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SASKIA V. POPESCU, PHD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in biodefense from George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in infection control and has worked in both pediatric and adult acute care facilities.
The dynamic between an infection prevention and control program and hospital administrators can make or break infection control efforts within a healthcare facility. Infection prevention isn’t easy. It often involves delivering bad news-findings of healthcare-associated infections (HAIs), poor hand hygiene compliance, or failures in practices that increase risk for patients and staff. The increasing attention to reducing HAIs and the financial penalties associated with them can create tension between IPC and hospital administrators, both of which may have competing priorities.
Although it’s not always a tenuous relationship-many IPC departments have harmonious dynamics with their administrators-there is an undeniable challenge in achieving such a balance. First, IPC programs are often seen as cost centers and not revenue generators.1Often a regulatory requirement to check the box for surveillance reporting needs, the scope of the IPC program can easily be constrained by what leadership determines a priority. For some hospitals, the IPC program is robust and encompasses more than just those HAIs linked to mandated reporting and Medicare reimbursement. For others, the program’s scope is narrowed to what hospital administrators deem as a priority-sometimes reimbursement, sometimes environmental disinfection, sometimes something else entirely. This limits the scope of the IPC program in ways that do it a disservice.
An honest and respectful relationship between hospital administrators and IPC programs is crucial, but building one takes work. A 2017 survey of IPs at roughly 900 US acute care hospitals found that 53% reported strong or very strong support of the program from hospital leadership-which means nearly half the respondents did not think leadership strongly supported their work.2So, how can the healthcare system create a strong foundation or improve a shaky relationship between IPC and hospital administrators?
There are a handful of things hospital administrators and other leaders can do to better support their IPC programs.
First, understand that infection prevention is a hard job. IPs are wholly dedicated to patients and staff but are often the bearers of bad news. IPs don’t want to find HAIs-not only do they mean a patient’s life has changed for the worse due to collective failures, but also that there is a lot of work to do to improve practices. Know that IPs often feel like the black sheep in the room-they are not always clinicians and do not offer bedside care or the most obvious of services, which some might feel diminishes an IP’s value. When people see IPs on units, it’s not uncommon for them to ask what is wrong. They are truly working to change that culture, but administrative support is critical.
Second, make sure IPC departments are well-staffed. Assessments have found that overall median IP staffing was 1.25 IPs per 100 inpatient beds, but more recent analyses have found that following needs assessments, the actual labor required a new benchmark of 1 IP per 69 beds.3Given the wide scope of what IPC work entails, adequate staffing is critical to ensure the programs are effective. Since so much time is spent on mandated surveillance and reporting, it becomes critical to have the necessary IPs to make the rounds on hospital units, in addition to educating other employees, reviewing hospital policies, assessing risk at areas under construction, and more. IPs want hospital administrators to ensure their programs are staffed adequately and not at the bare minimum.
Third, don’t just focus on those HAIs related to reimbursement. Although HAIs tied to Medicare reimbursement and mandated reporting are important and carry an obvious financial incentive, don’t let administrative focus on IPC programs become restricted. It can be easy to put more energy or resources behind those HAIs liable to financial penalties, but they do not represent all HAIs that occur. There are more surgical site infections than just abdominal hysterectomies and colon surgeries. When attention is limited, it can create a culture that values only those HAIs linked to reimbursement, which does staff and patients a disservice.
Any HAI is important and worth the resources to prevent or investigate as they can be life-changing for the patient. Simply put, in healthcare, professionals should aim higher than only caring about HAIs that have to be tracked and reported. Hospital administrators should support and facilitate robust IPC programs that have the resources and bandwidth to focus on all HAIs.
Lastly, hospital leaders and administrators should want to be a part of IPC HAI investigations. Too often, the only time IPs work closely with administrators is when they are getting pushback. Having hospital administrators partake in the review of these HAIs with unit staff, directors, and the IP not only showcases their dedication to the program and reducing HAIs, but could also facilitate change.
The deep dives that IPs conduct with key stakeholders following the identification of an HAI are where gaps and failures are identified, but they’re also a great opportunity for improvement. Having a hospital administrator present could make all the difference and show frontline staff how important these efforts are. Review cases of central-line associated bloodstream infections with IPC and the staff at the table, because if they find that a device has been problematic for staff, the administrator can help correct it then and there.
Part of this involvement is also the awareness that failures do happen, and that IPC is evolving, which requires constant vigilance and support. Having a chief nursing officer (CNO), chief medical officer (CMO), or chief operating officer (COO) in HAI review meetings truly affects how HAIs are approached at the hospital. Accountability is crucial, but it doesn’t just fall on frontline staff; hospital leadership must also engage in these processes.
Infection prevention efforts are complicated and often messy. IPC brings up failures and opportunities that some would rather avoid or ignore, but to improve patient and healthcare worker safety, everyone has to push through to create a culture of change. The relationship between hospital leadership/administrator and the IPC program is critical for the success of these efforts, but often marred by complex nuances.
Hospital administrators should see this as an opportunity to be a part of a cultural shift. Sit with
IPC team members and ask them how to improve communication, how leadership can better assist, and how they can better help their patients/staff.
Investigators, like Sanjay Saint, MD, of the Institute of Healthcare Policy and Innovation at the University of Michigan, have noted that “leadership plays an important role in infection prevention activities. The behaviors of successful leaders could be adopted by others who seek to prevent HAI.”5IPC and hospital leadership are all a team and part of that is understanding what hurdles they have accidently created for each other.
Saskia v. Popescu, PhD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in biodefense from George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in infection control and has worked in both pediatric and adult acute care facilities.
1. Murphy DM, Alvarado CJ, Fawal H. The business of infection control and epidemiology. Am J Infect Control. 2002 Apr;30(2):75-6.
2. Greene MT, Gilmartin HM, Saint S. Psychological safety and infection prevention practices: results from a national survey. Am J Infect Control. 2020 Jan;48(1):2-6. doi: 10.1016/j.ajic.2019.09.027. Epub 2019 Nov 7.
3. Pogorzelska-Maziarz M, Gilmartin H, Reese S. Infection prevention staffing and resources in U.S. acute care hospitals: Results from the APIC MegaSurvey. Am J Infect Control. 2018 Aug;46(8):852-857. doi: 10.1016/j.ajic.2018.04.202. Epub 2018 Jun 1.
4. Bartles R, Dickson A, Babade O. A systematic approach to quantifying infection prevention staffing and coverage needs. Am J Infect Control. 2018 May;46(5):487-491. doi: 10.1016/j.ajic.2017.11.006. Epub 2018 Jan 4.
5. Saint S1, Kowalski CP, Banaszak-Holl J, Forman J, Damschroder L, Krein SL. The importance of leadership in preventing healthcare-associated infections: results of a multisite qualitative study. Infect Control Hosp Epidemiol. 2010 Sep; 31(9):901-7.