New Method Needed to Determine Infection Preventionist Staffing Levels

Just what infection preventionists (IPs) do and how much time they spend doing it remains somewhat of a mystery because of a lack of evidence-based guidelines on this matter, according to a study in the American Journal of Infection Prevention. The way in which IPs spend their “time varies significantly from hospital to hospital and is driven in part by regulations, by the priorities of hospital administration and supervisors of IP, and by the strengths and interests of the IP,” according to the study.

But the common method used to determine IP staffing-using a ratio of IPs to the number of beds or the number of patients-might not be the best way of determining just how many IPs an institution needs. 

Instead, hospital administrators and others who determine IP staffing should use the World Health Organization’s Workload Indicators of Staffing Need (WISN) method, say investigators with the All India Institute of Medical Science, in New Delhi, India. As the name suggests, WISN looks at the workload, and not solely at the numbers of IPs, patients, or beds. 

“The WISN method is a human resource management tool that determines how many health workers of a particular type are required to cope with the workload of a given health facility and assesses the workload pressure of the health workers in that facility,” the study states. 

Investigators wanted to find out just what the correct staffing levels should be for acute care hospitals. To that end, they used the WISN method, dividing the work IPs do into 3 categories: control activities, support activities, and additional activities. The control activities are directly tied to infection prevention and performed by all IPs; support activities were also performed by all IPs but did not necessarily have to do with infection prevention, and additional activities were performed by only a few IPs. 

The investigators calculated how many IPs with an available working time of 6,132 hours it would take to handle a workload that should take 6,238.25 hours to complete in an acute care hospital with 182 beds and 69,331 annual admissions. 

“Core infection control activities consumed 78% time,” the study stated. “Support and additional activities consumed the remaining 22% time. Active surveillance required 44% time and education consumed 32% time. WISN ratio of available staff and required staff was 0.75.” In other words, there needs to be 4 IPs on staff, not 3 as would have been the case if common ratio calculations were used. 

Active surveillance consumed most of the IP workload; 44% out of the total available time adding up to about 14 hours a week. And most of that surveillance was conducted on central line associated blood stream infections (CLABSIs).

The study concluded that “staffing for infection control can no longer be made on the basis of bed numbers or patient census but rather must reflect the scope of the program, characteristics of the patient population and the workload involved, techniques for applying scientific knowledge base about IP, and the unique and/or urgent needs of the institution and community. WISN is a valuable method that can prospectively measure all infection control activities and translate workload into IP FTEs [full-time employees]. Staffing guidelines based on WISN will require periodic revisions.”