Study Links Inadequate Infection Prevention Staffing to Higher Infection Rates

How many infection professionals should be employed at a health care facility? A study published in the American Journal of Infection Control reveals a direct correlation between inadequate infection prevention and control (IPC) staffing levels and higher health care-associated infections (HAIs) rates. Conducted by the Association for Professionals in Infection Control and Epidemiology (APIC) Center for Research, Practice & Innovation, the study underscores the critical need for tailored staffing solutions to enhance patient safety.

The authors include the following:

Rebecca (Bartles) Crapanzano-Sigafoos, DrPH, MPH, CIC, FAPIC, executive director of APIC’s Center for Research, Practice, and Innovation, and lead author of the study.

Sara Reese, PhD, MPH, CIC, FAPIC, director of research for APIC’s Center for Research, Practice, and Innovation, and an Infection Control Today^® (ICT^®)’s Editorial Advisory Board member.

Alexandr Gumbar, SA, CSM, MCSE, is the chief technology officer for APIC.

ICT^® spoke with Crapanzano-Sigafoos about the study.

The pilot project evaluated a novel online staffing calculator designed to provide customized recommendations for IP staffing levels. Findings showed that 79.2% of 390 acute care hospitals surveyed had insufficient staffing, correlating with significantly higher rates of HAIs such as central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), Clostridioides difficile infections, and surgical site infections.

“The way the calculator works is it starts out with the IP-to-bed ratio, and if you look into the literature, all that's out there,” Crapanzano-Sigafoos said. “Either an IP-to-bed ratio or IP-to-hospital ratio. And we know it's not sufficient because if you have a hospital that's 150 beds and has no ICU and no emergency department, their needs are going to be different than a hospital that [has] 150 beds has both of those things and a burn unit. The infection prevention needs vary based on the services offered and the patient population. The calculator takes into consideration those factors, and so we start with the ratio, and then the number of beds in the ratio goes up and down based on those risk factors, things like, do you have an emergency department? Do you have an ICU? Do you have a burn unit, an inpatient rehab unit, et cetera? And so, based on the responses that the infection preventionist enters, then it gives a customized staffing ratio based on those needs.”

For instance, 25% of facilities with below-expected staffing levels reported elevated CAUTIs rates, compared to just 7% of adequately staffed hospitals. Historically, hospitals relied on outdated "one size fits all" benchmarks, such as 1 infection preventionist (IP) per 69 to 100 beds, which fail to account for modern health care complexities.

In response, APIC's predictive staffing calculator provides tailored recommendations based on hospital-specific factors, including emergency department presence, specialized units, and service complexity.

The study emphasizes that modern, data-driven staffing models are indispensable for infection control in today’s health care landscape.