Assessing and addressing IP staffing needs in a pediatric setting

A new paper published today in the American Journal of Infection Control (AJIC) describes efforts at a major children's hospital to assess and fulfill its staffing needs for infection prevention and control, highlighting the challenges of allocating sufficient resources to this important role. Infection preventionists (IPs) at Boston Children's Hospital found that conventional methods for calculating the number of staff for these roles do not accurately reflect the current needs of healthcare systems or the specific needs of a pediatric patient population, and that a new approach is required to ensure patient safety.

While infection prevention is widely regarded as critical for hospitals and other healthcare facilities, properly staffing these roles has long been a challenge, in part because IPs are expected to take on many responsibilities that are not directly associated with infection prevention and control. In a survey conducted by the Association for Professionals in Infection Control and Epidemiology (APIC) in 2020, just 14% of respondents said that their work was fully focused on infection prevention activities. Most respondents were also expected to perform quality improvement, education, and regulatory compliance work in addition to their infection prevention responsibilities.

The conventional approach to calculating IP staffing needs is based on the number of inpatient beds at a hospital, but this method does not take into account key trends in healthcare such as increased outpatient procedures, shorter durations of hospital stays, and more focus on ambulatory services. The need for IPs is likely to be significantly higher than an inpatient-bed-only calculation would suggest.

In their new paper, IPs described a detailed assessment of the infection prevention and control needs at Boston Children's Hospital, which includes more than 40 different clinical departments and handles more than 47,000 emergency department visits and more than 690,000 ambulatory visits annually, based on data for fiscal year 2021. At the time, hospital IPs were responsible for supporting the main hospital campus, four satellite campuses, four doctor's offices, and a community health center. The needs assessment focused on time devoted to on-site and off-site responsibilities, as well as an evaluation of ambulatory location complexity.

The complexity variables studied show that work performed by IPs is highly complex, with half of all services evaluated found to have at least one complexity indicator and many having two or more. Based on the estimate of how much time was needed to perform all required tasks, the team found that the hospital was operating at an IP deficit. Their calculation called for 4.5 full-time IPs for the ambulatory and procedural departments, and only two full-time IPs were already on staff in these locations. This finding was presented to hospital leadership, along with a business case for adding more infection prevention and control resources. Approval for new hires was granted, and four additional full-time IPs were added to the staff to increase support for the ambulatory and procedural departments and to add new infection prevention and control and quality improvement capabilities. Beyond highlighting staff shortages, the detailed assessment also allowed department leadership to understand how staff IPs were spending their time and to re-prioritize those responsibilities as needed.

"Our work highlights the complexity and scope of infection prevention and control needs in pediatric ambulatory and procedural settings, areas for which little published infection prevention staffing data exist," said Lindsay Weir, MPH, CIC, lead infection preventionist at Boston Children's Hospital and first author of the paper.

We hope that our work helps other infection prevention programs advocate for the critical resources they require to meet the expanding needs of their ambulatory and procedural services. "

Lindsay Weir, MPH, CIC, Lead Infection Preventionist, Boston Children's Hospital 

Additional details from the study include:

• Complexity variables included factors such as using endoscopes or similar devices, and performing high-level disinfection or sterilization, surgical procedures, and aerosol-generating procedures, among others.
• Complexity was calculated for 237 locations and services, with nearly 80% outside the main hospital campus.
• IPs reported spending the most time on providing consultations, and the least time on professional development and quality improvement projects.
• The assessment focused on the hospital's current needs, but the authors point out that by the time the analysis was finished, a new satellite location had been opened and plans for a new satellite campus were already underway.

"Across the healthcare landscape, we are seeing shifting patterns in how, where, and for how long patients are treated. All of these changes add to the complexity of determining adequate IP staffing to keep patients safe," said Tania Bubb, PhD, RN, CIC, FAPIC, 2024 APIC president. "Tools like the APIC IP Staffing Calculator and the assessment described in this paper provide excellent examples of how to successfully make a clear business case for adequate IP resources."