Two posters presented by Karen Jones, MPH, RN, CIC, FAPIC, at the APIC Annual Conference and Exposition examine surveillance responsibilities and staffing in small hospitals, as well as IPs’ reported experiences after implementing electronic surveillance. Findings highlight opportunities for more investigation, rounding, and communication.
Small hospitals can have complex infection prevention needs, even when their staffing and surveillance resources are limited. Critical care, inpatient dialysis, and oncology services all require attention, while infection preventionists (IPs) may also be responsible for gathering laboratory results, entering data, and completing reports through manual processes.
At the
Understanding the Work Before Implementation
Jones’s first poster, “Are We There Yet? Examining surveillance practices and IP responsibilities at small and critical access hospitals,” examined facilities preparing to implement an electronic surveillance system. Jones described a 45-question survey with 43 IP respondents. Half of the hospitals were considered critical access hospitals; among the remaining facilities, the average bed size was about 55 beds. These were hospitals moving from manual surveillance processes to an electronic system, rather than replacing an established electronic surveillance platform. Their services demonstrated why bed count alone could not describe the scope of an IP’s responsibilities.
“Many of them also had specialty units, including things like inpatient dialysis, oncology departments, which really underscores the fact that even though these are small hospitals, they still have a lot of oversight into very unique care settings,” Jones said.
Most hospitals had at least 1 dedicated IP full-time equivalent (FTE), but about a third had less than 1 FTE dedicated to infection prevention. Fewer than a third had administrative support, and fewer than half had support from an infectious disease or epidemiology physician. For an IP working with limited resources, those findings describe more than a staffing number. Administrative work competes with other responsibilities, while access to physician expertise may be limited when a difficult situation requires additional input.
Jones also highlighted work that extended beyond formal reporting obligations. Among surveyed critical access hospitals, two-thirds conducted surveillance for events outside their National Healthcare Safety Network reporting plans, including device-related infections tracked and reported internally. The methods used to obtain microbiology results varied considerably. Some facilities could generate reports through laboratory information systems. Others depended on paper printouts, telephone calls, or interoffice mail. Those processes required staff involvement to move information to the person responsible for reviewing it.
The first poster, therefore, documented both the breadth of surveillance work and the practical obstacles facing IPs before implementation. It also established the context for the second project: what might change when some of that manual work becomes electronic?
Examining What Changed After Implementation
The second poster, “Navigating change, reinforcing IPC knowledge and practices in small hospitals,” focused on feedback following the implementation of electronic surveillance. In January 2025, investigators sent a 12-question web-based survey to 34 IPs. Of those, 16 responded and completed the survey.
All participating hospitals had implemented the system within the preceding 23 months, with an average of about 9 months since implementation. That interval gave respondents experience with the system before they described its perceived benefits.
Jones said respondents reported time savings in reviewing microbiology information, reporting, and identifying notifiable conditions requiring communication with state or local health departments. The survey also explored whether those efficiencies created opportunities for other infection prevention activities.
“Over 80% of the respondents said they now had more time to be able to do deep dives into their HAIs [health care-associated infections] vs just reviewing results, following the definition and the protocol, doing the reporting, they could actually take a closer look at that,” Jones told ICT.
That distinction is central to the findings. Completing a surveillance definition and submitting a report are important responsibilities. Having time to investigate an infection more closely creates an opportunity to examine what happened and discuss prevention with the people involved in care.
“Two-thirds believe that they had more time to now do unit rounds and to be able to communicate the things that they're seeing using the electronic system,” Jones said.
For small hospitals, those reported gains suggest that evaluating surveillance technology should include questions about how IP time is used after implementation. The potential value lies partly in whether an IP can spend more time on units, communicate findings, and explore individual infections in greater depth.
Supporting the People Behind Surveillance
The findings should be interpreted within the surveys’ scope. The first project described hospitals preparing for implementation. The second captured perceived benefits from 16 respondents; Jones did not report measured hours saved, a comparison group, or reductions in HAI rates. The interview also did not establish that the same IPs participated in both surveys.
Those limitations do not diminish the practical questions the posters raise. Leaders can ask how surveillance information reaches IPs, which tasks consume their time, and whether staffing and clinical support match the services their hospitals provide.
Together, the posters make a case for examining surveillance as part of the broader infection prevention workload. For small and critical access hospitals, the goal is to support both accurate reporting and the time needed to act on what surveillance reveals.
