APIC Asks Feds for Infection Prevention Reinforcements
‘We were all running so lean, even without a pandemic’
Accordingly, the Association for Professionals in Infection Control and Epidemiology (APIC) has issued a call to action report, which describes IPs as key players in pandemics and emergency response, as well as the longstanding wall between vulnerable patients and healthcare infections.2
“Because infection preventionists are the only specialists in healthcare dedicated solely to infection prevention and control, facilities ranging from acute care hospitals, nursing homes, home health, and ambulatory surgery centers rely on their expertise on all protocols and policies that relate to preventing the spread of infections, including COVID-19, as well as healthcare-associated infections, such as Methicillin-resistant Staphylococcus aureus and Clostridioides difficile,” APIC states in the report.
The call to action, as well as an adjoining APIC campaign called “HAI Fast Forward,” is aimed at accelerating an infection prevention rebound to fight future pandemics and protect patients from routine infections.3
“We need to be able to do both,” says Linda Dickey, RN, MPH, CIC, FAPIC, president of APIC. “Another pandemic will happen in the future, so we need to be able to respond to a pandemic and continue to prevent HAIs. We have seen across the country that cases of HAIs have increased as we have been battling the pandemic. We need to get those numbers back down.”
The fast forward campaign will include webinars and resources to reduce HAIs, while the call to action report outlines more of a sea change to help the profession prepare for the next pandemic.
“Congress should allocate funds for healthcare facilities to build infection prevention and control capacity to ensure the continuity of safe patient care during a pandemic and to have enough frontline infection preventionists during an infectious disease emergency," the APIC report states.
When COVID-19 hit the United States in 2020, there was little redundancy and resilience built into infection prevention programs, says Ann Marie Pettis, RN, BSN, CIC, immediate past president of APIC.
“In other words, it’s not like you had somebody extra,” she says. “If anything, we were all running so lean, even without a pandemic, without a crisis — and then those things happened.”
Although federal funding is needed to bolster infection prevention departments, APIC has a separate problem of finding enough staff to fill them.
“One of the vulnerabilities we have is that we are going to be seeing attrition among infection preventionists,” Dickey says. “It’s not just in our sector, but it does prevent a challenge and a risk with healthcare and even broader [areas]. APIC is doing a lot to maintain and support our current infection preventionists, and also to create a strong pipeline going forward.”
The call to action report calls on Congress to “invest now in incentivizing the next generation of healthcare professionals [to] join the infection prevention and control pipeline. Legislation has been introduced to create a loan repayment program for infectious disease personnel, which can be crucial to attracting and retaining talent.”
Seeking CMS ‘Requirements’
As part of rebuilding the profession and seeking federal resources, APIC is asking the Centers for Medicaid & Medicare Services (CMS) to “require” infection preventionists in key roles during future pandemics and crisis situations. That would include making sure infection preventionists are consulted on “all policies or protocols that affect disease transmission.”
Furthermore, the APIC report says these issues should include infection prevention oversight of “patient placement, patient and/or employee cohorting, PPE [personal protective equipment] use and selection, workflow reviews, airflow or ventilation issues, patient isolation, and direct patient care practices in healthcare facilities."
“Although many organizations, including my own, have infection preventionists at the table driving those decisions, unfortunately that didn’t happen all over the country,” Pettis says. “Mostly, it didn’t happen in smaller, non-academic type or non-university affiliated settings, which really describes many of our infection prevention programs throughout the country. They’re small, they don’t have an epidemiologist necessarily, and they might be wearing two or three different hats. We have to advocate for those smaller, rural programs that don’t have the resources.”
According to APIC, CMS also should require healthcare facilities to make sure infection preventionists:
- lead, or be a member of, every team that develops the crisis standards of care protocols related to PPE, anti-infective therapy, and vaccinations for the healthcare facility or agency;
- be involved in developing the infectious disease surveillance program, including decisions about surveillance testing plans for patients, employees, and visitors. In collaboration with the healthcare facility’s statistical experts, infection preventionists should be responsible for analyzing and reporting pandemic surveillance program data.
Such actions certainly would secure the infection preventionist role in future pandemics. APIC has been trying to build connections with CMS that could make the plan a reality. This has become a priority for APIC executive leadership, as well as raising the infection preventionist profile with other critical agencies and groups.
“We’ve identified groups like CMS that we need to really strengthen and fortify the relationship with so they have an understanding of really who we are and what we do,” says Pettis. “I think the feds, CMS, everybody recognizes the importance of this. I think that’s one we’ll be able to succeed with and have already made some headway with.”
It is a surprise to find out that infection control and prevention — a field that has existed in healthcare for more than 50 years — is not formally recognized by the Department of Labor as a distinct occupation. That said, the APIC call to action report asks the department to rectify the situation and identify infection prevention as a “separate and distinct profession.”
“We recognize that we are dealing with a bureaucracy, and we know that’ll take time,” Pettis says. “But on the other hand, to not even be identified as a profession makes it difficult to get the traction that we need to have. The one good thing COVID’s done is shine a bright light on the importance of infection prevention, but there’s still so many people [who] don’t realize that there are infection preventionists — and that’s true even now as the pandemic winds down.”
Given their expertise, infection preventionists have a “distinct vantage point” from which to survey the pandemic wreckage and look for lessons that must be learned, APIC emphasizes.
“From lessons learned, we have always been able to emerge with better practices to reduce infections,” Dickey says. “I see a strong component around education and implementation science.”
One of the harshest lessons has been in long-term care, where about 200,000 residents and staff have died during the pandemic, APIC reported.
“CMS should require that each nursing home have at least one full-time dedicated infection preventionist located on site,” APIC emphasized in the report. “Individuals serving in the position of infection preventionist in nursing homes should be certified in infection prevention and control whenever possible and should have ongoing continuing education requirements.”
“One of the things that we didn’t do well — we had such problems in long-term care,” Ruth Carrico, PhD, FSHEA, RN, CIC, a professor of infectious disease at the University of Louisville, said at an APIC webinar.
“We did not heed some of the lessons and the calls for broader engagement in long-term care settings around the world, and we saw just devastation occur,” she added.
One problem was long-term care staff have historically had among the lowest vaccination rates in the healthcare sector, and many workers refused the COVID-19 vaccine.
Infection preventionists were making efforts in this area before and during the pandemic, but there were elements in the nursing home industry wary of higher cost, and a staff exodus if the COVID-19 vaccine was mandated.
The staff vaccination rates in long-term care have improved considerably after CMS requirements and ensuing court battles, but still vary by state.
“With long-term care, they need to make sure they have an infection prevention person who’s trained, ideally certified,” Pettis says. “But if nothing else, they need to be focused on infection prevention. We haven’t had that in long-term care. We have their attention now because of all the deaths.”
In the chaos of the pandemic, some infection preventionists were pulled from traditional duties and assigned others related to COVID-19 or other areas. To guide this process now and in the future, APIC has created an acuity scale for crisis situations, recommending which job duties are critical and which can be given less emphasis or dropped temporarily.
“It’s a prioritization tool, not just during the pandemic, but for any crisis situation,” Pettis says. “It really identifies what infection preventionists need to have as sacrosanct so CEOs don’t pull you in a lot of different directions.”
The full list, including lower priority duties, is available on the APIC website, but the high-priority tasks for infection preventionists during a pandemic or crisis include:4
- updating and providing education/support for PPE donning/doffing practices and supporting changes in practices as new guidelines emerge;
- vetting new PPE and low-level disinfection products (especially when supply chain issues emerge);
- surveillance activities for high-risk, high-impact HAIs;
- investigating clusters/urgent events (floods, foodborne outbreaks, etc.), providing response guidance and reporting (COVID and non-COVID);
- attending COVID-related operations/incident command/planning meetings and providing infection prevention and control input on COVID-related protocols;
- rounding to support staff, provide consultation, assess correct isolation precautions, etc.
- Weiner-Lastinger LM, Pattabiraman V, Konnor RY, et al. The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: A summary of data reported to the National Healthcare Safety Network. Infect Control Hosp Epidemiol 2022;43:12-25.
- Association for Professionals in Infection Control and Epidemiology. Between a rock and hard place: Recommendations for balancing patient safety and pandemic response. Published March 2022. https://apic.org/between-a-rock-and-hard-place-march-2022/
- Association for Professionals in Infection Control and Epidemiology. APIC calls for increased investment in infection prevention. Published Feb. 15, 2022. https://apic.org/news/apic-calls-for-increased-investment-in-infection-prevention/
- Association for Professionals in Infection Control and Epidemiology. IPC acuity scale for crisis situations. https://apic.org/ipc-acuity-scale-for-crisis-situations/
The leading organization for infection preventionists is trying to elevate and solidify their role in healthcare after many were dislodged from traditional duties or otherwise overwhelmed during the pandemic. The Association for Professionals in Infection Control and Epidemiology has issued a call to action report, which describes IPs as key players in pandemics and emergency response, as well as the longstanding wall between vulnerable patients and healthcare infections.
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