2010 State of the Industry Report: ICT Readers Speak Out

To acquire data for our 2010 State of the Industry Report, we conducted anonymous electronic polls of ICT readers who work in infection prevention, in the operating room, in sterile processing, in environmental services and in materials management. While the polls are unscientific in nature, we believe the results provide an intriguing look inside these departments and provoke dialogue about what is happening in the current economic climate. The conclusions that can be drawn from this report are varied, but two important trends are clear:

-- No matter the discipline, budget cuts have had an impact on professionals perceived ability to do perform their jobs.

-- Professionals in every discipline expressed the need for more education, resources and funding to enhance their job performance.

We present results for the five segments of the infection prevention community:

Environmental Services

From our poll it's clear that individuals working in environmental services (EVS) have a significant number of years of experience, are mostly in management, and are responsible for many other tasks beyond environmental services. Most EVS departments have experienced budget cuts, and the majority of poll respondents report that these cuts have in some way hampered their job performance. The good news is that a whopping 95 percent of respondents indicated they work closely with their facility's infection prevention and control department. Here are the results of our poll:

How long have you worked in environmental services?

Less than 1 year -- 2%

1-3 years -- 10%

4-8 years -- 10%

9-15 years -- 21%

16-20 years -- 21%

21+ years -- 36%

Are you a:

Technician -- 2%

Supervisor -- 7%

Manager/Director -- 90%

Do you hold a CHESP credential?

Yes -- 19%

No -- 81%

How many employees work in your department?

1-5 -- 7%

6-10 -- 14%

11-15 -- 5%

16+ -- 74%

How many licensed beds are in your facility?

1-50 -- 24%

51-99 -- 14%

100-250 -- 31%

251-300 5%

301-500+ -- 29%

Where do you work?

Acute-care hospital -- 86%

Long-term acute-care facility -- 12%

Other -- 12%

(county hospital, critical care hospital, VA medical center)

Long-term care facility -- 10%

Community clinic -- 10%

Ambulatory surgery center -- 7%

Where are you located?

Midwest -- 36%

Northeast -- 24%

Southeast -- 14%

West -- 14%

Pacific Northwest -- 10%

Southwest -- 2%

Are you located in:

A rural area -- 40%

A small city -- 36%

A major metropolitan area -- 26%

Are you responsible for:

Environmental services only -- 53%

Other -- 47%

(Laundry/linen; waste management; hazardous materials management; patient transportation; other physical-plant responsibilities)

Has your department experienced staffing and/or resource/budget cuts in the last year or so?

Yes -- 71%

No -- 29%

Have these cuts diminished your capacity to do your work?

Yes -- 57%

No -- 43%

Do you have the tools and equipment you need to perform your job properly?

Yes -- 88%

No -- 5%

Uncertain -- 7%

What activities do you engage in daily?

Administrative tasks and meetings -- 95%

Observational rounds -- 90%

Education -- 86%

Supervision of cleaning and sanitation activities -- 88%

Human resources-related tasks -- 79%

Cleaning and sanitation activities-- 62%

Other -- 5%

(Corrective actions, purchasing)

How often do you participate in educational events (conferences, Webcasts, etc.)?

Rarely -- 26%

Regularly -- 62%

Frequently -- 19%

Do you pay for your own education?

Yes -- 36%

No -- 71%

What resource(s) do you use for on-the-job information?

Internet research -- 86%

Industry guidelines and recommendations -- 83%

ASHES resources -- 74%

Trade journals -- 64%

Other -- 17%

(Webinars, in-services, colleagues and peers at other facilities, sales reps )

Are you a member of:

ASHES -- 69%

Other -- 38%

APIC -- 7%

Are you involved in cleaning/sanitation/waste management/infection prevention-related product evaluation and/or purchasing?

Yes -- 100%

No -- 0%

How is your department perceived by your facilitys administration?

Positively-- 81%

Neutrally -- 17%

Uncertain -- 2%

Negatively-- 0%

Does your occupation receive the respect it deserves?

Yes -- 45%

No -- 45%

Uncertain -- 10%

Do you work closely with your facilitys infection prevention department?

Yes -- 95%

No -- 0%

No, but I would like to if given the opportunity -- 5%

Has your facility ever experienced an outbreak of infections tied to improperly cleaned surfaces/patient rooms?

Yes -- 7%

No -- 93%

Do you feel confident in your ability to properly clean the patient environment to prevent infections?

Yes -- 95%

No -- 2%

Uncertain -- 2%

What would improve your departments performance?

More personnel -- 66%

More educational opportunities -- 54%

Bigger budget -- 44%

Better/more equipment and tools -- 34%

Better/more cleaning products -- 10%

Other -- 10%

(Better collaboration/cooperation from nursing, better quality of ES staff)

Better/more personal protective equipment -- 2%

Sterile Processing

As with EVS, individuals working in the sterile processing department (SPD) also had a significant number of years of experience in the field, are mostly supervisors and managers; in addition, many hold a credential and 82 percent say they believe that all SPD professionals should be certified in order to elevate the profession. Here are the results of our poll:

How long have you worked in sterile processing?

1-3 years -- 6%

4-8 years -- 17%

9-15 years -- 25%

16-20 years -- 17%

21+ years -- 35%

What is your education level?

High school diploma -- 33%

Trade school diploma -- 18%

Associate degree -- 29%

Bachelors degree -- 19%

Masters degree -- 6%

Are you a:

Technician -- 18%

Supervisor -- 24%

Manager/Director -- 46%

Other -- 15%

(SPD educator, lead technician, coordinator, consultant)

Do you hold a credential?

CRCST -- 67%

CIS -- 4%

CHL -- 11%

Other (CNOR, etc.) -- 46%

Do you think all SPD professionals should be certified?

Yes -- 82%

No -- 7%

Uncertain -- 11%

How many employees work in your department?

1-5 -- 20%

6-10 -- 15%

11-15 -- 20%

16+ -- 47%

How many licensed beds are in your facility?

1-50 -- 9%

51-99 -- 13%

100-250 -- 24%

251-300 -- 17%

301-500+ -- 37%

Where do you work?

Acute-care hospital -- 80%

Other -- 13%

(Academic medical center, VA hospital, military hospital, trauma center, burn center)

Ambulatory surgery center -- 8%

Specialty surgical hospital -- 5%

Where is your facility located?

Midwest -- 25%

Northeast -- 23%

Southeast -- 18%

Southwest -- 10%

West -- 11%

Pacific Northwest -- 8%

Mid-Atlantic -- 4%

Are you located in:

A major metropolitan area -- 48%

A small city -- 30%

A rural area -- 22%

Has your department experienced staffing and/or resource/budget cuts in the last year or so?

Yes -- 74%

No -- 26%

Have these cuts diminished your capacity to do your work?

Yes -- 36%

No -- 64%

Which activities do you engage in daily?

Sterile processing-related activities -- 95%

Infection control-related tasks -- 77%

Administrative tasks and meetings -- 73%

Product evaluation/interacting with vendors -- 69%

Participating in education events -- 61%

Research and/or writing -- 19%

Community leadership/advocacy -- 16%

Other -- 6%

(Inventory; safety and quality Improvement committee; teaching; testing sterilization products; budgeting; ordering/purchasing; cost-savings initiatives; policy and procedure evaluation, etc.)

How often do you participate in educational events (conferences, Webcasts, etc.)?

Rarely -- 25%

Regularly -- 52%

Frequently -- 24%

Are you a member of:

IAHCSMM -- 77%

Other -- 37%

(CBSPD, AORN, AAMI, AST, regional associations, etc.)

APIC -- 2%

Do you pay for your own education/travel?

Yes -- 43%

No -- 21%

Sometimes -- 38%

What resource(s) do you use for on-the-job information?

AAMI Recommended Practices -- 93%

IAHCSMM resources -- 82%

Internet research -- 81%

Trade journals -- 63%

Other -- 3%

(CDC and FDA information; AORN recommended practices; SGNA recommended practices; company reps/in-services; Infection Control Today magazine; benchmarking and networking with other hospital SPD managers; manufacturers recommendations, etc.)

Are you involved in infection prevention-related product evaluation and/or purchasing?

Yes -- 65%

No -- 35%

Do you work closely with your facilitys infection prevention department?

Yes -- 81%

No -- 7%

No, but I would like to if given the opportunity -- 13%

Are you a member of your facilitys infection control committee?

Yes -- 52%

No -- 34%

No, but I would like to if given the opportunity -- 15%

Does your facility provide the equipment and tools you need to do your job properly?

Yes -- 9%

No -- 14%

Uncertain -- 7%

Does your SPD have a good working relationship with the operating room?

Yes -- 86%

No -- 5%

Uncertain -- 10%

Do you believe your profession lacks the recognition and respect it deserves?

Yes -- 88%

No -- 8%

Uncertain -- 4%

Has your facility experienced an outbreak of infections tied to improperly sterilized instruments?

Yes -- 2%

No -- 97%

Uncertain -- 1%

Do you feel confident in your ability to properly process instruments?

Yes -- 98%

No -- 2%

Uncertain -- 1%

What would improve your SPDs performance?

More educational opportunities -- 72%

More personnel -- 53%

Better/more cleaning, decontamination, sterilization tools and equipment -- 45%

Bigger budget -- 43%

Better/more personal protective equipment -- 6%

Other -- 15%

(Staff certification; more input in purchasing decision; more department space/better workflow; use of an instrument tracking system; better pay; updated technology; increased tray inventory; more storage space, etc.)

Better/more cleaning and decontamination products -- 8%

What do you consider to be the most important issues facing sterile processing professionals?

Education of SPD professionals -- 87%

Respect for the profession -- 86%

Mandatory certification of SPD professionals -- 70%

Infection prevention and control -- 59%

Budget cuts -- 54%

Going "green" -- 23%

Community leadership/advocacy -- 19%

Other -- 7%

Respondents from the sterile processing community had a number of items on their mind, including the challenge of keeping up with new technology; a lack of clear, enforceable requirements for staff; availability of qualified applicants for open positions; and working within labor budget limits and still being able to get the job done. The issue of pay for SPD personnel came up quite frequently; as one respondent commented, "Such low pay for employees makes managers unable to hire the best candidate or we take the time to train someone and then they leave for a higher-paying department." Another respondent noted, "Our profession is notoriously underpaid and demeaned as doing the dishes and cooking the instruments, a job which anyone is capable of. The pay rate should be equal to that of OR technicians." Yet another respondent commented, "The SPD is not a revenue-generating department so we are the first to receive unrealistic budget cuts."

Materials Management

Individuals working in materials management showed a high level of involvement in all of the sectors addressed by this report. Respondents indicated that they sit on their facility's product evaluation committees, and that they are very engaged in infection prevention and control-related purchasing. Here are the results of our poll:

How long have you worked in materials management?

1-3 years -- 9%

4-8 years -- 8%

9-15 years -- 14%

16-20 years -- 14%

21+ years -- 55%

What is your background?

Always been in materials management -- 58%

Was a clinician previously -- 29%

Was in administration previously -- 5%

Other -- 4%

(Nursing; corporate consultant; operating room background; sterile processing background; laundry, maintenance or housekeeping background, etc.)

What is your education level?

Associate degree -- 23%

Bachelor's degree -- 34%

Master's degree -- 22%

Other -- 22%

(high school graduate, some college, nursing degree)

How many employees work in your department?

1-3 -- 20%

4-7 -- 12%

8+ -- 68%

How many licensed beds are in your facility?

1-50 -- 15%

51-99 -- 12%

100-250 -- 17%

251-300 -- 5%

301-500+ -- 52%

What is your geographical region?

Southeast -- 29%

Midwest -- 20%

Southwest -- 15%

Northeast -- 14%

Pacific Northwest -- 12%

Mid-Atlantic -- 6%

West -- 5%

Are you located:

In a major metropolitan area -- 60%

In a rural area -- 26%

In a small city -- 14%

Where do you work?

Acute-care hospital -- 78%

Other (corporate office) -- 17%

Long-term acute-care facility -- 8%

Specialty surgical hospital -- 3%

Ambulatory surgery center -- 0%

Long-term care facility -- 0%

Are you responsible for :

Product evaluation -- 88%

Purchasing -- 75%

Central sterile management -- 31%

Other -- 9%

(Lab; pharmacy; distribution; OR inventory; linen)

Has your department experienced staffing and/or resource/budget cuts in the last year or so?

Yes -- 58%

No -- 42%

Have these cuts diminished your capacity to do your work?

Yes -- 25%

No -- 75%

Does your facility belong to a group purchasing organization?

Yes -- 95%

No -- 5%

Are you happy with your current GPO access to products with which to stock your central sterile?

Yes -- 95%

No -- 5%

Does your facility plan to switch/drop/add a GPO membership this year?

Stay the same -- 92%

Switch -- 5%

Add -- 3%

Drop -- 0%

Are you involved in infection prevention-related product evaluation and/or purchasing specifically?

Yes -- 87%

No -- 13%

Are you a member of your facility's product evaluation and purchasing committee?

Yes -- 87%

No -- 13%

Does your facility use:

Bar coding -- 50%

Instrument/device tracking -- 29%

RFID technology 16%

All of the above -- 37%

Are you ready for the GS1 transition relating to healthcare supply chain data standards?

Yes -- 16%

No -- 37%

Uncertain -- 48%

How often do you participate in educational events (conferences, Webcasts, etc.)?

Rarely -- 27%

Regularly -- 61%

Frequently -- 13%

Do you pay for your own education/travel?

Yes -- 37%

No -- 34%

Sometimes -- 29%

Is your department "going green" in any way?

Yes -- 77%

No -- 23%

Did your facility experience a shortfall in personal protective equipment such as masks, respirators or gloves during the 2009 H1N1 influenza outbreak?

Yes -- 59%

No -- 38%

Other -- 5%

(backorders and delayed shipments)

Do you work closely with managers in these departments:

Infection prevention and control -- 95%

Surgical services -- 92%

Environmental services -- 90%

Sterile processing department -- 85%

Other -- 23%

(Lab; pharmacy; nursing; radiology; plant operations; occupational health, disaster planning team)

Does your facility engage in just-in-time purchasing?

Yes -- 46%

No -- 56%

What would improve your job performance?

More educational opportunities -- 43%

More resources -- 41%

More personnel -- 41%

Better department funding -- 34%

Other -- 18%

(Better technology usage and support; more technology such as bar coding and asset tracking; policies and procedure update, etc.)

More flexible purchasing policies -- 11%

Operating Room

Our poll indicates that individuals working in the operating room (OR) and perioperative services are committed to infection prevention in the OR, since more than half of respondents say they are responsible for it as a job task. Whats more, 90 percent of respondents say they work very closely with their facility's infection control department. Here are results from our poll:

How long have you worked in perioperative nursing?

1-3 years -- 1%

4-8 years -- 6%

9-15 years -- 13%

16-20 years -- 16%

21+ years -- 65%

What is your education level?

RN or associate degree -- 33%

BSN or other bachelors degree -- 42%

MSN, MPH or other masters degree -- 24%

Doctorate -- 1%

Are you a:

Supervisor -- 8%

Manager/director -- 62%

Scrub/circulating nurse -- 7%

Technician -- 1%

Other -- 26%

(Perioperative educator; SCIP coordinator; nurse analyst, etc.)

Do you hold a CNOR credential?

Yes -- 60%

No -- 36%

In the process of preparing for the examination -- 3%

Will you be retiring in the next 1-5 years?

Yes -- 21%

No -- 79%

If you are retiring, do you believe your facility will be able to find a capable replacement?

Yes -- 77%

No -- 23%

How many employees work in your department?

1-5 -- 6%

6-10 -- 7%

11-15-- 8%

16+ -- 80%

How many licensed beds are in your facility?

1-50 -- 21%

51-99 -- 11%

100-250 -- 29%

251-300 -- 13%

301-500+ -- 26%

How many surgeries are performed annually in your facilitys ORs?

Less than 1,000 -- 13%

1,000 to 5,000+ -- 42%

6,000 to 10,000 -- 24%

10,000+ -- 21%

Where do you work?

Acute-care hospital -- 87%

Ambulatory surgery center -- 5%

Specialty surgical hospital -- 5%

Other -- 5%

(Critical-access hospital)

Where are you located?

Midwest -- 35%

Southeast -- 21%

Southwest 13%

Northeast -- 11%

West -- 8%

Mid-Atlantic -- 7%

Pacific Northwest -- 5%

Are you located in:

A major metropolitan area -- 37%

A rural area -- 35%

A small city -- 28%

Are you responsible for:

Surgical services only -- 76%

Infection prevention in the OR -- 54%

Other -- 30%

(PACU; endoscopy center; central sterile; sterile processing; GI lab; ambulatory surgery center; anesthesia; bariatric services, etc.)

Has your department experienced staffing and/or resource/budget cuts in the last year or so?

Yes -- 69%

No -- 35%

Have these cuts diminished your capacity to do your work?

Yes -- 28%

No -- 75%

Which activities do you engage in daily?

Administrative tasks and meetings -- 90%

Perioperative nursing-related activities-- 89%

Infection control-related tasks -- 86%

Product evaluation/interacting with vendors -- 83%

Participating in education events -- 80%

Research and/or writing -- 25%

Other -- 5%

(Direct patient care; patient safety; risk management; performance improvement; quality improvement; informatics, etc.)

How often do you participate in educational events (conferences, Webcasts, etc.)?

Rarely -- 18%

Regularly -- 59%

Frequently -- 26%

Do you pay for your own education/travel?

Yes -- 56%

No -- 48%

Are you a member of:

AORN -- 89%

Other -- 24%

(ASPAN, AANA, AAMI, AST, Sigma Theta Tau )

APIC -- 4%

What resource(s) do you use for on-the-job information?

AORN Recommended Practices -- 100%

Internet research -- 83%

Other professional association resources -- 72%

Trade journals -- 62%

Other -- 5%

(Mosby's Nursing Consult; OVID; CINAHL; manufacturer information; AAMI; OSHA; EPA; CDC; hospital medical libraries and university libraries; Infection Control Today magazine, etc.)

Are you involved in infection prevention-related product evaluation and/or purchasing?

Yes -- 86%

No -- 17%

Should vendors be allowed in the OR?

Yes -- 74%

No -- 12%

Case dependent -- 22%

Respondents had very clear ideas about parameters for vendors in the operating room. Some said it was okay if the vendors had all of the proper credentials/were screened, if the surgeon needs guidance with a new product, and only if cleared in advance by the OR director. Most respondents desired to see vendors allowed into the OR on a very restricted basis, and only if they could demonstrate proof of immunization and knowledge of aseptic technique and transmission-based precautions. Some professionals thought that having clear policies and procedures for vendors in the OR was a necessity, and that their presence was dependent upon following the same rules as OR personnel.

Have you participated in any quality improvement program related to the OR?

Yes -- 98%

No -- 2%

Do you work closely with your facilitys infection prevention department?

Yes -- 91%

No -- 3%

No, but I would like to if given the opportunity -- 6%

Are you a member of your facilitys infection control committee?

Yes -- 44%

No -- 44%

No, but I would like to if given the opportunity -- 12%

What would improve the performance of your department?

More/better educational opportunities -- 77%

Bigger budget -- 51%

More/better technology for the OR -- 44%

More personnel -- 7%

More/better products for the OR -- 32%

Other -- 4%

(More department/work space; better housekeeping practices by personnel; accountability for adhering to policy; more input from staff, etc.)

What do you consider to be the most important issues facing perioperative nurses?

Education of OR personnel -- 70%

Budget/resource cuts -- 67%

Cost containment -- 63%

Quality improvement measures -- 53%

Surgical site infections -- 53%

"Sacred cow" practices in the OR -- 52%

Compliance with evidence-based practices -- 51%

Inadequate staffing -- 48%

Legislative/regulatory issues -- 43%

Breaches in infection prevention practices -- 42%

Wrong site/side/patient, etc. surgery -- 7%

Retained objects -- 2%

Other -- 6%

Respondents said they were concerned about OR staff being able to fully understand and implement evidence-based practices. As one respondents noted, "There is a lack of everyone being engaged in the common cause." Professionals also noted that workloads were growing exponentially; one respondent commented, "With all the mandates coming out it makes it extremely hard for small hospitals to comply with all of them." Another person said, "Institutions want it done faster, more economical and doing it right takes a back seat."

Infection Prevention

One of the more surprising results of our poll was the indication that the majority of respondents are very new to infection prevention, with more than one-third saying they had only worked in the field for three years or less. It's encouraging to know that these practitioners have gone the extra mile to pursue their CIC credential; 43 percent say they hold this certification, with another 26 percent saying they are currently studying for the examination. Here are the results of our poll:

How long have you worked in infection prevention?

1-3 years -- 35%

4-8 years -- 22%

9-15 years -- 18%

16-20 years -- 11%

21+ years -- 14%

What is your education level?

RN or associate degree -- 26%

BSN or other bachelors degree -- 47%

MSN, MPH or other masters degree -- 22%

Doctorate -- 2%

Other (MD) -- 8%

Do you hold a certified-in-infection-control (CIC) credential?

Yes -- 43%

No -- 34%

In the process of studying for the exam -- 26%

Will you be retiring in the next 1-5 years?

Yes -- 18%

No -- 69%

Uncertain -- 14%

If you are retiring, do you believe your facility will be able to find a capable replacement?

Yes -- 31%

No -- 18%

Uncertain -- 52%

How many employees work in your infection control department?

Me, myself and I! -- 49%

2-3 -- 34%

4-7 -- 13%

8+ -- 5%

How many licensed beds are in your facility?

1-50 -- 16%

51-99 -- 13%

100-250 -- 32%

251-300 -- 8%

301-500+ -- 31%

Where do you work?

Acute-care hospital -- 86%

Other -- 11%

(in-patient psychiatric; home health; physician practice; surgical hospital; critical-access hospital; in-patient rehabilitation hospital; outpatient rehabilitation; chemical dependency clinic; hospice; behavioral health center; correctional facility, etc.)

Long-term acute-care facility -- 8%

Long-term care facility -- 5%

Ambulatory surgery center -- 4%

Community clinic -- 3%

Where are you located?

Midwest -- 33%

Southeast -- 22%

Northeast -- 18%

Southwest -- 10%

West -- 9%

Mid-Atlantic -- 5%

Pacific Northwest -- 4%

Are you located in:

A major metropolitan area -- 39%

A rural area -- 32%

A small city -- 31%

Are you responsible for:

Infection prevention only -- 50%

Infection prevention and employee health -- 18%

Infection prevention and quality improvement -- 14%

All of the above -- 12%

Other -- 15%

(Emergency/disaster preparedness; regulatory compliance; risk management; accreditation; staff education; safety training; utilization review; workers comp; wound care, etc.)

Has your department experienced staffing and/or resource/budget cuts in the last year or so?

Yes -- 51%

No -- 49%

Have these cuts diminished your capacity to do your work?

Yes -- 38%

No -- 66%

What percentage of your time is spent on non-infection prevention work?

Less than 10 percent -- 36%

Approximately 25 percent -- 35%

Approximately 50 percent -- 3%

Approximately 75 percent -- 7%

More than 75 percent -- 3%

What activities do you engage in daily?

Surveillance/crunching numbers -- 95%

Meetings -- 92%

Observational rounds -- 82%

Auditing/oversight/consulting -- 81%

Teaching/giving in-services -- 71%

Participating in education events -- 55%

Product evaluation/interacting with vendors -- 44%

Research and/or writing -- 27%

Other -- 11%

(Policy/procedure writing; emergency preparedness drills; pandemic preparedness exercises; outbreak investigation; grant writing ; administration/management; data entry/report writing; education development; patient-care activities; fit-testing; occupational health activities; crisis management; survey preparedness; mentoring activities)

How often do you participate in educational events (conferences, Webcasts, etc.)?

Rarely -- 23%

Regularly -- 63%

Frequently -- 18%

Are you a member of:

APIC -- 91%

Other -- 17%

(CHICA, INS, AACN, ENA, state associations)

SHEA -- 4%

AORN -- 3%

Do you pay for your own education and/or travel?

Yes, all of the time -- 13%

Yes, sometimes -- 50%

No -- 40%

Do you pay for supplies (such as for in-service activities) out of your own pocket?

Yes -- 13%

No -- 55%

Sometimes -- 36%

Do you use electronic surveillance?

Yes -- 38%

No -- 51%

Looking into it -- 17%

Are you involved in infection prevention-related product evaluation and/or purchasing?

Yes -- 92%

No -- 12%

How is your department perceived by your facilitys administration?

As an asset -- 55%

Neutrally -- 25%

Uncertain -- 15%

As a line item to cut from the budget -- 4%

Negatively -- 3%

Do you meet regularly with managers from other key departments?

Environmental services -- 83%

Operating room -- 75%

Sterile processing department -- 62%

Other -- 46%

(Pharmacy; lab; radiology; dialysis; ICU; nursing; materials management/purchasing; finance/administration; plant operations/ maintenance; dietary, etc.)

What do you consider to be the biggest barriers to healthcare workers compliance with infection prevention practices?

Lack of time -- 60%

Lack of education -- 30%

Lack of resources -- 5%

Other -- 5%

Many respondents cited apathy, forgetfulness, carelessness, a lack of accountability and laziness of healthcare workers as a major reason why they do not comply with infection control principles. They also pointed to lack of an institutional safety culture, with one respondent explaining, "Some staff just don't care about infection prevention." Some practitioners said that there were little, if any, consequences for compliance, and that they felt their hands were tied by management when attempting to rectify the situation. Several blame the indifference of staff on the "me generation" and a distinct lack of administrative support and buy-in from stakeholders at all levels throughout the facility. One infection preventionist noted, "I don't really think they comprehend the danger no matter how you educate them, " while another said, "Staff do not consider infection prevention a priority; they do not internalize the message; they do not relate the consequences to a bad outcome."

What do you consider to be the most important issues facing infection preventionists?

Staff compliance -- 82%

Workload -- 74%

Budgeting/resourcing infection prevention programs -- 60%

Quality measures and patient safety -- 57%

Mandatory reporting -- 55%

Inadequate staffing -- 53%

Pandemic/emergency preparedness -- 52%

Outbreak investigation and surveillance activities -- 46%

Evidence-based research -- 35%

HAI-related litigation -- 32%

Mentoring new infection preventionists -- 29%

Occupational health issues -- 18%

Legislative advocacy -- 17%

Other -- 5%

Topics that frequently came up in the "other" category include:

-- "Everything related to HAIs: education, prevention, monitoring, litigation."

-- Effective communication

-- Need for IT/administrative support

-- Lack of resources

-- Lack of administrative buy-in

-- Lack of quality education

-- Increasing workloads, dual roles and added responsibilities

As part of our poll we asked infection preventionists what concerns kept them up at night and why, and received some eye-opening answers:

"Everything!"

"We are spending so much more time doing chart reviews and less time actually preventing."

"Not enough time! Sometimes the units are short and I am pulled to cover a unit for the day. I then return the next day to my infection control work (which is left when I am pulled)."

"Since the ICP can't be everywhere, will the staff recognize that we are experiencing an unusual or new issue? I am also constantly trying to reach the new employee and the students as to the basic care issues that I think have been lost with the emphasis on technology."

"Lack of time to keep up with the regulatory components, new legislation, changes to policy and integrating the new electronic surveillance system."

"All that I can think of at the moment is that our hospital is in the process of deciding where to cut 100 jobs, so will I lose my job?"

"Micro-management of infection control programs by government/accreditation agencies and others who are out of touch with day-to-day issues and difficulties associated with clinical medicine and care of patients."

"The endless demands that are placed on infection control and the lack of support. The non-stop 12-hour days/ seven-day a week with very little time off seems to be the normal demand. Not considered a management role but functions as such."

"As ICPs we tell people what they need to do but are unable to hold them accountable if they don't do. It is reported to their managers and we hope they deal with it."

"Looking for innovative ways to ensure compliance with infection prevention strategies, increasing hand hygiene, preventing HAIs, pandemics, antimicrobial-resistant organisms."

"Lack of comprehensive electronic surveillance software and our ability to meet growing demands from internal and external stakeholders."

"Inadequate staffing. If my manager or I were to go out for an extended period of time, it would leave one person to run the department for a facility licensed for 732 beds."

"Trying to focus on breaking the chain of infection, not multiple-reporting mechanisms."

"Staff compliance with policies and procedures in place; adherence to infection prevention and patient safety standards."

"Feeling like there is not enough time to accomplish all that needs to be done and do it as thoroughly as I would like. Sometimes things suffer because of my lack to time to devote to them."

"Exposures, because we never know if we have included everyone that may have been exposed. Also staff compliance with infection prevention practices despite repeated education."

"Trying to do the best job possible with the resources available to me to deliver the best and safest healthcare possible to our patients."

"How to motivate staff to pay more attention to infection prevention measures and hand hygiene."

"Increased mandates but no increase in staff."

"Lack of a mandatory number of ICPs-to-hospital beds by any regulatory organization. New ICPs do not get the CIC credential due to lack of support. Mandatory re-testing but APIC gives no support for an increase of ICP in overcrowded hospitals."

"How can I help staff keep patients safe from infection and how can I educate patients to help staff keep them safe?"

"I am basically a consultant and content expert, but not an enforcer. That is management's duty. I can give the staff the knowledge and guidance, but I can't enforce compliance."

"Meeting all of the demands placed on me!"

"Unfunded mandates and the increased scope of the infection control department."

"Lack of acknowledgement of the importance of the job we do."

"Losing my job to budget cuts."

"As CEOs and CFOs continue to cut FTEs and reduce budgets, having a business case for increased resources does not make a difference."

"How to get the financial resources to do my job."

"Ensuring compliance with evidence-based infection control measures and preventing HAIs."

"Being able to keep up with my workload, having many different responsibilities. I worry I will miss something important such as with mandatory reporting requirements. I also feel stressed in finding ways to motivate staff to work on the quality measures and have everyone feel the same sense of accountability."

"Feeling like I'm not making a difference in patient care."

"Trying to get it all done by myself! I am having difficulty keeping up with the secretarial part of my jobs. They want me to be a computer expert and complete my own forms, etc. Much of my time is taken up in non-IC functions."

"Patients developing HAIs and getting sued for it. When you have the right policies and procedures and the staff just ignores it or pretends that they do not know that such policy and procedure exist, it is very worrisome."

"How to do it all."

"Am I doing what I need to do or am I just putting out current fires?"

"I am concerned that there is no one trained to step in should I get hit by a truck. No one knows exactly what I do or how I do it. An IC program should not be so dependent on one person. Experienced ICPs are hard to find."

"I am concerned that in my facility, I am in my position in name only. We recently had an outbreak of scabies, myself and the infectious disease physician met with administration in regard to our plan for the outbreak, which included putting a hold on admissions until we were sure the outbreak had passed. Administration decided against our advice and ended up admitting patients in the middle of this outbreak. This was very unethical to me. "

"What will get added next to my job responsibilities."

"Inability to get the message across the first time."

"Conveying to bedside staff the absolute criticality of following good infection prevention technique. There just isn't enough time and staff to provide the mentoring and monitoring that is required to ensure all staff are following expectations."

"Am I monitoring everything I'm supposed to be and if so, am I doing it effectively?"

"We are drowning in more and more laid on us by state groups for mandatory reporting; they have move resources but we do not!"

"What I don't know."

"The fact that there is too much work and not enough staff. Even with our successes that show financial data linked with infection prevention, it is impossible to convince them that we need more staff. I have done a productivity study and the issue have had my request for extra staff turned down."

"How can I get staff to understand the importance of basic infection prevention? Who would fill my shoes if I left (not that I plan on leaving, but you never know), how can I balance all the things that I oversee and know need to be changed, with the staff that we have? How will public reporting be congruent from hospital to hospital and state to state? How can that really be monitored?"

"My budget has been cut to bare bones, I have absolutely no resources, and I just received notice that I need to cut another 5 percent off of my budget. I don't even get office supplies, I purchase these with my own money. The only thing left to cut is my salary. We can't give good patient care if we don't have the resources to do it."

"So much work, so little time and resources."

"Trying to keep my head above water. So many things coming at me at once. Feeling burned out."

"24/7 responsibility for a high-profile department; must be able to respond quickly and decisively to any infection crisis; hospital administrators give more support to their other clinical management staff, especially if they have large number of employees; many of us report to nursing, an inherent conflict of interest. It is the top guy in the organization we should report to and who should be paying the most attention to infection prevention in the facility."

"When an unusual situation occurs, such as H1N1, finding concrete answers to the best practice."

"Increases in the demands of regulatory agencies, increased service lines, and facility growth put increased demands on my very small department. While the budget was not cut this year, it also did not increase. May fear is that we will not be able to effectively do our jobs and the patients will suffer for it."

"Healthcare reform frightens me. I fear that undereducated people on healthcare are making major decisions that will affect all of us greatly."

"Missing something because I was in meetings or off-site at corporate meetings. Corporate dictating what surveillance will be done instead of letting our risk assessment determine where I spend my energies."

"Antimicrobial abuse despite stewardship programs, not only by physicians but by nurses as well. For instance, during times of exposure rather than wait for culture returns everyone automatically takes prophylaxis. My other concern is disregard for isolation and hand hygiene practices. The 'it won't affect me' mentality still exists. I constantly try to obtain real life examples of how the breach in infection control practices did affect the staff so I can influence at least one person a month."

"The lack of trained ICPs to assume positions vacated by retiring nurses. This is a major problem in our area of the country; only one ICP per hospital and no one receiving the training necessary to assume our jobs when we retire or if we should become unable to work. I have talked with our administrators to try to budget for a part-time training position for this preparatory phase. To date this has not been approved."

"The feeling of responsibility for non-compliant staff. If hand hygiene is not being done, or isolation precautions are not being followed, I feel responsible, regardless of the amount of staff education that I have provided."

"So much to do in so little time!"

"Providing education that is stimulating and engaging to staff; resources are limited to do so."

"The increase in government reduction in paying for HAIs based on the current CDC definitions. I feel the definitions are not always consistent with what is a true hospital-acquired infection."

"Lack of administrators' understanding of infection control. We have become number crunchers, not preventionists."

"I am retiring in five weeks and my replacement has never done infection control. I hate to see a department that I have nurtured for 16 years not be as effective as it could be."

"Concern that given the limited time, unless I want to live at the facility, that I may be missing important HAIs. If I am I am not giving a true picture and we won't respond appropriately."

"How infection prevention is bigger than all of us... HAIs require all of us to be at the top or our game."

"I am frequently concerned that we are never doing enough and hand hygiene compliance is a struggle, everyone says and thinks they do it but the reality is different. I would like to see more government interest which would enable us to use more financial resources to do our jobs and do them well. I feel like I only do pieces of my various jobs."

"People dying from HAIs. I don't think zero HAIs is possible but on paper it will be made possible if hospitals start to get punished for recognizing true rates."

"Not being able to get all the work done yet still being held responsible for it."

"How to keep infection prevention visible to all staff. I'm convinced that education is the least of what staff needs; it is the way to internalize it into all their day-to-day processes. It is creating standardized work processes that make the job easier and straight forward. It is getting rid of consistently poor performers."

"Inability to institute effective change."

"Our administration does not view infection control as a cost-saving, quality-care program. No support and a 'we-have-bigger-fish-to-fry' attitude trickles down to clinical staff. There's no incentive to follow evidence-based infection control practices. The infection control budget is barebones, covering my salary and little else. After beating my head against the wall I'm ready to move on. What will happen to the program I sweated over? Will someone qualified be hired to carry on? I hope for our patients and staff there will be."

"Attitudes: both of the staff and of the management. Compliance with infection prevention issues seems voluntary rather than mandatory."

"Administrators need to truly put the word out that infection prevention is vital and put some 'oomph' behind it."

"Too much needless, but required paperwork. Infection prevention is not brain surgery. It is simple and easy to teach, enforce and monitor. Yet, now it is full of risk assessments, performance improvement, logs, etc. It should be surveillance and education. Common sense taught from someone with knowledge. The paperwork and logs tell me people are lazy and have to prove they did their work."

"How to engage line staff members in such a way as to increase the culture of safety and raise accountability to best practice and patient advocacy."

"How to get it all done and make a difference in practice."

"Lack of administrative understanding of infection control. They know it is a necessity, but without understanding what it is all about they are less likely to budget or staff accordingly."

"People not doing what they should, whether due to lack of time, non-belief or whatever."

"Time to promote positive change is limited at best, no budget or resources to adequately teach and roll out improvement measures. As mandatory reporting increases, time is taken away from improvement activities."

"Expanding infection prevention practices to all levels of the institution, while responding to leadership expectations of infection reduction as the responsibility of our small unit."

"The shortage of smart, new ICPs who are passionate about infection prevention; shortage of adequate evidence-based research on which to base decisions."

"The difficulty in educating the physicians who practice in our hospital to follow simple infection control measures such as hand hygiene and isolation precautions."

"Not having enough time to do everything that I need to do and being expected to do it anyway."

"The increase in reporting has dramatically increased in our state and I do not know where this will end."

"Workload and stress from being the only FTE in infection control."

"Missing an employee immunization or mask fit-testing and have that person get exposed. I spend all my time these days crunching numbers. I no longer have time to drive home education and observe clinical practice for employee and patient safety."

"How to keep up with all the patient safety initiatives, implementing new guidelines, how to keep various project team going and how to emphasize to administration the importance of infection control activities for better patient outcomes that will affect our bottom line."

"Prioritizing workload to complete work in a timely manner. Thinking about ways to better educate and involve healthcare workers. Infection control measures aren't always understood clearly and getting active participation is critical for patient safety. 'Edu-tainment' involves and shows infection control measures in a more tolerable way."

"Not having enough time in the day to do the job I think needs to be done."

"Will I really have to do this job for the rest of my life?"

"Trying to please an administration that does not understand our needs."

"Healthcare workers and the lack of respect for the welfare of patients. That healthcare workers only wash their hands about 50 percent to 60 percent of the time!! That it has taken the public and healthcare facilities so long to acknowledge infection control practices/basic simple hygiene practices that your mother should have taught you! It scares me that pandemic outbreaks like SARS and H1N1 are only going to get more frequent and that we do not have enough training."

"How to get buy in from staff that hand hygiene is required; trying to get physician buy-in to evidence based practices such as maximal barrier precautions for central line insertion; trying to convince hospital administration that it is necessary to understand that Employee health is important and that we need to know if an employee is immune to varicella or has had adequate number of MMR immunizations. I feel like administration considers infection control to be a necessary evil."

"Fellow IPs who don't understand and wish to practice in the 'old school' mentality and don't wish to become contemporary in their thinking; lack of acknowledgment regarding my value and worth to the system I work for; lack of value about my position from the organization."

"Not being able to get it all done. Feeling very ineffective and not adequately educated on infection control issues."

"Staff's lack of compliance with hand hygiene. Being the primary witness to this lack of compliance, I am the one taking it to the next level in the chain of command. Staff get hostile in regard to being accused of not performing hand hygiene or wearing appropriate PPE in isolation rooms. It is a constant struggle to get staff buy-in to the importance of performing hand hygiene before and after each patient contact. I am always trying to think of creative educational tools."

"The increasing workload, increasing responsibilities, increasing deadlines, decrease in job security."

"How to overcome apathy of staff and get them really invested in understanding infection prevention practices. Also data reporting deadlines - no clerical support means I often spend time on less skilled tasks that takes away from surveillance and data analysis."

"Trying to get staff to believe that hand hygiene really can make a difference."

"When cuts are made, the infection control programs are the first to be cut."

"The corporation doesn't seem to have little understanding of the time and effort it takes to effectively oversee an infection control program. It feels like I get 'dumped on' too often."

"Did I forget to do something?"

"Increased mandates with no increase in resources."

"Legislative mandates with little/no sound studies to justify the cost/benefit of mandated actions. Ability of the ICP to perform requirements of the job with resources being cut."

"Trying to keep up with the workload, I'm actually at work about 50 hours a week plus bring things home on the weekend!"

"We cannot get healthcare workers to wash their hands!"

"Worry that budget and FTEs will be cut in next round of budget cuts and new regulations will require more and more surveillance.

"How to create an effective infection control program with no more education than I have, and no more power than I have with the staff. I'm doing my best, but my best is only as good as I can do with the time allotted for infection control in my schedule. We are a small rural area, and change comes very hard here, and usually at a very high price. I don't want that to happen. I also wonder how long I can continue to subsidize my department out of my pay. I can't spend much, but as a single Mom, a little can be a lot."

"Until a mandate for staffing occurs we won't get more staff."

"Turnover of well-trained staff, lack of champions."

"How is the data I collect and disseminate used effectively and efficiently."

"The lack of resources to do the barest essentials of a functioning infection control program. Despite and active role in managing multiple infection control challenges, the workload continues to expand."

"Fear of the unknown. Will we be able to deal with the unexpected when it arises?"

"Not having enough time to do all the things I have to do."

"New laws being passed that are written by those who do not work in the infection prevention field."

"Getting tired of doing it all and of the powers-that-be not really understanding the complexity and the workload of the job."

"An increase in MDROs coming into the hospital no matter what we do."

"I need more hours in a day. I am afraid I miss something every single day that could prevent an infection."

"Getting everything done in timely manner, since I am a department of one."

"I keep hearing 'do more with less' from our administration and do more, more, more from the regulatory agencies. How?"

"Just having enough time to get everything completed and stay informed about current recommendations/requirements."

"Trying to take the program to the next level, beyond daily monitoring and reports."

"Being so overworked that something slips through the cracks and a patient has a negative outcome and the press and the state are camped on the sidewalk."

"My value is to teach staff. Performing data entry is a clerical function, not master's prepared function."

"Knowing that the great majority of staff are in non-compliance with basic infection control practices."

"Not having enough time or resources to accomplish the job in the manner in which it should be done."

"Not enough time to complete the work. Not to be able to delegate reliably to staff. lack of support and appreciation from the leadership. still working in silos after all it has being said and done for teamwork and communication."

"Never having enough time to do everything - the job is just endless. It's very difficult to ever take any time off. I end up falling so far behind. Also lack of time to do active surveillance rather than retrospective chart reviews."

"Consistent auditing of hand hygiene compliance. Do results really show improvement or not?"

"The ability to keep up with all of the new laws and regulations for reporting, it becomes overwhelming when coupled with out break situations such as occurred with the H1N1 pandemic."

"What happens when I leave for the day. Each and every time I make rounds on nursing units I find healthcare workers not performing hand hygiene or following transmission-based precautions."

"How can I get it all done and still have a life?"

"Continually not able to meet my professional and personal expectations due to increasing requirements I have no control over."

"Resistance to infection prevention!"

"I have no clerical support and spend most of my time entering data and keeping track of employee health issues. This has to be completed but could easily be done by a clerical person."

"Government taking over healthcare without the expertise or experience to understand the nature or complexity of healthcare; Organisms having the ability to become resistant; global infectious events; trying to change culture in the facilty to make prevention an everyday priority; potential for bioterrorism events."

"Trying to remember why I went into nursing."

"The patients who suffer because nurses are too busy jumping through administrative hoops to be at the bedside."

"Wondering how to get everything done in hours allotted I have both a 25 bed hospital and 50 bed long term care on .5 FTE."

"Lack of investment for education for future ICPs."

"Joint Commission inspections due to unreasonable requirements of national patient safety goals."

"Have I done enough to protect my patients and staff?"

"Fear of missing something, not catching it in time."

"Being on call 24/7. I am going to get out of infection control for that reason. I have two small children and I am tired of carrying a pager all the time that interferes with my time with them and my own personal time. By the way not compensated in any form for the constant on call."

"There are always initiatives added to our job but not enough staff to cover. The workload is unbearable and it is very easy to get burned out and frustrated."

"I ask myself, what can I do or say to make all staff understand how important IC is and that they need to be just as responsible for putting up an isolation sign as I am."

"Getting to zero tolerance, how to continually improve infection prevention and share current results and initiatives."

"I worry that our hospital may have an outbreak of something contagious and it happened because of poor transmission based precautions."

"How to best engage line staff and medical providers so that they clearly understand their impact on IC patient outcomes. For many, they see infection prevention as MY job and don't embrace the concept of personal accountability."

"That legislators will make reporting mandatory and I won't have the time to do so."

"My staff are chained to their desks, slaves to surveillance, analysis, and report writing. They would much more effective on the units doing real-time education/intervention/monitoring (i.e. Hand Hygiene). Also, do to ever increasing budget cuts, education was the first to be eliminated from our budget. Our staff work harder, with less resources, and aren't given the opportunity to work 'smarter.'"

"Will I still have a job tomorrow?!"

"My main concern in the IC world is an overall lack of personal responsibility on the part of HCWs to incorporate safe IC practicing into their daily job tasks. In many healthcare organizations, administration is also not as involved in IC awareness as is needed for real change to occur. A lot of times it is expected that the ICP is solely responsible for making staff behavior improvements when in the end it must be administration that demands it and the individual HCW that implements it.

"Limited time to get great ideas accomplished."

"Lack of hand hygiene!

"Seems there is always something that is going on that ICP has to deal with and often alone. Some without support, of management team. "

"It worries me that the infections are getting bigger and stronger and the ones who prescribe medications continue to do so without thought of what it is doing to all of us. There must be more research on cleaning products that manage the bacterial growth without killing the staff and patients."

"Trying to develop teaching strategies to enhance staff knowledge of infection prevention."

"Getting staff buy-in! Infection prevention viewed as unnecessary. Staff don't get that infection prevention keeps them safe too."

"Not having enough time, not having the proper tools (such as an electronic data mining system) to make work more efficient."

"How can I get the staff to understand how important infection control measures are?"

"Being in compliance with all the agencies to their satisfaction."

"How to implement evidence-based best practices. With so many issues with the documentation at a facility how I can have it be most user friendly and ease for me to collect all the data."

"Lack of accountability and responsibility."

"I try not to take work home with me, but I always wonder if I will learn everything I need to know to be proficient at my job."

"There are so many things that need to be done and I don't have the time to do them. Working only 20 hours per week means I rarely have time to do staff education. The lack of resources dedicated to IC education is frustrating. I have never been to a national conference in my nine years in infection control."

"The inability to meet all the demands of the job. There are unrealistic expectations by administrative staff that IC can do surveillance, attend meetings, launch new projects such as antibiotic stewardship. Inability to achieve physician support and compliance in simple things such as hand hygiene, and eating at nurses stations. The herding of wild cats. Job impossible?"

"Trying to streamline and organize work activities to better utilize dwindling resources and available time."

"The incredible workload."

"The sheer volume of what needs to be done each day; lack of financial support to attend national conferences; having to say 'no' to requests for in-services, etc. due to lack of time."

"What remains undone at the end of each day."

"How to get the front line staff to respect and adhere to prevention measures."

"Too many meetings to get the actual infection control done."

"The uncertainty and frailty of the economic state of our country. And how this is impacting the world I have come to know. Wondering how much worse will it become before it turns for a long term improvement."

"The ability to keep up with the demands, what on my plate for tomorrow, am I prepared, I am missing something. This is my first year and it is overwhelming."

"Too many responsibilities, everything becomes an infection control issue."

"Too much to do in so little time."

"All of the new requirements ensures that the infection preventionist is spending more and more time in front of the computer doing administrative stuff instead of being out on the front lines."

"How to engage staff and keep infection prevention initiatives on their radar screen."

"The lack of interest in infection control initiatives."

"Non-compliance with education of infection prevention measures that cause a HAI that goes to court and I have to go and testify, tired because I work 50 to 60 hours per week and only get paid for 40, no respect for amount of work is required for infection prevention."

"What is happening to this discipline when there is not enough time or money to protect the patient or the facility or the employees."

"Lack of feedback and support from administration, until there is a problem. Then they want it done yesterday."

"C. diff. Our numbers increased last year and we are having trouble reducing them."

"H1N1 has 'helped' administrators recognize the value of ICPs. Administrators need education about infection prevention and how it enhances bottom line, versus viewing as a 'cost necessity.' Biggest issue: constantly increasing workload without enhancing staffing. This leads to very long hours without compensation, and with financial issues preventing raises anyway, it is a true burden. If recognition was more evident, it would be easier to sustain without salary increases."

"Not having enough quality time to do my job effectively."

"Equipment cleaning. The process is complicated and not well documented."

"Not losing the everyday surveillance in the mess of dealing with all the others which are a 'priority.'"

"Exposure to frivolous legal liability."

"Non-compliance with handwashing, which is a simple solution to spreading infections."

"Unable to make daily rounds."

"Trying to meet all of the regulatory requirements."

"The fact that infection preventionists should be at the level of vice president or hospital operations because it impacts everything within the healthcare setting. We should be autonomous reporting directly to the chief operations officer."

"Constant additions from regulatory agencies, unfunded mandates."

"Emergence of new multidrug-resistant organisms and the isolation practices pertaining to these organisms."

"Recruiting new ICPs."

"Things falling through the cracks."

"Not being able to perform my job efficiently and effectively due to time and financial constraints."

"Lack of time in the day to get everything done!"

"That we are not teaching effectively, getting to hung up on organisms and not on practices."

"Doctors' non-compliance because they are not our employees and we have no control over them."

"We continue to battle the lack of hand hygiene and this was determined to be a necessity by Florence Nightengale. Healthcare has become so complex but I wonder if things could be simpler if we concentrated more on the basics such as hand hygiene. The use of PPE also continues to be a struggle. The resulting exposures are sad and disheartening. All too often there is a lack of accountability for doing the right thing."

"Always trying to keep up with everything expected with minimal time to complete a job well done."

"Knowing there is so much education to do to make a difference and not having time to prepare it and present because there is so many other things scheduled into your day."

"Time for analyzing data."

"Not enough people to do all the things that I need to do relating to infection prevention -- inadequate staffing. I do not have time to do the important things because of the amount of time I need to comply with Joint Commission National Patient Safety Goals and standards. Multi-drug resistant organisms are becoming more prevalent so more time is needed for surveillance for these organisms."

"Are we prepared for surveys?"

"Did I forget to do something?!"

"Working 40-plus hours and never completing the work."

"Keeping employees and other patients safe when it is difficult at best to obtain MDRO information on patients prior to admission."

"Implementing all the regulatory requirements."

"I work in California. The state Legislature believes that part of their role is to "legislate away" HAIs. Great idea but it doesn't work in practice. As a result, we have some pretty unbelievable laws that impact they way we practice. They remain a never ending source of concern, amusement and bewilderment."

"Missing a significant lab report or clinical situation that requires isolation or intervention, resulting in an outbreak."

"The inability to give 100 percent to the infection preventionist role."

"Not being able to do my job because I have to learn as I go. I feel that I am not adequately doing my job."

"How to get staff to wash their hands!"

"People who just don't care."

"My to do list!!!!!

"Out-of-control situations that may place patients and healthcare workers at risk of infection."

And now for the most chilling response of all: "I don't lose sleep any more. I've given up."