Special Report: Infection Control and Managed Care
IC programs clinically strong but clerically weak
1998 HIC reader survey on program infrastructure
Infection control professionals report their programs are strong by traditional clinical measures, but some are struggling for adequate clerical services, office and computer support, and funding needed for continuing education, according to the 1998 Hospital Infection Control reader survey.
ICPs were asked to assess their current programs relative to some of the recommendations in a landmark consensus report on the essential elements of a modern infection control program.1 Respondents graded whether various aspects of their programs did not meet the consensus panel’s recommendations or met them completely, partially, or minimally.
In all, some 98% of the 263 respondents to the survey answered that their programs either completely or partially met the committee’s recommendations to analyze surveillance data (65% completely; 33.1% partially); have access to relevant medical records and staff members (84.4% completely; 13.7% partially); report infections to health departments (95.1% completely; 4.2% partially); and educate health care workers about infection prevention and control (73.8% completely; 24% partially).
"I think the survey results imply at least from a self-assessment standpoint that most people are fairly satisfied that their program is on the right track clinically," says Ona Baker, RN, MSHA, CIC, infection control coordinator at the Veterans Affairs Medical Center in Amarillo, TX. "I think that speaks well for the field trying to encourage ICPs over the last decade or so to be more data-driven, to base their interventions and their consultative activities on data — whether it is their own or recommendations and findings in the literature."
Slightly less favorable results — as reflected by the percentage of "minimally meets" answers — were found on the consensus panel’s recommendations for consultation with clinicians in areas where active surveillance is not conducted (4.6% minimally meet); adequate resources available to investigate outbreaks, (3.4% minimally meet); collaboration with employee health (3.1% minimally meet).
However, the largest percentages of answers in the minimally meets and "doesn’t meet" categories occurred in the recommendations for supporting resources, including secretarial services, office space and equipment, statistical and computer support, and funding for continuing professional education. (See charts, p. 183 and below.)
Among the survey respondents was an ICP who lost secretarial support last year, but had it successfully restored after convincing administrators that secretarial support was an important component of the infection control and prevention program.
"Having secretarial support really frees us up to do other things like infection control rounds, surveillance, and the kind of stuff that we were having trouble doing," says Jerold Crawford, RN, BSN, CIC, infection control program manager at University Community Hospital in Tampa, FL. "I would spend three hours collating 150 policies to send out for policy manual updates."
Likewise, Crawford has not lost support for continuing education and networking efforts, though he is aware that many ICP colleagues are struggling in that area.
"Among my peers here within the area, budgets are tightening up, training and travel are being cut a little bit," he says. "That’s a shame, because we all learn well from each other. Infection control is probably one of the more collaborative disciplines. I have a very supportive administrator who realizes the importance of networking."
While lack of clerical support has been a common lament by ICPs for years, the recommendations by the consensus panel cast an old issue in a somewhat different light, Baker adds.
"The difference is with the release of the infrastructure recommendations, we know that that is considered by experts to be an essential component — not fluff," she says. "Most administrators know that you assign tasks to the appropriate level and you don’t use highly trained clinical people for clerical duties where avoidable. That has not come as far as we would like to see it in this field."
Regarding the recommendations for statistical and computer support, the 8% reporting only minimal compliance with the recommendation may in part reflect the need for computer system improvements.
"Even though I’m sure a huge proportion of ICPs have computers available, we’re beyond the desire to have a simple PC at our disposal," Baker says. "What we need now is highly interfaced programs that can get us data in an efficient way. That is probably what is causing those answers to be fairly low in that rating."
Likewise, the prevailing attitude that infection control efforts should be documented and reported to administrators has created a new pressure to access medical databases and produce computer-generated reports, adds Julia Wendt, RN, BSN, CIC, an ICP at University Hospitals of Cleveland.
"We just hired somebody to help collect sur veillance data and we were looking for somebody who knew computers," Wendt says. "She is actually a med tech by trade and went into computers as a specialty. She can help us navigate some of this stuff. All the administrators want reports, and you have to prove yourself and show what you are doing."
1. Scheckler WE, Brimhall D, Buck AS, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: A consensus panel report. Infect Control Hosp Epidemiol 1998; 19:114-126.