Infection Preventionists Face Demographic Challenges

For a while 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 a devastating pandemic. IPs were crucial players in turning the tide against COVID-19, but they also have paid the price. The headline for the Infection Control Today® (ICT®) May cover story sums it up: “As COVID-19 Recedes, Infection Preventionists Must Still Battle Stress.” ¹ The article’s author, Saskia v. Popescu, PHD, MPH, MA, CIC, a member of the ICT® Editorial Advisory Board, wrote: “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, 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 (AJIC).² 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.³

Retirement

“The retention and development of employed IPs should be a priority to increase staff tenure (eg, length of employment), engagement, and to decrease turnover,” the investigators of the AJIC study stated. “Some turnover cannot be controlled, such as the anticipated retirement of nearly 40% of current US 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.”

This “silver tsunami of baby boomer retirements has been discussed for years,” an author of the study, Heather Gilmartin, PhD, NP, CIC, told ICT®.

“I believe retiring IPs will be successfully replaced in organizations that invest in training and mentoring the next generation,” said Gilmartin, of Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care at the VA Eastern Colorado Healthcare System. “These organizations should look for professionals with diverse backgrounds [eg, 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.

Participants were asked the following questions:

• 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 past 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 respondents had worked in their current position for 4 years or more, and 52% (230) said that 1 or 2 members of their infection control department would retire in the next 5 years.

To explain why IPs left their health care organizations, 445 respondents cited the following reasons:

• 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%)

In addition, respondents said there are ways health care organizations could improve IP retention.
These suggestions 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 (37.2%)

The fact 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 authors stated. For instance, APIC suggests 4 levels, based on length of experience: novice, becoming proficient, proficient, and expert.

Supporting Roles

“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 investigators wrote. “These 2 programs provide road maps 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.”

“Smathers” refers to Sarah Smathers, MPH, CIC, FAPIC, the system director for infection prevention and control at Children’s Hospital of Philadelphia in Pennsylvania. Smathers is also one of the coauthors of the AJIC study. In an interview with ICT®in October 2020, she outlined one of her methods for recruiting IPs, by creating an IP training program at
Drexel University in Philadelphia.⁴

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

Increased Enrollment

“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 on-site. To overcome this, our department launched a 100% remote learning experience in infection prevention.”

To decrease burnout, work-life balance should be promoted by engaging staff in hospital decision-making committees, supporting self-care, allowing flexible schedules, and encouraging time off from work, the investigators of the AJIC study concluded.

Implementation

Establishing trust, building collaborative relationships, and having a sense of community bolsters teamwork.

These factors don’t happen organically, though. They need to be planned and implemented, according to IP experts interviewed for this article.

“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,” the investigators stated.

Impressed

There is more awareness of the role of infection prevention because of COVID-19, according to Gilmartin. “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,” she said.

References

1. Popescu S. As COVID-19 recedes, infection preventionists must still battle stress. Infection Control Today®. April 30, 2021. Accessed May 15, 2021. infectioncontroltoday.com/view/as-covid-19-recedes-infection-preventionists-must-still-battle-stress
2. Gilmartin H, Smathers S, Reese SM. Infection preventionist retention and professional development strategies: insights from a national survey. Am J Infect Control. Published online May 4, 2021. doi:10.1016/j.ajic.2021.04.083
3. Dyer J. Ready for the next pandemic? (spoiler alert: it’s coming). Infection Control Today®. March 1, 2021. Accessed May 20, 2021. infectioncontroltoday.com/view/ready-for-the-next-pandemic-spoiler-alert-it-s-coming-
4. Diamond F. Q&A: IPs at Children’s Hospital were ready when COVID struck. Infection Control Today®. October 8, 2020. Accessed May 23, 2021. infectioncontroltoday.com/view/q-a-ips-at-children-s-hospital-were-ready-when-covid-struck