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P25_-_Anderson_et_al._SHEA_2006_-_Workload_of_ICPs

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					146                                      Results of a Survey of Work Duties of 56 Infection Control Professionals (ICPs):                                                                                                                                                      Contact information:
                                                                                                                                                                                                                                                                               Deverick J. Anderson, M.D.

                                         Are New Guidelines Needed for the Staffing of Infection Control (IC) Programs?                                                                                                                                                        Box 3824
                                                                                                                                                                                                                                                                               Duke University Medical Center
                                                                                                                                                                                                                                                                               Durham, NC 27710
                                                 DJ Anderson1,2, KB Kirkland3, JR McDonald4, DK Warren4, Z Kanafani1,2, E Cook2, C Clark2, D Boyette2,                                                                                                                         Phone: (919) 684-4174
                                                                                                                                                                                                                                                                               Fax: (919) 681-7494
                                                                         LH Adcock2, JJ Engemann1,2, KS Kaye1,2, DJ Sexton1,2                                                                                                                                                  ander077@mc.duke.edu

                     Abstract                              1Duke     Univ Med Ctr, Durham, NC, USA; 2 - Duke Infection Control Outreach Network, Durham, NC, USA;
 Background: Despite radical changes in the scope
 and severity of risks for developing healthcare-
 associated infections (HAI) during the past 20 years,
                                                                3 - Dartmouth-Hitchcock Med Ctr, Lebanon, NH, USA; 4 - Barnes-Jewish Hospital, St. Louis, MO, USA
 there have been no official guideline changes
 regarding ICP workload and responsibilities since                BACKGROUND                                                                Table 2 – Education and job characteristics of 56                           Table 3. Infection control and non-infection control work
 the authors of the SENIC study recommended a
                                                           • Radical changes in the scope and severity of risks for                         ICPs from 3 tertiary care hospitals and 28                                  responsibilities for 56 ICPs.
 minimum of one ICP per 250 hospital beds in 1985.
 In fact, studies that critically assess the work          developing healthcare-associated infections (HAI) have                           community hospitals                                                                                                         All ICPs          Median time/week
 responsibilities of ICPs have not been published                                                                                                                                                All ICPs                                                                (n=56)                 (%)
 despite steady increases in regulatory mandates and       occurred during the past 20 years                                                                                                      (n=56)              Infection Control Responsibilities
 responsibilities related to IC.                           • There have been no official guideline changes regarding                                                                               n (%)              Environmental rounds                               54 (96)                 5 (4-8)
 Objective: To characterize the work requirements of                                                                                        ICP Characteristics
 a group of 56 ICPs.                                       ICP workload and responsibilities, however, since the                            Job title
                                                                                                                                                                                                                      Employee orientation                               47 (84)                 3 (2-5)
 Methods: A cohort of ICPs from 31 hospitals               authors of the SENIC study recommended a minimum of                                                                                                        Employee education                                 53 (95)               5 (3.3-8.8)
                                                                                                                                              ICP                                                 31 (55)
 answered questionnaires regarding work                                                                                                                                                                               Oversee isolation                                  55 (98)             7.7 (3.8-10.8)
                                                           one ICP per 250 hospital beds in 1985.                                             Director/Coordinator                                16 (29)
 characteristics, education, work experience, and
                                                                                                                                              Manager                                              6 (11)             Surveillance                                       53 (95)             30 (18.1-46.7)
 work responsibilities. ICPs were asked if they            • Studies that critically assess the work responsibilities of                      Epidemiologist                                        2 (4)               Type
 perform specific duties and the proportion of time                                                                                                                                                                       Targeted                                       35 (63)
 spent on each duty in an average week.                    ICPs have not been published despite steady increases in                           Nurse                                                 1 (2)
                                                                                                                                              ≥ 2 titles                                          13 (23)                 Hospital-wide                                   8 (14)
 Results: Fifty-six (98%) of 57 ICPs from 31               regulatory mandates and responsibilities related to IC.                                                                                                        Both                                            8 (14)
 hospitals (bed range 30 – 962) completed our survey;                                                                                       Certified ICP                                         27 (52)
 42 (75%) of these 56 ICPs worked in 28 community                 METHODS                                                                   No of years at current position       1
                                                                                                                                                                                                 3 (1.5-8)            Resistant organisms                                55 (98)             50 (23.7-57.5)
 hospitals; the remaining 14 ICPs worked in tertiary-      • A cohort of ICPs from 31 hospitals answered                                    No of years in infection control                   7.5 (3-13.5)           Construction oversight                             45 (80)               5 (2.3-5.4)
 care hospitals. Thirty-five (63%) of the ICPs held                                                                                         No of hours of work/week                            40 (40-45)            Investigation                                      53 (95)              4.8 (2.5-6.3)
 multiple degrees; 35 (63%) had worked in IC for 5         questionnaires regarding work characteristics, education,                        ICP Education                                                             Research                                           15 (27)              4.9 (2.2-5.4)
 or more years; 27 (48%) were certified. Only 20           work experience, and work responsibilities.                                      Degree                                                                    Quality improvement                                47 (84)               5 (2.7-8.2)
 (36%) respondents, however, had attended a national
                                                           • ICPs were asked if they perform specific duties and the                          RN                                                  41 (73)             Management                                         31 (55)               10 (5-17.7)
 IC meeting in the past year; only 70% of ICPs had
                                                                                                                                              BSN                                                 23 (41)             Other                                              17 (30)              6.7 (5-10.6)
 support staff available. The 5 most commonly cited        proportion of time spent on each duty in an average week.
 IC-related ICP duties were implementing isolation                                                                                            Multiple                                            35 (76)             Non-Infection Control Responsibilities
 policies (98% of respondents), making                     • Hospital data for 2004 was obtained                                            Meeting attendance                                    52 (93)             Any                                                49 (88)               15 (5-25)
 environmental rounds (96%), conducting                                                                                                       National                                            20 (36)             Patient safety                                     28 (50)                5 (2.3-5)
 surveillance (95%), educating employees (95%), and               RESULTS                                                                        SHEA                                               5 (9)             Budget                                             18 (32)              1 (0.5-2.5)
 investigating individual cases or outbreaks (95%).        •  56 (98%) of 57 ICPs responded                                                      National APIC                                    15 (27)
                                                                                                                                                                                                                      Employee Health/Occupational medicine              27 (48)               5 (2.5-15)
 The most time consuming activity was surveillance,                                                                                              CDC course                                         5 (9)
 accounting for a median of 30% (IQR 18-47) of             •  Hospital data for 2004 summarized in Table 1                                    Local                                               51 (91)
                                                                                                                                                                                                                      Committees                                         44 (79)                5 (5-12)
 ICPs’ time (approximately 12 hours/week). Despite            •Bed range (30-962)                                                                Local APIC                                       43 (77)             Other                                              19 (34)              10 (5-15.6)
 the fact that only 21 (38%) respondents had dual job
 titles, 49 (88%) respondents had non-IC                   • 42 (75%) ICPs worked in 28 community-based                                          Other:                                           39 (70)
                                                                                                                                            Job characteristics
 responsibilities. Overall, surveyed ICPs spent a          hospitals; 13 (25%) worked in 3 tertiary-care hospitals                          Support staff available                               39 (70)         CONCLUSIONS
 median of 15% (IQR 5-25) of their time on non-IC
 related activities, including employee health (EH),       Table 1 – Characteristics of 30 Hospitals during 20041                           Other job appointments                                21 (38)         •    A substantial proportion of duties of many ICPs are not directly
 budget management, and non-IC committee work.                                                                                                Employee Health                                     14 (25)              related to infection control, especially in community hospitals.
 Compared to ICPs in tertiary care hospitals,                  Hospital Data               Total         Median (Interquartile range)         Continuing Education                                 7 (13)
 community ICPs were more often responsible for                Daily census                5,223               128.5 (80-230)                 Supervising – Nursing                                 3 (5)         •    Despite extra responsibilities, only 38% of ICPs have other official
 non-IC responsibilities (95% v. 64%, p < 0.01).               No. of beds                 8,251               247 (137-384)                  Supervising – Other                                   2 (4)              job titles, many lack support staff, and many do not receive support
 Conclusions: Surveyed ICPs were highly educated,                                                                                             Staff Nurse                                           5 (9)
 experienced, and qualified. Surveillance, instead of
                                                               No. of ICUs2                  58                    1 (1-2)                                                                                             to attend continuing education conferences.
                                                               Patient-days              1,747,196        43,073 (24,295 – 81,086)            Other                                                 1 (2)
 intervention, constitutes the most time consuming
                                                                                                                                           1 All continuous variables = median (IQR) unless otherwise indicated   •    Most ICPs spend more time on surveillance than on prevention. We
 activity. Additionally, non-IC responsibilities such as       Surgical procedures        146,188            4389 (1,967-5,983)
 EH and administrative duties related to committee             Infection Data
                                                                                                                                                                                                                       think these data should be a stimulus to refocus infection control
                                                                                                                                           Subgroup Analysis (42 Community ICPs vs.
 work and budget consume a substantial portion of              BSI3                        1,281                    9 (5-28)                                                                                           activities, as much as possible, towards infection prevention.
 ICPs’ time, especially in community hospitals.                                                                                            13 Tertiary-care ICPs):
                                                               SSI4                        1,217                   31 (13-61)                                                                      •                   Most ICPs do not have adequate resources for continuing education.
 Despite extra responsibilities, only 38% of ICPs have
                                                               VAP5                                                                        • Community ICPs were more often responsible for non-
 other official job titles, many lack support staff, and                                    225                    2.5 (0-4.5)                                                                     •                   Many ICPs do not have adequate administrative support.
 many do not receive support to attend continuing              MRSA6 infections            1,061                   14.5 (8-59)             IC tasks (95% v 64%, p<0.01).
                                                                                                                                                                                                   •                   With increasing rates of HAI and with shifting responsibilities of our
 education conferences. With increasing rates of HAI
                                                               1 Data unavailable for one hospital; 2 ICU – intensive care unit; 3 BSI –   • Community ICPs were less likely to have support staff
 and with shifting responsibilities of our workforce,                                                                                                                                                                  workforce, new guidelines are needed to better define the work
 new guidelines are needed to better define the work           blood stream infections; 4 SSI – Surgical site infections; 5 VAP –          available (60% v 100%, p<0.01)
                                                               ventilator-associated pneumoniae; 6 MRSA – methicillin-resistant                                                                                        duties and responsibilities for ICPs who practice in the 21st century.
 duties and responsibilities for ICPs who practice in
 the 21st century.
                                                                                                                                           • Community ICPs more commonly had other job
                                                               Staphylococcus aureus
                                                                                                                                           appointments (50% v 0%, p< 0.001)
                                                                                                                                                                                                                                     * Dr Anderson is a recipient of a Pfizer Fellowship in Infectious Disease

				
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