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If we want to see sustained improvements in our hospitals, administrators must step in and visibly show their support of IPs while investing their time, resources, and hospital funding to increase the capacity of the IPC department.
Before the COVID-19 pandemic, hospital administrators were familiar with the purpose and vision of the infection prevention and control (IPC) department. When health care–acquired infections (HAIs) were high or outbreaks present, administrators would turn to their IPC colleagues to better understand what steps were being taken to reduce infection rates and prevent the spread of disease within the hospital. Despite their importance in the prevention and control of infections, some IPC departments have historically felt unsupported by hospital administrators.1 Occasionally, these departments have received little to no support for more full-time employees and no additional funding for prevention efforts. They also have had a limited role in making hospital decisions that ultimately affect infection prevention and control.
As COVID-19 spread, hospital administrators looked to IPC experts to determine how to protect employees, patients, and visitors. IPC quickly became one of the most important departments in the hospital. Infection preventionists (IPs) were at the table for every decision and department capacity was increased to sustain prevention and control efforts. The increased attention and support are what we have needed for decades to substantially reduce HAIs in hospitals.
The pandemic has had a detrimental effect on progress in reducing HAIs.2 (See table below.) If we can harness the energy present between the IPC department and hospital administration during the pandemic, together we can become change catalysts, tackling HAIs with such gusto that the road back to zero infections will be paved in yellow bricks. But to accomplish this, we need a road map. We need defined steps that will lead hospital administrators and IPs along the path to improved patient safety with decreased HAIs.
Hospital Leadership Support
First, to see the changes we hope for in hospital IPC, we need the full support of hospital administration. For too long, preventing and controlling infections has rested solely on the IPC department. If we want sustained improvements in our hospitals, administrators must visibly show support for IPs while investing time, resources, and hospital funding to increase the capacity of the IPC department.
As Tamasin Adams, MPH, CIC, manager of infection prevention for the Lutheran Hospital of Indiana, states, “With the combination of administrative support and IP knowledge, new processes can be supported and implemented to keep patients and staff safe.” Yet many activities, such as increased surveillance for HAIs or electronic hand hygiene monitoring, will require additional staff and funding. Currently, many IPC programs barely have the capacity to keep up with mandatory HAI surveillance and reporting requirements.
Although HAIs tied to mandatory reporting and hospital reimbursement are priorities for the hospital, many other HAIs are being neglected due to limited staffing within IPC departments. With administrative support to increase infection prevention staffing, IPs could move beyond HAIs tied to reimbursement and target those not regulated by mandatory surveillance and reporting requirements.
Visible support from hospital administration increases staff buy-in for IPC efforts. Although IPs have the tools and knowledge to decrease HAIs, hospital administrators must make those efforts visible and rally buy-in from frontline staff. Without frontline support, efforts to improve prevention practices and mitigate the spread of infections will quickly fail.
One of the most overlooked methods for gaining frontline support is having existing relationships and trust with frontline staff members. When hospital administrators and IPs show their respect, trust, and support of frontline staff, those staff members will respond in kind. When we work collaboratively, we work toward positive change. During the pandemic, everyone throughout the hospital turned to the IPC department for answers.
Relationships with frontline staff members were forged through the fires of COVID-19 prevention and response. Now that trust, respect, and collegial relationships have been established, hospital administrators and IPs must continue to collaborate with frontline team members to prevent and control HAIs.
For Sara Townsend, MS-HQS, FAPIC, CIC, manager of infection prevention for Children’s Hospital of Philadelphia, COVID-19 allowed her IPC department to develop partnerships with frontline staff in their fight against HAIs. According to Townsend, “Suddenly [individuals] I never knew existed called me their new best friend. I, like others on my team, saw the never-ending list of questions and [individuals] as an opportunity. Today, as we dive back into scary times, those who labeled us their ‘new best friends’ have become reliable partners.” When hospital administrators and IPs build relationships with staff, those individuals become collaborators in the journey toward decreased infections.
Back to Basics
Once we have the full support of hospital administration and the buy-in of frontline staff members, we must get back to the basics of infection prevention to reduce the rate of HAIs. We must reemphasize the focus on basicpractices such as good hand hygiene, proper use of personal protective equipment (PPE), and environmental cleaning and disinfection. These are effective strategies that will work again with support and resources provided to infection prevention teams. But how, with extreme staffing shortages and a burned-out workforce, do hospital administrators and IPs successfully improve infection prevention practices? In short, we must keep it simple. First, we must set up our staff for success in achieving best practices in all areas of basic infection prevention. Hand hygiene supplies, disinfectant products, and PPE must be kept readily available and easily accessible to support best practices. Next, we need hands-on education with return demonstration by all staff to ensure competency. Then, to ensure practices are sustained, we need appropriate auditing, monitoring, encouragement, and feedback to frontline staff. Finally, we must continue education through frequent reminders and signage about best practices for basic infection prevention.
But according to Erica Jones, BSN, RN, CIC, director of infection prevention for Mt. Washington Pediatric Hospital in Baltimore, Maryland, “Education isn’t always the answer.” Sometimes, even with the best hands-on education, we find that our efforts fall short of producing sustainable change. Jones says “it is about engaging frontline staff in processes to understand their day-to-day and how to incorporate basic prevention principles into processes that are already in place.” It comes back to collaboration. Again, for prevention efforts to succeed, we must work as a team with frontline staff, listening to their perspectives and involving them in our efforts to improve the prevention and control of infections.
But listen closely, because this is important: None of this can be accomplished without the full support of hospital administration.
The work ahead for IPs will take more administrative support and funding than ever. The COVID-19 pandemic has brought a significant rise in HAIs. The reasons are abundant but the solution is simple. We need administrative support to increase the capacity of the IPC department, we need increased funding and visible support from hospital administrators for IPC efforts, we need buy-in and involvement from frontline staff, and we need to return to the basics of infection prevention. But together, hospital administrators and IPs can stem the rising tide of HAIs in our hospitals. United, with increased support of the IPC department, we can sustain positive change in the prevention and control of infections.
HEATHER SAUNDERS, MPH, RN, CIC, is director of infection control at Johns Hopkins Office of Population Health in Baltimore, Maryland. She is also owner of and primary consultant for Broad Street Prevention, where she guides health care and business leaders in the prevention and control of infectious diseases.