Addressing Infection Prevention Staffing Gaps in Pediatric Health Care: A Call for Change

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

Infection Control Today^® (ICT^®) spoke with Lindsay K. Weir, MPH, CIC, lead infection preventionist/infection preventionist III, and lead author of the study at Boston Children’s Hospital, Boston, Massachusetts, to learn more.

The other authors are Jennifer A Ormsby, DNP, RN, CPN, CIC, CPNP-PC; Ana M Vaughan-Malloy, MD, MPH; and Celeste Chandonnet, MSN, RN, CIC.

“Our study came out of a lot of growth with our institution," Weir said. "So, in addition to opening a brand new clinical inpatient building, we were opening multiple ambulatory satellites, and our concern about how we will support those satellites and new clinics is that traditional staffing models only accounted for the inpatient beds. So, we were concerned that with our expansion, we might not be able to support all these spaces to the degree that we wanted to. So that was really what drove this assessment. We were trying to find another way to quantify our department’s needs to support the hospital as it grew.”

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

“What we ended up finding is that the most common indicators in our institution were performing aerosol-generating procedures, performing surgical procedures, even minor ones, like biopsies and using semicritical devices, and those particular ones are certainly at the top of IP’s brains in terms of who needs support, what needs more oversight," Weir said. "When you look at almost a quarter of your clinics performing minor surgical procedures, which was surprising to me—and I covered many of our ambulatory sites at the time—it helped emphasize how complex our system was in these clinics were, and how many things that we always would think of, traditionally as procedural spaces,[like] the operating room had moved into the ambulatory setting?”

The conventional approach to calculating IP staffing needs is based on the number of inpatient beds at a hospital. Still, this method does not consider critical trends in health care, such as increased outpatient procedures, shorter hospital stays, and more focus on ambulatory services. The need for IPs will likely be significantly higher than an inpatient-bed-only calculation suggests.

“The most immediate benefit of the 4 additional FTEs is our ability to be more present in these clinics and locations. When starting this assessment, as I said, we had 2 FTEs devoted to this space, and only 1 was fully ambulatory and procedural. So, at that time, our goal for rounding in these spaces was usually quarterly, and then, since we were able to add on these FTEs now, the routine cadence of rounding is monthly," Weir explained. "That gives the clinics more face time with us to bring up concerns. It helps us identify any regulatory gaps we need to address, and it helps build that relationship. Still, it also keeps us more eyes more frequently on spaces, which is a huge benefit to regulatory readiness and identifying opportunities for quality improvement work. But in addition to that, from a staff development perspective, it's beneficial for professional development.”