State of infection prevention and control in nonacute care US settings: 2020 APIC MegaSurvey

Published:August 09, 2022DOI:


      • The majority (57%) of respondents working in non-acute care settings reported working in more than one setting type.
      • Reported time spent on HAI activities by infection preventionists in non-acute care settings decreased by 31% compared to the 2015 APIC MegaSurvey.
      • Only one in three respondents working in a non-acute care setting reported being satified with their overall compensation.



      Strengthening infection prevention and control programs in nonacute care settings is a national priority. Efforts require thorough and ongoing appraisal of organizational structures, human resources including personnel training and competencies, system challenges and adaptive strategies implemented. Assessment of those in infection preventionist (IP) roles outside of the acute care setting is necessary to capture ongoing changes and challenges in the IP profession.


      This cross-sectional study utilized data derived from the 2020 APIC MegaSurvey and applied descriptive and bivariate analyses to describe the state of infection prevention and control programs and personnel across nonacute clinical settings in the United States.


      Of 1,991 respondents, 57% of frontline IPs or administration/director IPs (1,051) indicated working in 1 or more nonacute care clinical settings. Of these, 33% (343) worked exclusively in only 1 type of nonacute care setting. Consistent with findings from the 2015 APIC MegaSurvey, IPs employed in nonacute care settings are a homogenous group with 88% of respondents indicating they are white, non-Hispanic (88%), female (94%), with nursing as their primary discipline (95%). A notable change in the proportion of time spent on health care-associated infection (HAI) activities in general was found, with a 31% decrease in reported time spent compared to respondents from the 2015 survey. Nearly half (47%) of respondents reported an annual salary of $50,000-$80,000; only 35% of respondents reported they were satisfied with their overall compensation. More than half (57%) of respondents reported having 5 or less years’ experience in IPC and the majority, 82% reported they expected to be working in the IP profession in the next 5 years.


      The majority of IPs in nonacute care settings also worked in acute care. Of those who exclusively worked in nonacute care settings, they were predominately female, white, and had an educational background in nursing. A decrease in time spent on HAI activities was noted compared to respondents in 2015. Although the 2020 APIC MegaSurvey captured information previously not assessed in 2015, further studies are necessary to more robustly characterize the IP profession in nonacute care settings. Enhancements to current resources and services provided by APIC may serve to fill gaps in nonacute care settings related to gaining experience in research, general expertise, advocacy, and diversity.

      Key words

      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


        • Pogorzelska-Maziarz M
        • Kalp EL.
        Infection prevention outside of the acute care setting: results from the MegaSurvey of infection preventionists.
        Am J Infect Control. 2017; 45: 597-602
        • Landers T
        • Davis J
        • Crist K
        • Malik C.
        APIC MegaSurvey: methodology and overview.
        Am J Infect Control. 2017; 45: 584-588
        • Stone PW
        • Herzig CTA
        • Agarwal M
        • Pogorzelska-Maziarz M
        • Dick AW.
        Nursing home infection control program characteristics, cms citations, and implementation of antibiotic stewardship policies: a national study.
        INQUIRY: The J Health Care Organization, Provision, and Financing. 2018; 55004695801877863
        • Shang J
        • Chastain AM
        • Perera UGE
        • et al.
        The state of infection prevention and control at home health agencies in the United States prior to COVID-19: a cross-sectional study.
        Int J Nurs Stud. 2021; 115103841
        • Pogorzelska M
        • Stone PW
        • Larson EL.
        Certification in infection control matters: impact of infection control department characteristics and policies on rates of multidrug-resistant infections.
        Am J Infect Control. 2012; 40: 96-101
        • Marx JF
        • Callery S
        • Boukidjian R.
        Value of certification in infection prevention and control.
        Am J Infect Control. 2019; 47: 1265-1269
        • Carrico RM
        • Wiemken T
        • Westhusing K
        • Christensen D
        • McKinney WP.
        Health care personnel immunization programs: an assessment of knowledge and practice among infection preventionists in US health care facilities.
        Am J Infect Control. 2013; 41: 581-584
        • Gilmartin H
        • Smathers S
        • Reese SM.
        Infection preventionist retention and professional development strategies: insights from a national survey.
        Am J Infect Control. 2021; 49: 960-962
        • Vassallo A
        • Boston KM.
        The master of public health graduate as infection preventionist: navigating the changing landscape of infection prevention.
        Am J Infect Control. 2019; 47: 201-207
        • Rebmann T
        • Alvino RT
        • Mazzara RL
        • Sandcork J.
        Infection preventionists' experiences during the first nine months of the COVID-19 pandemic: findings from focus groups conducted with Association of Professionals in Infection Control & Epidemiology (APIC) members.
        Am J Infect Control. 2021; 49: 1093-1098
        • Rebmann T
        • Alvino RT
        • Mazzara RL
        • Sandcork J.
        Rural infection preventionists' experiences during the COVID-19 pandemic: findings from focus groups conducted with association of professionals in infection control & epidemiology (APIC) members.
        Am J Infect Control. 2021; 49: 1099-1104
        • Stevens MP
        • Doll M
        • Pryor R
        • Godbout E
        • Cooper K
        • Bearman G.
        Impact of COVID-19 on traditional healthcare-associated infection prevention efforts.
        Infect Control Hosp Epidemiol. 2020; 41 (Erratum in: Infect Control Hosp Epidemiol. 2020;41(10):1249. PMID: 32297849; PMCID: PMC7188960): 946-947
        • Dickey L.
        APIC vision.
        Am J Infect Control. 2022; 50: 243-244
      1. Become acquainted with APIC’s Roadmap for the Novice Infection Preventionist.
        Am J Infect Control. 2015; 43: 547
      2. Association for Professionals in Infection Control and Epidemiology.
        Am J Infect Control: Sci into Pract. 2022; (Accessed July 20, 2022.)
      3. (APIC), A. f. P. i. I. C. a. E. (2022). Proficient Practitioner Bridge. Accessed June 10, 2022.

        • Miller S.
        Embedding EDI into APIC's DNA: an interview with the APIC diversity, equity, and inclusion task force.
        Prevention Strategist. 2022; 15: 33-34
      4. (APIC), A. f. P. i. I. C. a. E. (2022). Advocacy toolkit: a guide for visits with State Legislators. Accessed June 10, 2022.