Infection Prevention and Control Programs

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Candace Friedman, MPH, CIC

Project Manager/Office of Clinical Safety

University of Michigan Hosptials and Health System

Ann Arbor, MI

Abstract

Infection prevention and control programs in the United States have changed significantly since the mid-

20th century. Much of this change was a result of the influence of professional and nonprofit

organizations; government, regulatory, and accrediting agencies; and scientific research and

publications. Other influences include increasing acuity of patients, aging of the population, complexity

and location of treatment interventions, and the increasing move toward care in home/ambulatory

settings. There are various models outlined for infection prevention and control programs and standards

developed for infection prevention professionals. This chapter includes information on Health and Human

Services activities, the National Healthcare Safety Network , and information on international infection

prevention and control programs.

Key Concepts

Infection prevention and control programs have evolved significantly over the past 50 years.

Infection prevention and control programs are affected by professional and nonprofit organizations;

government, regulatory, and accrediting agencies; and scientific research and publications.

An infection prevention team is an important component of the infection prevention and control

program.

BACKGROUND

The first infection prevention and control efforts in the United States began in hospitals in the 1950s

concurrent with the growth of intensive care and increasing staphylococcal infections.1 Infection

prevention and control programs extended into thousands of hospitals in the late 1960s and 1970s in

response to urging from various organizations (e.g., American Hospital Association [AHA] and The Joint

Commission [TJC]).

In the decades since the 1970s, changes to these programs have occurred as a result of state and

federal agencies, professional and nonprofit organizations, and scientific information published in journals.

The 21st century brought increased attention to infection prevention and control programs because of

government interest and oversight and activities of patient safety organizations. Other influences on

programs include increasing acuity of patients, aging of the population, complexity and location of

treatment interventions, and the increasing move toward care in home/ambulatory settings.

One major influence is the Department of Health and Human Services road map for healthcare-

associated infections (HAI) elimination outlined in 2008. It focused on broad programs to significantly

reduce harm in hospitals and improve care across healthcare settings.2 Elimination of HAIs requires a

culture change for healthcare personnel (HCP) in which no infection is perceived as acceptable by any

member of the healthcare teamsupport and direction from senior leadership is essential.3 This support

includes implementation of evidence-based practices, alignment of financial incentives, research,

acquiring pertinent information, and accountability.

In addition, changes in the healthcare industry over the past few decades have placed increased

demands on infection prevention and control programs. There are various quality improvement/patient

safety activities focused on HAI reduction, including value-based purchasing, evidence-based practice

centers, use of technology, implementing a culture of safety, and public reporting of data.4-6 Public

reporting, pay-for-performance, and reduced payment for hospital-acquired conditions have increased the

focus on infection prevention.

While these changes were occurring, there have been dramatic successes in the infection prevention and

control field resulting in decreased infections in hospitalized patients.7 The modern concept of infection

prevention and control also includes areas beyond HAIs (e.g., risk to employees, cleaning, maintenance

Chapter 1 InfectionPrevention and ControlPrograms

View full chapter

Abstract

Key Concepts

Background

Organizations Influencing

Practice

Overall Structure and

Function

Documenting Impact of

Healthcare Associated

Infections on Outcomes and

Costs

Influencing Practice

Quality of an Infection

Prevention and Control

Program

International Perspective

References

Supplemental Resources

Web-Based Resources

CHAPTER 1 INFECTIONPREVENTION AND CONTROLPROGRAMS

A A A



and evaluation of the physical environment, health policy, and various other adverse events).8 In addition,

programs must also address risks to the public (e.g., emergency management, education of the

community, and use of implementation science techniques).

Infection prevention professionals need to be alert to changing recommendations/requirements and new

scientific literature and guidelines. They then need to make appropriate modifications to infection

prevention and control programs. In addition, federal, local, and state requirements must be followed. This

chapter outlines the specific agencies and organizations that have a major impact on infection prevention

and control programs and the general issues to consider in the organization and function of infection

prevention and control programs.

ORGANIZATIONS INFLUENCING PRACTICE

American Hospital Association

The AHAs Advisory Committee on Infections within Hospitals published its first edition of Infection

Control in the Hospital in 1968. The purpose of this manual was to describe the elements of an infection

prevention and control program that an AHA advisory committee considers essential to the reduction and

elimination of the human and economic wastage that results from our failure to prevent those nosocomial

infections that are preventable. . . . Three editions of the manual were printed, the last published in

1979.9 The AHA affected infection prevention and control practice through educational programs and

conferences, journals and other publications, briefings, and consultants. Currently, the AHA issues

Advisory Reports for healthcare executives, keeps track of legislative and regulatory issues regarding

HAIs, and maintains its Hospitals in Pursuit of Excellence (HPOE) Web-based platform. The HPOE

Website disseminates information, shares proven practices, and supports improvement activities. The

HPOE has also developed Partnership for Patients Hospital Engagement Networks to disseminate best

practices in 10 focus areas, including HAIs.

Association for Professionals in Infection Control andEpidemiology

The Association for Professionals in Infection Control and Epidemiology (APIC) was established in 1972

to provide education and science-based information to strengthen and improve the practice of infection

prevention. APICs major influences on infection prevention and control activities are its development of

professional and practice standards, education and training programs, a scientific journal, and

governmental affairs activities. It established the Certification Board of Infection Control and Epidemiology

(CBIC) in 1981 to administer an infection prevention and control certification program. APICs research

program was established in 1993 and is supervised by the APIC Research Committee. The committee

coordinates initiatives focused on practical solutions, grounded in science, and that can be implemented

across the spectrum of healthcare settings.8

APIC has partnered with other professional organizations to produce two consensus documents outlining

infrastructure requirements for infection prevention and control programs in hospitals and nonhospital

settings and a document defining practice and professional standards for the field.10-12 A competency

model has also been developed for professionals to guide their acquisition of knowledge and skills over

their career.13

Centers for Disease Control and Prevention

In the 1960s, the Centers for Disease Control and Prevention (CDC) began recommending that hospitals

conduct surveillance for the occurrence of healthcare-associated infections (HAIs; previously referred to

as nosocomial infections). The CDC started training programs in infection surveillance in the early 1970s.

The programs stressed surveillance for infections, developing and implementing policies for prevention of

infections, and reducing wasteful activities (e.g., environmental culturing). Because of increased training

opportunities available in the United States, the CDC discontinued these programs in 1983.

The Division of Healthcare Quality Promotion (DHQP) of the National Center for Emerging and Zoonotic

Infectious Diseases is the CDCs focus for information, surveillance, investigation, prevention, and control

of HAIs. The mission of DHQP is to protect patients, protect healthcare personnel, and promote safety,

quality, and value in both national and international healthcare delivery systems.

In January 1970, the CDC began the National Nosocomial Infections Surveillance (NNIS) system. One

purpose of this program was to monitor trends in HAI rates, pathogens, and antibiotic susceptibility

patterns in the United States. The CDC transitioned NNIS to a Web-based knowledge systemthe

National Healthcare Safety Network (NHSN)in 2005.

National surveillance of HAIs is coordinated and analyzed by NHSN; the program publishes HAI rate data.

The NHSN data are intended for benchmarking and can be used by institutions in performance-

improvement activities.14

State and federal requirements to report data to NHSN, creating a national database used by payers and

various states, have led to changes in HAI reporting. These changes include a focus to change, improve,

and validate surveillance definitions. Reliability of these data in an era of increasing public scrutiny is

particularly important.15

In 1974, the CDC initiated a study to determine the efficacy of infection prevention and control activities in

reducing the risks of HAIs in hospitals: the Study on the Efficacy of Nosocomial Infection Control (SENIC)

project. The SENIC project defined an infection surveillance and control program as one containing three



main elements:

1. Epidemiological surveillance for the occurrence of infections in patients within the hospital

2. Formulation of policies and procedures to control infections based on data generated by surveillance

and other sources

3. Personnel specially trained in hospital epidemiology to collect the surveillance data and coordinate

intervention activities.

The SENIC project compared HAI rates that occurred in 1970 and 1976 in a stratified random sample of

U.S. hospitals.16 The project found that compared to hospitals that had no program activities, hospitals

that established infection surveillance and control programs reduced their HAI rates by approximately 32

percent.17

The DHQP began an HAI guidelines and recommendation process in 1981. Several documents were

developed for specific infection prevention and control practices. This process was discontinued in the

mid-1980s.

The Healthcare Infection Control Practices Advisory Committee (HICPAC) was established in 1991 to

provide advice and guidance to the CDC and others regarding the practice of infection prevention and

control, and strategies for surveillance, prevention, and control of HAIs and antimicrobial resistance. The

committee influences infection prevention and control programs through its periodic updating of guidelines

and other policy statements. These guidelines are developed in partnership with various affiliated

professional organizations.

Centers for Medicare & Medicaid Services

As part of the Centers for Medicare & Medicaid Services (CMS) required conditions for certification and

participation in Medicare and Medicaid programs, hospitals must comply with federal standards that

include specific requirements for an active infection prevention and control program.18 A program to

investigate, control, and prevent infections in long-term care facilities accepting Medicare and Medicaid

patients is also mandated by CMS.19

In addition, Conditions of Participation (CoP) apply to other healthcare organizations, including

ambulatory surgery centers, home health agencies, hospices, some providers of outpatient services, and

psychiatric hospitals.20

The CoP related to hospital infection prevention was updated in 2013.18 The standards include

requirements to maintain a sanitary environment, designate an infection control officer, and develop,

implement, and maintain an active infection prevention and control program.

CMS also updated its Medicare hospital inpatient prospective payment system in 2008. It no longer

reimburses hospitals for certain hospital-acquired conditions (HAC) if it is high-cost, high-volume; not

present on admission; would be assigned a higher payment because of the HAC; and could reasonably

have been prevented through application of evidence-based guidelines.21 These efforts are designed to

increase health, improve care, and lower costs. There are concerns regarding use of administrative data

versus standardized surveillance definitions as part of this process.22 See Chapter 4, Accrediting and

Regulatory Agencies, for more information on CMS requirements.

Certification Board of Infection Control and Epidemiology

The CBIC is a multidisciplinary board that provides direction for and administers the certification process

for professionals in infection control and applied epidemiology. CBIC is independent and separate from

any other infection preventionrelated organization or association. The mission of CBIC is to protect the

public through the development, administration, and promotion of an accredited certification in infection

prevention and control.

Food and Drug Administration

The Food and Drug Administration (FDA) is responsible for implementing, monitoring, and enforcing

standards for the safety, efficacy, and labeling of all drugs and biologicals for human use. Of particular

interest to the infection prevention team are the FDAs activities related to food, blood, medical devices

(especially single-use devices), and antimicrobial products and chemical germicides used with medical

devices.1The Environmental Protection Agency also is involved in testing and use of hospital germicide

products.

Health and Human Services

The Department of Health and Human Services (HHS) is the principal agency for protecting the health of

all Americans and providing essential human services. In 2009 the agency increased its focus on HAIs

with the release of Health-Care-Associated Infections in Hospitals: Leadership Needed from HHS to

Prioritize Prevention Practices and Improve Data on These Infections.23 The HHS has identified the

reduction of HAIs as an Agency Priority Goal through its National Action Plan to Prevent Health Care-

Associated Infections: Road Map to Elimination.2

Institute for Healthcare Improvement

The Institute for Healthcare Improvement (IHI) is an independent not-for-profit organization helping to lead

the improvement of healthcare throughout the world. IHI works to accelerate improvement by building the

will for change, cultivating concepts for improving patient care, and helping healthcare systems put those

ideas into action.



IHIs 5 Million Lives Campaign was a voluntary initiative to protect patients from 5 million incidents of

medical harm over 2 years (December 2006 to December 2008). It included prevention of HAIs.24

IHI has targeted the identification and subsequent spread of best practices and established a focus on

innovation regarding HAI reduction. Their current framework focuses on optimizing health system

performance by centering on the health of a population, the experience of care for individuals within that

population, and the per capita cost of providing that care.

The Joint Commission

The Joint Commission (TJC) started publishing minimal infection prevention and control standards for

hospitals in 1953. In 1976, infection prevention and control programs became a specific requirement for

accreditation by the TJC.1 TJCs standards for infection prevention are used by many institutions,

including hospitals, long-term care facilities, behavioral health facilities, and home health agencies, to

establish a framework for an infection prevention and control program.

These standards have undergone many revisions over the years. In general, the standards state that the

goal of the surveillance, prevention, and control of infection function is for the healthcare organization to

identify and reduce the risks of infections in patients and HCP. There must be a functioning program,

coordinating all activities related to the surveillance, prevention, and control of infections. The program

should be doing the right things, doing these things well, be supported, and be focused toward

improvement of processes and outcomes.25 See Chapter 4, Accrediting and Regulatory Agencies, for

more information on TJC standards.

National Institute for Occupational Safety and Health

The National Institute for Occupational Safety and Health (NIOSH) was established in 1970 and became

part of the CDC in 1973. It is responsible for conducting laboratory and epidemiological research on

occupational hazards.26 Decisions regarding types of devices used for employee protection (e.g.,

respirators, sharps containers) are part of NIOSHs mandate.

Occupational Safety and Health Administration

The Occupational Safety and Health Administration (OSHA) began its infection prevention and control

activities in 1987 with the draft publication of bloodborne pathogens rules. These rules were finalized in

1991.27 In 2001, a revision to the bloodborne pathogens rules was published to clarify issues related to

sharps safety.28 OSHA may enforce other infection prevention issues (e.g., tuberculosis) under the

General Duty Clause of the Occupational Safety and Health Act. OSHA standards focus on determining

employees health risks as the result of exposure to communicable diseases.

Society for Healthcare Epidemiology of America (SHEA)

The Society for Healthcare Epidemiology of America (SHEA) was founded in 1980 to foster the

development and application of the science of healthcare epidemiology.29 SHEAs mission is to prevent

and control HAIs and advance the field of healthcare epidemiology.

The organization provides educational programs, develops position papers, and produces a scientific

journal. SHEA was a partner in the development of two consensus documents outlining infrastructure

requirements for infection prevention and control programs.10,11

OVERALL STRUCTURE AND FUNCTION

Infrastructure documents outline the three principal goals for infection prevention and control

programs:10,11

Protect the patient.

Protect HCP, visitors, and others in the healthcare environment.

Accomplish the previous two goals in a cost-effective manner whenever possible.

Each institution is unique, and its specific needs must be considered when developing or reorganizing an

infection prevention and control program. Factors include size, case mix, and types of care provided. The

principal functions are generally similar, however, and include the following:

1. To obtain and manage critical data and information, including surveillance for infections

2. To develop and recommend policies and procedures

3. To intervene directly to prevent infections and interrupt the transmission of infectious diseases

4. To educate and train HCP, patients, and nonmedical caregivers

Because of differing needs, there may be various groups, individuals, and functions within the organization

that are responsible for the infection prevention and control program. The following sections outline various

persons and activities essential to an infection prevention and control program.

Infection Prevention Team

Often the core of the infection prevention and control program is the infection preventionist (IP), chair of

the infection prevention committee, and the healthcare epidemiologist. An individual responsible for

occupational health or administration also may be a part of this team. The team is responsible for



carrying out all aspects of the infection prevention and control program. There should be one person,

however, who is designated as having responsibility for the program.10,11 Team members must be

qualified and guided by sound principles and current information. It should set goals, collect and analyze

data, and select interventions.

A facility may have an infection prevention committee (IPC) that functions as the central decision-making

and policy-making body for infection prevention. The IPC chair reports to the medical staff and/or

administration. The IPC acts as the advocate for prevention and control of infections in the facility,

formulates and monitors patient care policies, educates staff, and provides political support that

empowers the team.30,31

The IPC must be multidisciplinary, composed of representatives from appropriate departments; examples

include nursing, administration, engineering, pharmacy, building management. It should meet regularly,

usually monthly or quarterly. Representation typically includes members of administration and clinical

and ancillary staff. Because infection prevention issues and measures often cross departmental lines, an

IPC that is multidisciplinary is crucial.

The IPC often refines and ratifies the ideas of the infection prevention team. Its members disseminate the

information discussed in the meeting.

An IPC is not required by TJC; however, some states do require an IPC (also called an infection control

committee). Institutions may support a committee structure for the reasons outlined earlier. If a

committee is not used, the infection prevention team needs to develop other mechanisms (e.g., use of

quality improvement [QI] models) to obtain multidisciplinary support for changes and actions. QI models

use a collaborative approach, including use of multidisciplinary teams. These teams meet regularly and

are responsible for planning, policy development, interventions, and decision making. The team leader

may be the infection prevention professional.

Dissemination of infection prevention information is a crucial component of an infection prevention and

control program. Surveillance data and policy decisions should be communicated throughout the

organization. This communication may be accomplished through routine written and/or verbal reports to

clinicians, committees, and/or department heads and through various electronic methods. It is important

to provide appropriate information to medical staff and administration as well as front-line HCP.

Infection Prevention Professionals

There are two key infection prevention professionals: the IP and the healthcare epidemiologist. The IP

predominately has a background in nursing, medical technology, microbiology, or public health.32

Additional titles used by IPs may include infection control nurse, infection control coordinator, nurse

epidemiologist, infection control officer, and infection control practitioner. The IPs role involves the daily

collaborative efforts within all facets of healthcare. The IP typically functions as a consultant, educator,

role model, researcher, and change agent. Infection prevention and control responsibilities include

education, consultation, surveillance, implementation science, patient safety, and quality improvement.12

The healthcare epidemiologist may be the chair of the IPC or may occupy a separate position as either a

technical advisor or member of the committee. This person is often a physician with special training in

healthcare epidemiology and infection prevention. In the United States, the position is usually filled by an

infectious diseases physician who works closely with the medical staff.

Depending on the institution, infection prevention professionals may report to administration, nursing or

medical services, or quality improvement departments; other reporting relationships also exist. In some

institutions, the infection prevention and control program is integrated with other departments (e.g., risk

management, utilization/case management, patient safety, or quality improvement).

The role of infection prevention professionals includes responsibilities such as the following:10-12,31

1. Collection and analysis of infection data

2. Evaluation of products and procedures

3. Development and review of policies and procedures

4. Consultation on infection risk assessment, prevention, and control strategies (includes activities

related to occupational health, construction, and emergency management)

5. Education efforts directed at interventions to reduce infection risks

6. Education of patients and families

7. Implementation of changes mandated by regulatory, accrediting, and licensing agencies (includes

reporting communicable diseases to health departments)

8. Application of epidemiological principles, including activities directed at improving patient outcomes

using implementation science33,34

9. Antimicrobial management

10. Participation in research projects

11. Provision of high-quality services in a cost-efficient manner

Some infection prevention professionals work less than full-time on infection prevention. They also may be

involved in such areas as occupational health, quality improvement, patient safety, and risk management.

In nonacute care facilities, infection prevention professionals typically have multiple roles to fill and

usually have a designated number of hours per week to devote to infection prevention activities.35

An infection prevention professionals time is split among data management, policy and procedure

development, education, occupational health, quality improvement, program development, consulting, and



investigating potential outbreaks. Infection prevention professionals should be involved in implementation

science activities and some may take part in Institutional Review Board (IRB)approved research

activities.12 Task and job analyses have been performed to specify what the infection prevention

professionals day-to-day work may entail.36 The development and availability of electronic data mining

systems have impacted the infection prevention professionals day-to-day priorities, an area which is still

under evaluation. The infection prevention professional may also be involved in investigations related to

adverse outcomes other than infections.37

Successful infection prevention professionals improve their leadership strategies and pursue opportunities

for self-development.6 Certification for infection prevention professionals is available through CBIC.

Practice and professional standards are available for various practice settings and professional

backgrounds and include key indicators to be used in evaluating both the competency of the individual

and their practice. The key indicators represent multiple skills considered necessary to meet the

demands of the evolving healthcare environment.12 In addition, competency models are available for

professionals to use for successful practice.13,38

Many training courses exist for infection prevention professionals. Local and national APIC organizations,

SHEA, state organizations, academic institutions, and private firms offer training courses. Courses are

available for both beginning and experienced individuals.

Staffing

In 1969 the CDC recommended one full-time IP for every 250 occupied beds on the basis of pilot studies

in eight community hospitals in which different staffing levels were evaluated.39 The SENIC project

strongly supported the 250-bed recommendation.16

Because the CDC recommendation is more than 40 years old, these staffing recommendations are

outdated. This is especially true because there have been dramatically increased demands on the IPs

time for surveillance, education, quality improvement, patient safety, and consultation in addition to many

changes in healthcare. Changes in healthcare delivery have also expanded the range of infection

prevention activities. These programs require sufficient resources to be effective and maintain program

responsibilities.4,40,41 In most acute care hospitals, the IPs scope of work is much greater than that

evaluated in the CDC recommendation.

A 2004 Health Canada model projected three full-time IPs for every 500 beds in acute care hospitals.42

A group in the Netherlands estimated that one full-time IP was needed per 178 hospital beds or one per

5,000 admissions. The Dutch group also estimated one infectious disease physician was needed for

every 25,000 admissions.43

One work group in California categorized the major functions of the infection prevention and control

program created a method that uses workload units to develop staffing requirements.44 A Belgian

Department of Health working group adopted a point system for staffing. The number of infection

prevention professionals required is based on the number of points obtained by multiplying the number of

beds of each patient-care unit by a factor that is specific for the patient population treated in the unit.45

APIC initiated a Delphi project on staffing that was published in 2002.46 It noted that staffing

recommendations must consider the number of occupied beds, scope of the program, complexity of the

healthcare facility, characteristics of the patient population, and unique needs of the facility. This study

recommends a ratio of 0.8 to 1.0 IP for every 100 occupied acute care beds.

Long-term care facility resources have also been evaluated.47 The Health Canada study estimated the

need for one full-time IP per 150 to 250 beds.42 The Delphi project assessed the need for 0.8 IPs for a

facility with 100 beds, increasing to three for a 500-bed facility.46 A Dutch group estimated a need of 500

hours per 100 residents per year.48

CMS does not specify either the number of infection prevention professionals to be designated or the

number of hours that must be devoted to infection prevention and control programs. However, resources

must be adequate to accomplish the tasks required for the program. It recommends using studies and

recommendations on resource allocation published by APIC and SHEA to make staffing decisions.18

DOCUMENTING IMPACT OF HEALTHCARE ASSOCIATEDINFECTIONS ON OUTCOMES AND COSTS

The SENIC project found that one third of HAIs could be prevented by effective infection prevention and

control programs that included surveillance and practice activities. The project also noted that prevention

of approximately 6 percent of HAIs offset the cost of a program in a 250-bed hospital.16

Part of a programs effectiveness is a reflection of the influence of infection prevention professionals. They

must be visible, provide a resource for staff, and use their scientific expertise when making specific

recommendations. Effectiveness also depends on commitment to infection prevention by

administration.49

It is important to outline the cost-benefit of an infection prevention and control program.50 Demonstrating

value is important for healthcare facilities that need to make economic decisions regarding support for

infection prevention and control programs.51 Targeted surveillance should be tied to specific interventions

to decrease HAIs. Appropriate interventions to decrease infections will then result in documentation of

cost savings.7

Economic evaluations can be used to compare costs with outcomes.52 Cost-effectiveness and cost-

benefit are examples of decision analysis studies. Effectiveness refers to the outcome of care. It can be



expressed as the number of cases of disease prevented, the number of lives saved, or the number of life-

years saved. Cost-benefit analysis looks at outcomes in terms of cost. Benefits other than direct

financial costs also are important in evaluating the impact of infection prevention activities. These include

decreasing malpractice claims, protecting employees from injury, assisting in patient safety efforts, and

enhancing the organizations image.53

Various methods can be used to estimate how much HAIs cost an institution. The cost of the infection

prevention program itself consists of salaries, employee benefits, education, and commodity expenses.

Cost-benefit estimates also can be developed for mortality and morbidity in patients. A crude estimate of

cost can be obtained by multiplying the estimated numbers of HAIs at various sites by the site-specific

cost weights (cost per infection) and adjusted for time. Other methods use actual cost weights or costs

determined through prospective, randomized studies. Prevalence surveys also can be used to assess the

costs of HAIs.54

INFLUENCING PRACTICE

Characteristics of the Organization

The ability of the infection prevention and control program to influence practices that affect safe patient

care depends on certain characteristics of the patient population, patients risk of infection, and

characteristics of the organization and personnel. These characteristics include number of beds,

professional school affiliation, geography, volume of patient encounters, patient population served, clinical

focus, number of employees, and administrative philosophy. It is important to understand these

characteristics when developing a program to optimally meet the infection prevention needs of the

organization and the patients it serves.

Written infection prevention policies are often developed that relate to staff and patient-care practices,

construction/renovation, emergency management, occupational health, and sterilization/disinfection.

General policies are applicable to staff in the whole facility. These policies may form the basis of an

infection prevention manual. Specific policies may also be developed for each unit or area. These policies

must be supported scientifically and address the infection prevention needs for the institution.

However, providers of direct patient care must implement these policies consistently to benefit patients

and protect staff. Infection prevention professionals usually attempt to affect patient care outcomes by

influencing other healthcare personnel and their practices. Teaching personnel to increase their

knowledge and skills of appropriate infection prevention practices is one method to influence quality

patient care and protect employees. Education of staff is crucial to the success of any infection

prevention and control program.

The infection prevention and control program thus influences practice through direct actions (e.g., review

and evaluation of products, policy and procedure review and development, and observations). In addition,

training and education of staff can assist in skill development and increase employees knowledge base

to affect practice.

Patient Safety

Infection prevention personnel play a crucial role in preventing infections and other adverse events.55

Because of their expertise in epidemiological methods, IPs can support infection prevention, quality

improvement, patient safety, and adverse health-event reduction programs. Infection prevention

professionals can use basic healthcare epidemiology (e.g., surveillance, outbreak investigation, and

special studies), implementation science, and other quality improvement tools (e.g., root cause analysis)

to improve patient outcomes. Implementation science can be useful in transitioning evidence-based

practices into routine work.34

Administrative Support

It is important that the administrative leaders of the organization approve and support its infection

prevention activities. Infection prevention professionals should schedule regular meetings with the

administrator to whom they are responsible. This practice helps to maintain liaison between the program

and administration and increase awareness of the institutions leaders of infection prevention and control

program activities. There should also be routine reports presented to senior leaders.

QUALITY OF AN INFECTION PREVENTION AND CONTROLPROGRAM

The interdisciplinary infection prevention team determines goals and objectives for the infection prevention

and control program by performing an annual risk assessment.56 These should be based on the

institutions strategic goals and institutional data and findings from the previous years activities.

Identification of high volume, high risk, and problem prone activities is an important component of the risk

assessment. Infection prevention resources and data systems needs should be evaluated in the context

of these goals and objectives. The risk assessment can assist in setting priorities and obtaining support

from key stakeholders.

Set priorities to help focus on appropriate allocation of infection prevention and control program resources.

Realistic strategies for surveillance and intervention should be developed. Steps to use in this process

include the following:57



1. Establishing a reliable, focused surveillance program based on the annual risk assessment

2. Streamlining data management activities

3. Analyzing HAI rates

4. Aiming for zero HAI rates

5. Educating staff regarding prevention strategies

6. Identifying opportunities for performance improvement

7. Taking a leadership role on performance improvement teams

8. Developing and implementing action plans that outline the steps needed to accomplish each objective

9. Evaluating the success of action plans in accomplishing the goals and objectives of the infection

prevention plan

The quality of the infection prevention and control program should be assessed routinely by evaluating

customer satisfaction, appropriateness, efficacy, timeliness, availability, effectiveness, and efficiency.

An annual evaluation of the infection prevention and control program is important to outline achievements

and activities of the program and describe support requirements. The value of the infection prevention and

control program to the organization should be emphasized, along with patient outcomes and cost

savings. This evaluation report should be widely disseminated to leaders throughout the organization, in

particular to the chief executive officer, chief medical and nursing executives, and board members.

An additional method to explain the importance of the program to others is through a mission statement,

a description of the vision for the program, and an outline of core values.

INTERNATIONAL PERSPECTIVE

Infection prevention and control programs worldwide are organized around local guidelines and regulations

to optimize quality healthcare and are influenced by various payer models;58 there are many different

models. The International Federation of Infection Control produces a handbook that includes information

on infection prevention and control programs.59 The World Health Organization recommends an appointed

technical team of trained nursing and medical professionals who are responsible for organizing,

implementing, and monitoring practices.60,61

Programs in most countries are coordinated through an infection prevention team, typically a physician

(infectious disease physician) and an infection control nurse.62 The infection control doctor could be a

medical microbiologist, an epidemiologist, or an infectious diseases physician. An infection control nurse

is typically a registered nurse with an academic education (perhaps with a qualification, such as

specialized training) and practical training that enables him or her to act as a specialist advisor in all

aspects relating to infection prevention and control.

The team coordinates the planning, implementation, and evaluation of the program. It is responsible for

the day-to-day running of the program. Many programs use infection control link nurses to develop

educational programs and provide operational support. They help identify problems, implement solutions,

and maintain communications with the team.

REFERENCES

1. McDonald LL. Health policy for infection control and epidemiology in critical care. Crit Care Nurs Clin

1995;7:727-732.

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The Joint Commission (TJC). Available at: http://www.jointcommission.org.

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