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Address correspondence to Timothy Landers, PhD, RN, CNP, CIC, The Ohio State University College of Nursing, 1585 Neil Ave, 376 Newton Hall, Columbus, OH 43210. (T. Landers).
The APIC MegaSurvey was completed by 4,078 infection preventionists (IPs) in 2015.
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MegaSurvey methods and study design are reviewed.
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37.7% were considering certification.
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Surveillance and investigation accounted for a mean of 25.4% of IP practice.
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66.2% of IPs practiced in acute care, with a wide variety of other practice settings.
Background
Infection preventionists (IPs) play key roles in preventing health care-associated infections and ensuring quality of care. To develop strategies to support comprehensive infection prevention practice, it is critical to understand key aspects of their practice.
Methods
A task force of expert IPs, staff representatives from the Association for Professionals in Infection Control and Epidemiology (APIC), and survey designers developed and pilot tested a survey addressing 4 components of infection prevention practice: demographic characteristics, compensation, organizational structure, and practice and competency.
Results
During mid- to late-2015, 4,078 APIC members (response rate 31%) participated in the study. Results indicated that all of the practice domains of the APIC Competency Model for the Infection Preventionist were rated as “important” or “very important” to supervisors or managers of IPs. Surveillance and investigation accounted for the most time in an IPs typical day, followed by prevention and control of transmission, identification of infection, and management and communication.
Discussion
Future analyses will examine the validity of the APIC Competency Model for the Infection Preventionist; factors related to professional development, including addressing the needs of IPs who may be ready for certification; and current compensation of IPs.
Conclusions
The results of the APIC MegaSurvey can be used to guide development of programs and initiatives for the future of infection prevention.
Infection preventionists (IPs) are the backbone of efforts to prevent infections in health care settings. IPs are responsible for a wide range of activities, including identifying outbreaks, implementing preventive measures, monitoring compliance, and developing organizational capacity in response to infection-related issues.
The Association for Professionals in Infection Control and Epidemiology (APIC) is the leading professional organization of IPs, composed of approximately 15,000 members, including nurses, physicians, public health personnel, epidemiologists, microbiologists, medical technologists, and other professionals working to improve patient safety. Founded in 1972, APIC is a nonprofit organization with a mission to “create a safer world through prevention of infection.”
APIC programs, products, and services support infection prevention activities worldwide.
A major APIC initiative has been the development of the essential knowledge, skills, and abilities of IPs. These key domains of infection prevention practice have been outlined in the APIC Competency Model for the Infection Preventionist (Fig 1).
The APIC Strategic Plan 2020 identified key goals for the organization in patient safety, implementation science, IP competency, advocacy, and data standardization (Table 1).
Despite increasing recognition of the importance of infection prevention, relatively little is known about contemporary IP practice. To provide resources to support IPs and identify future directions for infection prevention, it is critical to understand IPs' practice environments, demographic characteristics, organizations in which they work, and the relative importance of different domains of their practice.
Table 1Association for Professionals in Infection Control and Epidemiology strategic goals 2020
1. Demonstrate and support effective infection prevention and control as a key component of patient safety.
2. Promote and facilitate the development and implementation of scientific research to prevent infection.
3. Define, develop, strengthen, and sustain competencies of the IP across the career span and support board certification in infection prevention and control to obtain widespread adoption.
4. Influence and facilitate legislative, accreditation, and regulatory agenda for infection prevention with consumers, policy makers, health care leaders, and personnel across the care continuum.
5. Promote and advocate for standardized, quality, and comparable health care-associated infection data.
The last formal study of APIC members, conducted nearly 20 years ago, identified practice location and components of IP practice among 1,100 APIC members.
Although member surveys are conducted periodically, few studies have systematically addressed trends or changes in practice in a robust sample of IPs. To address the gap in understanding current IP practice, the aim of the APIC MegaSurvey was to describe the current practice environment for IPs and to provide detailed information about current practice. The overall goal of the project was to provide information that could be used to help identify research gaps and future direction for APIC's activities in education, policy, outreach, and advocacy. The survey was also designed to provide empiric data to validate the APIC Competency Model.
Methods
Design
This was an anonymous, cross-sectional, online survey of IPs delivered using a database of current APIC members.
Setting and sample
All current, active members of APIC were eligible to participate if they were able to read and respond to the questions in English and were not current employees of APIC or its affiliates. APIC members are highly engaged with their professional organization, and the APIC MegaSurvey was a major organizational priority, with promotion of the survey at local and national meetings and in APIC publications. Administration and data collection were conducted by an independent third-party agency: Industry Insights.
Procedures
Participants were recruited through an e-mail request sent to current, active APIC members. Survey participants were also recruited by announcement at APIC local chapter meetings, presentations at the APIC 2015 Annual Scientific Meeting, through the APIC Web site, and through APIC's member publications. Participants were provided a customized invitation containing a link to the online survey. At the survey home page, participants received an introduction to the survey and were asked to complete basic eligibility questions. After agreeing to participate, participants completed a series of questions addressing 4 domains. Survey questions were administered using a custom-designed survey portal and stored on a secure server located behind a firewall with intelligent threat defense, and all data were encrypted at rest.
Measures
A survey of IPs was developed by members of the APIC MegaSurvey Task Force appointed by the APIC Board of Directors. Beginning in 2014, this group of expert IPs, APIC staff members, and survey design experts identified key areas for the survey in a series of conference calls over 3 months. Content validity was achieved through iterations of the survey, and pilot testing was completed with 2 groups of subject matter experts who were practicing IPs, researchers in the field of infection prevention, and other thought leaders. To provide a comprehensive assessment of current IP practice, the questions elicited responses in 4 main domains of the survey: Demographic Characteristics, Organizational Structure, Practice and Competencies, and Compensation (Table 2).
Table 2Survey domains, components, and sample questions
Domain
Sample question
Demographic Characteristics
Primary practice setting
Academic, acute, behavioral health, long-term care, military
Data were reviewed to identify outliers and errors in the response set, and these were recoded as missing. When appropriate, sparsely populated categories were collapsed. Standard parametric and nonparametric statistics were used to describe demographic characteristics and infection prevention practice competencies using standard statistical software (SPSS version 22; IBM-SPSS Corp, Armonk, NY, and Excel; Microsoft, Redmond, WA). For categorical values, the midrange value was used to calculate descriptive statistics. The APIC Competency Model for the Infection Preventionist was used to evaluate competency in each domain by IPs by facility type, practice setting, years of experience, and educational preparation.
Human subjects protection
Sensitive information such as salary and compensation, demographic characteristics, and information about specific institutions was obtained during the interview. No personally identifiable information was associated with individual responses. To be eligible for the incentives for participation, participants had the option to provide a name and contact e-mail address. Participants who opted to provide contact information were eligible for incentives in 2 rounds, which included gift cards ranging from $100-$1,000. In addition, participants who provided contact information were provided with a benchmark compensation report. The APIC MegaSurvey was determined to be exempt by the Western Institutional Review Board (FWA IRB No. 00000533).
Results
Of 13,050 eligible members, 4,079 (31%) participated in the APIC MegaSurvey during mid- to late-2015. Demographic characteristics of participants are shown in Table 3. The majority (82%) of respondents had a primary discipline of nursing. Table 4 shows Certification Board of Infection Control and Epidemiology certification in infection prevention and control (CIC) certification status and plans to obtain CIC status of participants by years of experience. In regard to CIC certification, 37.7% reported that they planned to sit for certification in the future and 8.3% were unsure about future certification. Specifically, 19.0% (n = 772) of participants planned to sit for CIC during the next 12 months, and 18.7% (n = 760) reported that they planned to pursue certification in the future. Among all participants, 8.3% were unsure if they would be pursuing certification, and 5.2% of respondents reported that they were not considering certification.
Table 3Demographic characteristics of APIC MegaSurvey participants
Among all participants, the mean salary was $76,933 (median, $75,000; range, $25,000-$225,000) (Table 5). Individuals with current CIC certification had higher base compensation than those without current CIC certification ($85,911 vs $68,817; P < .01). The factors most frequently reported by participants as the criteria for compensation included experience (54.6%), performance measures (41.0%), highest degree earned (38.8%), and CIC certification (31.5%). Surveillance and investigation were reported as the most frequent activities by IPs, accounting for approximately 25.4% of infection prevention efforts (Table 6).
Table 5Compensation by geographic region, United States only
The results of the APIC MegaSurvey provide the foundation for understanding the state of IPs' practice, establishing a benchmark for practice and compensation data, and suggesting directions for future growth of the IP role. Forthcoming articles, developed by the APIC Research Committee, will provide in-depth analyses of the data to frame IP practice for the coming years.
Aligned with APIC's strategic goals, these analyses will offer the foundation for growth of infection prevention as a core element of patient safety. Each group of authors is closely analyzing the significant findings of the APIC MegaSurvey with implications for APIC overall and for chapter members, individual members, policy makers, educators, and others deeply invested in preventing infection. These articles will help to shape the future of IP practice and achieve APIC's mission to “create a safer world through the prevention of infection.”
The APIC Competency Model for the Infection Preventionist: Current and future IP practice
Results from the APIC MegaSurvey are rich in data on the APIC Competency Model for the Infection Preventionist, allowing a more granular look at IP competency within a wider context of facility type, years of experience, professional development, and current position. The data allow a better definition and understanding of the roles and responsibilities of IPs by positioning infection prevention and control (IPC) as a discipline to compare its professionals and their competencies to affiliated disciplines and roles. Exploring IP placement in this wider context is being undertaken jointly by the APIC Research Committee and the APIC Professional Development Committee to draw useful associations between adult skill acquisition models and IP practice. Such an exploration will provide insight into opportunities for professional development.
IP compensation and satisfaction
A forthcoming article will address IP satisfaction with compensation and the factors associated with satisfaction with compensation. The goal of this article will be to provide an overview of IP compensation based on current practice setting, experience, and other factors. This is important because it will help organizations plan compensation packages that are more conducive to future recruitment strategies, encouraging retention of IPs as well as increased productivity (metrics-based performance) and higher levels of satisfaction.
Current IP practice: Staffing and organizational structure
The issue of staffing levels for IPs is perhaps among the most urgent and common concerns expressed by IPs. Variations in staffing levels, organizational structure, and support of IPC programs will be explored in another article. That article will describe the current staffing levels, organization, and support of IPC programs across different types of practice settings to examine the relationship between organizational structure, staffing, and resources for IPC and facility characteristics. This information will be useful also in terms of benchmarking and developing business cases for additional staffing and resources.
IP competency and diversity
Health care professionals with a nursing background have traditionally dominated the IP role. In a forthcoming article, the expansion of the IP workforce to include professionals from nonclinical backgrounds will be explored. The contributions of IPs from other professional backgrounds to IPC will be addressed.
Differences in prior experience and backgrounds have important implications for practice, in that the recruitment of professionals with diverse educational backgrounds may benefit an organization that has multiple IP positions or unique infection prevention needs. It also has the potential to broaden the worldview of our profession, potentially encouraging the implementation of innovative ideas and practices at the bedside. The ability to examine the educational background of practicing IPs is an important contribution to the field and will facilitate recruitment and hiring strategies to cater to the evolving needs of our profession.
IP practice: Nonacute care settings
The APIC MegaSurvey data show that, although approximately two-thirds of IPs work in the acute care/inpatient setting, one-third work with long-term care facilities, outpatient settings, ambulatory care, or other settings. An upcoming article will describe the current roles and responsibilities of IPs outside of the inpatient setting. Specifically, the aim is to examine the implementation of infection prevention, control, and surveillance policies and practices in the ambulatory care setting and to describe the current spectrum of roles and responsibilities of IPs working in this setting. Differences in staffing, resources, and support for infection prevention and control are explored, as are types of roles and responsibilities across different types of ambulatory care settings, and their implications for new and creative ways to meet the needs of IPs working to prevent infections in nonacute care settings are outlined.
To date, there is a paucity of research from these types of settings of the IP role in the implementation of IPC activities and the resources dedicated to IPC. Better understanding of the resources available and best practices related to IPC in ambulatory care is needed to improve practice.
Certification and organizational factors
IPs demonstrate competence by completing a certification exam offered by the Certification Board of Infection Control and Epidemiology. An upcoming article will examine the current model of IP competency and suggest ways that local APIC chapters and APIC committees and leaders can support CIC certification. This is important because to be successful in its effort to promote certification actively and achieve widespread adoption in multiple practice settings, APIC needs a clear understanding of facilitators and barriers to certification, and how certification influences the roles and practice of IPs.
There is mounting evidence that certification is associated with better clinical outcomes for patients.
Perceived strength of evidence supporting practices to prevent healthcare-associated infection: Results from a national survey of infection prevention personnel.
In particular, the role of CIC certification in IP placement within an organization, roles, responsibilities, positions within a facility, and compensation will be explored.
Conclusions
This large-scale survey of current IP practice provides critical data on the state of IP practice. Information about benchmark resources, compensation, organization structure, and competencies will be valuable to individual members. APIC leaders, including local chapter leaders, can use these data to plan and implement education and outreach activities to advance implementation science and infection prevention. Industry representatives can use the data from the survey to identify gaps in IP practice and develop products and services to advance prevention activities. Researchers can use the information from the survey to validate the APIC Competency Model for the Infection Preventionist and identify practice trends and patterns to help plan and design studies of infection prevention activities. Administrators can use the information to benchmark IP practices and IPC programs within facilities.
To achieve APIC's mission, a standardized level of IP competency with future-oriented growth and influence on infection prevention, control, and patient safety, a thoughtful, diligent approach to the current and desired future state is required. It is hoped that these analyses will provide the platform from which we can demonstrate infection prevention as the key element of patient safety on our road to 2020 and beyond.
Acknowledgements
APIC MegaSurvey Task Force members include John A. Calderone, PhD, Olympia Medical Center; Barbara Smith, MPA, BSN, RN, CIC, Mount Sinai Health System; Sue Barnes, BSN, RN, CIC, Kaiser Permanente; Donna M. Giannuzzi, RN, chief patient care officer and chief administrative officer, HealthPark Medical Center; and Kathleen A. Gase, MPH, CIC, BJC Healthcare. The authors thank the leadership of APIC: 2016 President Susan Dolan, MS, RN, CIC, FAPIC; Past President Mary Lou Manning, PhD, CRNP, CIC, FAAN, FNAP; and the Board of Directors. The authors also thank current and former members of the APIC Research Committee for providing input to the analysis and interpretation of the results. In addition, the authors thank Shawn Six, principal, Industry Insights (Dublin, OH), for his contributions to the formatting and administration of the MegaSurvey; Grace Zawistowski, MPH, for providing data management; and Kevin Grandfield, MFA, for providing editorial assistance.
References
Association for Professionals in Infection Control and Epidemiology.
Perceived strength of evidence supporting practices to prevent healthcare-associated infection: Results from a national survey of infection prevention personnel.
This study was supported by the APIC Research Fund. On behalf of the Research Fund, the APIC Research Committee appointed 2 members to serve on the APIC MegaSurvey Task Force that designed and oversaw the conduct of the survey, but the funding agency had no role in the development or deployment of the survey.
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