, flexible schedules, and encouraging time off from work,” the study states. “IP leaders should prioritize teamwork through establishing trust, building collaborative relationships and a sense of community within their department. These strategies should be purposefully implemented and adapted to evolving work-life challenges. These strategies are salient in the context of the COVID-19 pandemic, given IPs have been under significant stress for over a year and will require support and guidance to process and recover from an unprecedented public health crisis. We urge IP leaders to talk with staff about their current needs and adopt retention practices to ensure a healthy and stable IP workforce.”

Gilmartin tells ICT® that she thinks that the “there is more awareness of the role of infection prevention due to COVID-19. I have talked to many nurses who are newly interested in the field. They have been impressed with the science and practice of infection prevention and are interested in moving away from direct patient care.