An infection preventionist with three decades of experience in the field will serve as the 2019 president of the Association for Professionals in Infection Control and Epidemiology (APIC).
Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC, is currently an infection prevention consultant for the Survey and Certification Group at the Centers for Medicare & Medicaid Services (CMS). Since 1988, she has been a clinical instructor in the division of infectious diseases at the University of North Carolina School of Medicine in Chapel Hill. For 23 years, she served as the associate director for the North Carolina Statewide Program for Infection Control and Epidemiology.
Hoffmann discussed some of the current issues and challenges facing IPs in the following interview with Hospital Infection Control & Prevention. The exchange has been edited for length and clarity.
HIC: What are some of the major areas you expect to focus on as APIC president?
Hoffmann: Increasing the value of IPs in their practice setting. We are doing that through editorials and education to the C-suite, encouraging their support for infection control programs. We are working with our strategic partners, the CDC, regulatory agencies, as well as other associations that we work collaboratively with like SHEA, AORN [Association of periOperative Registered Nurses], and so forth. We want IPs to be recognized for their leadership potential. To do that, we are offering leadership courses in a collaboration with SHEA. That has been really well-received, and we expect to continue to do that to add IP value and leadership opportunities for them.
Our membership is expanding and becoming more diverse. We have a lot of alternative practice settings now that we are working within, including long-term care, ambulatory surgery centers, and dialysis. We have done a practice analysis for those settings, and we are looking at creating more manuals and training available for people working in them.
HIC: Will you continue to underscore the value of IPs being certified in infection control?
Hoffmann: We want to keep up the momentum for more CIC [Certification in Infection Prevention and Control] requirements. There are three state legislatures that already have some requirements to be certified in infection control, but we want to push that with other legislatures. We are working with some states that we think will be accepting of that and hope to get the ball rolling for more states, too.
Another area that IPs really need to think about is increasing data management, research, and leadership competencies. APIC is planning to publish a revised IP competency model before June. Part of that will be expanding the IP leadership program offerings for IPs and epidemiologists. We are doing some of that through the course we have begun with SHEA.
Also, we want to be sure to remain focused on recruiting and maintaining a new generation of IPs. I’m part of the generation that will be retiring in the next five to 10 years, so we need to be focused on that.
HIC: An ongoing challenge has been securing program resources for the expanding array of IP responsibilities. What can IPs do to make the business case, and will your background at CMS shape your message about the effect of infections on the bottom line?
Hoffmann: My CMS consulting work does not involve the value-based programs that began in 2008, but I do think there are a lot of pros and cons to this national reimbursement strategy that CMS has mandated. Value-based programs reward healthcare facilities with incentive payments for the quality of care — for people who perform well. Some hospitals are going to do better, and some hospitals won’t in terms of Medicare reimbursement, but certainly payment issues get the attention of the C-suite. IPs need to leverage that pressure and use that opportunity to promote HAI reductions.
In terms of the business case in general, it is hard to say that resources are continuing to dwindle, but they are. But many of my IP colleagues tell me about dramatically increasing resources and the number of FTEs because of the business case they are able to present.
For some IPs, it can be intimidating to think about creating a business case. It really involves several straightforward steps. First, use a HAI calculator tool. That can help IPs estimate the costs of infections in their own facility. It is really important to present data that relates to their facility and not just national rates. They can then interpret those results and statistical models to build their customized business case. Present that to your healthcare administration leadership. The goal of that is really to create a compelling proposal so they can increase resources in infection prevention and control. This demonstrates their value to their board, stakeholders, and everyone.
Most of us who are clinical specialists, whatever our background is in infection prevention, don’t generally have the skills for making a business case. I really suggest that IPs educate themselves by reviewing what we consider the authoritative publications on the topic, 1,2 both of which were published in 2007. Also, find a financial expert to help you as the IP — having the expertise can really help.
HIC: The CDC is drafting guidelines to prevent healthcare worker infections, calling for more collaboration between IPs, employee health, and administration. Can you comment on the challenge of preventing occupational infections in addition to keeping patients safe?
Hoffmann: First, there is the challenge of hazardous workplace conditions. The exposures to the environment of care and equipment and the high-risk patient exposures. Regardless of the job category, healthcare workers have the potential to be exposed to bloodborne pathogens via needlesticks, TB exposures, laser and electrosurgical plumes, MDROs [multidrug-resistant organisms], and even bioterrorism and other emerging infectious diseases. These hazards are manageable through the use of policies and practices as well as engineering controls. A well-defined prevention program includes work-related illnesses, injury, education of staff, monitoring the environment, engineering controls, and work practices.
There is the challenge of compliance. Personnel are more compliant with a program if they understand its rationale. The knowledge of what it costs in illnesses, injuries, and even disabilities can help them understand their responsibility in complying with the policies. Policies that are clearly written, coordinated between departments, and [applied] consistently with employee input have the best chance of being used by employees. Having this updated CDC guidance will be really helpful.
- Murphy D, Whiting J. An APIC Briefing. Dispelling the Myths: The True Cost of Healthcare-Associated Infections. February 2007. Available at: https://bit.ly/2FkebfC.
- Perencevich EN, Stone PW, Wright SB, et al. Raising standards while watching the bottom line: making a business case for infection control. Infect Control Hosp Epidemiol 2007 Oct;28(10):1121-33.