Staffing and structure of infection prevention and control programs

Published:February 09, 2009DOI:


      The nature of infection prevention and control is changing; however, little is known about current staffing and structure of infection prevention and control programs.


      Our objectives were to provide a snapshot of the staffing and structure of hospital-based infection prevention and control programs in the United States. A Web-based survey was sent to 441 hospitals that participate in the National Healthcare Safety Network.


      The response rate was 66% (n = 289); data were examined on 821 professionals. Infection preventionist (IP) staffing was significantly negatively related to bed size, with higher staffing in smaller hospitals (P < .001). Median staffing was 1 IP per 167 beds. Forty-seven percent of IPs were certified, and 24 percent had less than 2 years of experience. Most directors or hospital epidemiologists were reported to have authority to close beds for outbreaks always or most of the time (n = 225, 78%). Only 32% (n = 92) reported using an electronic surveillance system to track infections.


      This study is the first to provide a comprehensive description of current infection prevention and control staffing, organization, and support in a select group of hospitals across the nation. Further research is needed to identify effective staffing levels for various hospital types as well as examine how the IP role is changing over time.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Haley R.W.
        • Quade D.
        • Freeman H.E.
        • Bennett J.V.
        Appendix B: design of the Preliminary Screening Questionnaire and specifications for computing indexes of surveillance and control.
        Am J Epidemiol. 1980; 111: 613-621
        • Haley R.W.
        The usefulness of a conceptual model in the study of the efficacy of infection surveillance and control programs.
        Rev Infect Dis. 1981; 3: 775-780
        • Haley R.W.
        • Quade D.
        • Freeman H.E.
        • Bennett J.V.
        The SENIC Project. Study on the Efficacy of Nosocomial Infection Control (SENIC Project): summary of study design.
        Am J Epidemiol. 1980; 111: 472-485
        • Quade D.
        • Culver D.H.
        • Haley R.W.
        • Whaley F.S.
        • Kalsbeek W.D.
        • Hardison C.D.
        • et al.
        The SENIC sampling process: design for choosing hospitals and patients and results of sample selection.
        Am J Epidemiol. 1980; 111: 486-502
        • Haley R.W.
        • Culver D.H.
        • White J.W.
        • Morgan W.M.
        • Emori T.G.
        • Munn V.P.
        • et al.
        The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals.
        Am J Epidemiol. 1985; 121: 182-205
        • Richards C.
        • Emori T.G.
        • Edwards J.
        • Fridkin S.
        • Tolson J.
        • Gaynes R.
        Characteristics of hospitals and infection control professionals participating in the National Nosocomial Infections Surveillance System 1999.
        Am J Infect Control. 2001; 29: 400-403
        • Murphy D.M.
        From expert data collectors to interventionists: changing the focus for infection control professionals.
        Am J Infect Control. 2002; 30: 120-132
      1. Real Pro, infection control specialist: Nancy Dupont. Healthwire issues May/June 2008. Available at: Accessed July 2, 2008.

        • Goldrick B.A.
        • Dingle D.A.
        • Gilmore G.K.
        • Curchoe R.M.
        • Plackner C.L.
        • Fabrey L.J.
        Practice analysis for infection control and epidemiology in the new millennium.
        Am J Infect Control. 2002; 30: 437-448
      2. Cook RJ. Kappa. In: Armitage T, Colton P, editors. The Encyclopedia of biostatistics. New York: John Wiley & Sons; 1998. p. 2160–2166.

      3. NHSN manual: patient safety component protocol. Centers for Disease Control and Prevention. Available at: Accessed February 23, 2007.

        • Dillman D.
        Mail and telephone surveys: the total design method614.
        Wiley, New York1978
        • Curchoe R.
        • Fabrey L.
        • LeBlanc M.
        The changing role of infection prevention practice as documented by the Certification Board of Infection Control and Epidemiology practice analysis survey.
        Am J Infect Control. 2008; 36: 241-249
        • Haas J.P.
        Measurement of infection control department performance: state of the science.
        Am J Infect Control. 2006; 34: 543-549
        • Stone P.W.
        • Pogorzelska M.
        • Kunches L.
        • Hirshhorn L.
        Nurse staffing and HAI: a systematic review.
        Clin Infect Dis. 2008; 47: 937-944
      4. Prevention and control of healthcare-associated infections in Massachusetts. Part 2: Findings from complementary research activities. Betsy Lehman Center for Patient Safety and Medical Error Reduction, JSI Research and Training Institute Inc, and Massachusetts Department of Public Health, 2008. Available at: Accessed August 21, 2008.

      5. New York State Hospital-Acquired Infection Reporting System, pilot year-2007. New York State Department of Health. Available at: Accessed August 21, 2008.

        • Jacobs P.
        • Rapoport J.
        • Edbrooke D.
        Economies of scale in British intensive care units and combined intensive care/high dependency units.
        Intensive Care Med. 2004; 30: 660-664
        • O'Boyle C.
        • Jackson M.
        • Henly S.J.
        Staffing requirements for infection control programs in US health care facilities: Delphi project.
        Am J Infect Control. 2002; 30: 321-333
        • Pronovost P.J.
        • Berenholtz S.M.
        • Goeschel C.
        • Thom I.
        • Watson S.R.
        • Holzmueller C.G.
        • et al.
        Improving patient safety in intensive care units in Michigan.
        J Crit Care. 2008; 23: 207-221
      6. Centers for Disease Control and Prevention. Reduction in central line-associated bloodstream infections among patients in intensive care units-Pennsylvania, April 2001-March 2005.
        MMWR. 2005; 54: 1013-1016
        • Leape L.L.
        • Berwick D.M.
        • Bates D.W.
        What practices will most improve safety? Evidence-based medicine meets patient safety.
        JAMA. 2002; 288: 501-507
        • Wong P.
        • Helsinger D.
        • Petry J.
        Providing the right infrastructure to lead the culture change for patient safety.
        Jt Comm J Qual Improv. 2002; 28: 363-372
        • Goldrick B.A.
        The Certification Board of Infection Control and Epidemiology white paper: the value of certification for infection control professionals.
        Am J Infect Control. 2007; 35: 150-156
        • Dillman D.A.
        Why choice of survey mode makes a difference.
        Public Health Rep. 2006; 121: 11-13
        • Dillman D.A.
        • Smyth J.D.
        Design effects in the transition to web-based surveys.
        Am J Prev Med. 2007; 32: S90-S96
        • Donaldson S.I.
        • Grant-Vallone E.J.
        Understanding self-report bias in organizational behavior research.
        J Bus Psychol. 2002; 17: 245-260
        • Larson E.L.
        • Quiros D.
        • Lin S.X.
        Dissemination of CDC's Hand Hygiene Guideline and impact on infection rates.
        Am J Infect Control. 2007; 35: 666-675