By Jeff Wardon, Jr., Assistant Editor

Healthcare-associated infections (HAIs) are a common occurrence for patients, with the CDC reporting one in 31 hospital patients having at least one HAI on any given day. Infection control plays a major role in preventing infections as hospitals and other healthcare facilities house medically vulnerable patients. A key part of best preventing HAIs is having enough infection control and prevention staff.

Almost 80 percent of hospitals are not staffed at sufficient levels to keep patients safe from preventable infections, according to a recent study by the Association for Professionals in Infection Control and Epidemiology (APIC).

“There's a list of things that an infection preventionist needs to accomplish their goals,” says Rebecca Crapanzano-Sigafoos, executive director, centers for research, practice, and innovation at APIC and the corresponding author of the study. “Surveillance is one of them, meaning both notifiable disease reporting and then the federal reporting for HAIs.”

Crapanzano-Sigafoos adds that with staffing being shorthanded, surveillance is all they have time for. With that, other critical functions, like talking to other healthcare professionals, consulting on patients and education, are left unattended to.

“All those things are where the actual prevention happens,” says Crapanzano-Sigafoos. “So, if we're not well staffed, we don't have time to do the work that actually makes a difference.”

The old and new ways of calculating staffing 

Historically, staffing levels were calculated using a ratio of full-time infection preventionists equivalent to the number of beds, according to Crapanzano-Sigafoos. She says that in the 1980’s, the range was about one infection preventionist per 250 beds, and that was essentially what healthcare facilities were reporting for their staffing levels.

Nowadays, there can be anywhere from one infection preventionist per 69 beds to one per 100 beds.

APIC created an online staffing calculator that has a predictive algorithm that allows users to enter information about their facility and get an evaluation of staffing needs tailored to them.

“It tells us what's happening, but it doesn't tell us how many infection preventionists are actually necessary,” she says. “The logic behind the calculator is based on the actual patient population served the services provided the type of care environment. So based on that, the ratio of infection preventionists to beds changes depending on if you have a highly complex patient population.”

For example, these could be stem cell transplant units, inpatient rehab units, burn units or a healthcare facility with a high case mix index, that all indicates a healthcare facility has much higher acuity patients. That then causes the denominator and ratio to drop, meaning that facility needs more infection preventionists for the same number of beds than a facility that is less complex.

The study used a beta version of the calculator and took into consideration whether the healthcare facility had an ICU, an emergency department, several different specialty units, and whether they conducted surgical procedures.

“There's the case mix index that assesses the acuity of the type of patient the facility sees and then also takes into consideration the tools that the infection preventionist has for surveillance,” says Crapanzano-Sigafoos. “So, do they have electronic surveillance systems? Or are they doing their work manually? Doing it manually has a significant impact on efficiency.”

The study also identifies whether the specific facility is part of a larger system, and if that system has a system surveillance program so that the algorithm can be more specific about if surveillance isn't being conducted, she says. If it's being conducted externally, then fewer full-time equivalents (FTEs) are needed in the facility because those FTEs are accounted for elsewhere.

“It's really the first time we've been able to draw a statistically significant correlation between staffing and HAIs,” says Crapanzano-Sigafoos. “As infection preventionists, we had always known that the two were related, but we haven't really had the literature to actually support it, but now we do.”

She stresses that people need to continue to publish works in this area and provide examples of programs that have increased their staffing and have successfully reduced their HAIs.

“This correlation that we've been able to demonstrate will give infection preventionists and program leaders what they need to talk to their chief leaders and to gain the confidence of the C-Suite that investing in the infection prevention program is going to be in the best interest of the organization,” she says.

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