By Jeff Wardon, Jr., Assistant Editor

As healthcare facilities expand their outpatient and procedural services, infection prevention (IP) teams face mounting challenges in maintaining patient safety across diverse and complex care environments. Traditional staffing models, usually based on inpatient bed counts, fail to account for the unique demands of ambulatory and procedural settings — something Boston Children’s Hospital set out to address with a comprehensive assessment of its infection prevention staffing needs. 

Healthcare Facilities Today spoke with Lindsay Weir, an infection prevention expert at Boston Children’s Hospital, to understand the key findings from the hospital’s assessment on IP staffing, how complexity indicators influenced resource allocation and the strategies used to secure additional staff to meet growing demands. 

Healthcare Facilities Today: What were the key findings of Boston Children’s Hospital’s assessment of its infection prevention staffing needs, and how did it highlight the challenges of adequately supporting both onsite and off-site responsibilities?   

Lindsay Weir: The biggest takeaway from our work is about the scope and complexity of ambulatory and procedural operations, and how high the actual infection control demands are in these spaces. So, at the time of the assessment, we had a large staff compared to many other infection prevention departments.  

We had seven full-time staff members at the time, and two of them were devoted to ambulatory and procedural spaces. Despite us having a large staff that was fully staffed by traditional ratios, our assessment found that when you account for the complexity and the geographic scope of these outpatient bases that we were operating at a 2.5 full-time equivalent (FTE) deficit.   

It really just drives home the point that the growing complexity and under-appreciation for that complexity and the scope of these spaces can really hide how much demand there is for infection control resources. 

HFT: Why do conventional methods of calculating infection prevention staff based on inpatient beds fail to account for the complexity of modern healthcare, especially in pediatric and ambulatory settings?   

Weir: I personally think that ambulatory and outpatient procedural spaces are treated as not requiring as much support or resources when you compare it to patient populations. This is because the inpatient side is traditionally thought of as more complex, as you have patients there with indwelling devices. Traditionally, we think of those spaces as being in higher demand, but I think all evidence is pointing to it changing and that the volume and complexity is shifting to the outpatient setting.

Related: Infection Preventionist Staffing Levels Correlate to HAI Incidence

I definitely think that our findings are in keeping with these national trends since we did find that half of all our ambulatory and procedural locations did have at least one indicator of being a complex space. Nearly 9 percent had three or more indicators, so these wouldn’t be accounted for at all in traditional metrics that would only look at inpatient settings exclusively. 

HFT: What roles do complexity variables, such as high-level disinfection or aerosol-generating procedures, play in determining infection prevention staffing levels, and how did Boston Children’s Hospital use these variables in its needs assessment?   

Weir: We didn’t necessarily look at complexity indicators as directly correlating to staffing levels. However, I definitely suspect that the complexity indicators are aligned with the number of IP hours spent in these spaces that have multiple indicators. These spaces do require more frequent rounding, and these rounds take longer and they’re therefore likely to have more in depth needs such as console, special projects, etc. 

In that way, their increased time requirements would impact on our staff assessment. However, I think the way we use them, which was really to help us scope and understand what was being done in our ambulatory set, and what that did was help our department leadership assess resource prioritization. This is especially true when faced with competing demand that all hospitals and IP departments are faced with. 

For example, we were able to use these complexity indicator distributions to look at and stratify our environment of care rounding by location complexity. That way we’re able to adjust the surroundings as needed for areas that have much more complexity and maybe pull back a little in places that aren’t as complex. 

HFT: How did Boston Children’s Hospital’s detailed assessment influence hospital leadership’s decision to approve new IP hires, and what were the business case strategies used to secure additional resources?   

Weir: In addition to highlighting that we had an IP deficit, this assessment gave us concrete data to bring to hospital leadership to show them the complexity of our needs for our ambulatory and procedural location. What we can do is help contextualize what the proposed benefits would be of adding these FTEs in terms of being able to enhance our regulatory preparedness and the professional development of our staff. 

We were also able to use this as context to highlight ongoing vulnerabilities that we would face in these areas if our staffing deficit continued. I think that it was really helpful to bring these concrete numbers and data to put in the context of how understaffed we were and how we would be able to use new resources should they be granted. 

Jeff Wardon, Jr., is the assistant editor of the facilities market.