JCAHO Update for Infection Control :ICPs won’t push JCAHO for new staffing formula

Study shows ratio of 1 ICP to 250 beds outdated

Though recent research supports the need for more infection control staffing than traditionally allotted, ICPs are not expected to press for a specific staffing requirement from the Joint Commission on Accreditation of Healthcare Organizations.

The guideline for staffing infection control programs has traditionally been one ICP for every 250 licensed beds, but a recently published study indicates the ratio should be approximately one ICP per 100 licensed beds under current conditions in health care.1 The longstanding benchmark of one ICP per 250 occupied beds was recommended by the Centers for Disease Control and Prevention’s Study on the Efficacy of Nosocomial Infection Control (SENIC) project1 The SENIC data were gathered in the 1970s.2

"That study was what was appropriate for that time in history," says Carol O’Boyle, PhD, RN, assistant professor at the University of Minnesota School of Nursing in Minneapolis. "I think we need to question the appropriateness of the guidelines that people derived from that in today’s contemporary health care."

O’Boyle is lead author of the new staffing study, which involves the Delphi method — time and task surveys and re-surveys of 32 participating ICPs. It is well known that ICPs are stretched thin over an increasing array of responsibilities. Infection control has expanded into a variety of different health care settings, including physicians’ offices, affiliated clinics, and long-term care. All the while, additional functions, including bioterrorism, patient safety, employee health, and management of central services have been added to the traditional ICP program.

Data were obtained from the ICPs in 20 states through a series of 10 surveys. Competing responsibilities and lack of adequate resources were the most frequently cited reasons for nonperformance of essential infection control tasks. A ratio of 0.8 to 1.0 ICP for every 100 occupied acute care beds was suggested as adequate staffing by the Delphi panel. However, the findings need to be confirmed through subsequent research, O’Boyle says.

"One needs to be careful in looking at these recommendations, in that these were made by a panel of 32 [people]," she says. "The advantages of using this Delphi method are that they did not meet each other and did not see what others were writing to me. So the value of a Delphi is that you are able to get recommendations without having panel members influence each other."

The Joint Commission has emphasized in its standards that infection control programs should be adequately staffed, but has never required a specific ratio or formula, "One of the issues that we always have to take into account is the differences in organizations and patient mix," says Paul Schyve, MD, Joint Commission senior vice president. "That’s one reason why we have concluded that hard-and-fast staffing ratios — say for nurses — are not the best way to approach staffing effectiveness."

Indeed, ICPs would be asking the Joint Com-mission to codify a ratio or formula that is not drawn out for any other medical profession.

"I can’t think of any other standard that says thou shalt have this number of people to do anything," says Candace Friedman, MT (ASCP), MPH, CIC, manager of infection control and epidemiology at the University of Michigan Hospitals and Health Centers in Ann Arbor.

"The staffing standards of the Joint Commission imply that an institution needs to evaluate all of its staffing and be staffed appropriately. If there are data that support a particular type of staffing, then that is what should be brought forward if there are issues within a particular institution. I don’t think it should be a specific number because there may be instances where an institution may need to be better staffed than that for other reasons. I wouldn’t want to be held to any specific requirement."

References

1. O’Boyle C, Jackson M, Henly SJ. Staffing requirements for infection control programs in US health care facilities: Delphi project. Am J Infect Control October 2002.

2. Haley RW, Culver DH, White J, et al. The efficacy of infection surveillance and control programs in preventing outbreaks of nosocomial infections in U.S. hospitals. Am J Epidemiol 1985; 121:182-205.