Competency in infection prevention: a conceptual approach to guide current and future practice.

Professional competency has traditionally been divided into 2 essential components: knowledge and skill. More recent definitions have recommended additional components such as communication, values, reasoning, and teamwork. A standard, widely accepted, comprehensive definition remains an elusive goal. For infection preventionists (IPs), the requisite elements of competence are most often embedded in the IP position description, which may or may not reference national standards or guidelines. For this reason, there is widespread variation among these elements and the criteria they include. As the demand for IP expertise continues to rapidly expand, the Association for Professionals in Infection Control and Epidemiology, Inc, made a strategic commitment to develop a conceptual model of IP competency that could be applicable in all practice settings. The model was designed to be used in combination with organizational training and evaluation tools already in place. Ideally, the Association for Professionals in Infection Control and Epidemiology, Inc, model will complement similar competency efforts undertaken in non-US countries and/or international organizations. This conceptual model not only describes successful IP practice as it is today but is also meant to be forward thinking by emphasizing those areas that will be especially critical in the next 3 to 5 years. The paper also references a skill assessment resource developed by Community and Hospital Infection Control Association (CHICA)-Canada and a competency model developed by the Infection Prevention Society (IPS), which offer additional support of infection prevention as a global patient safety mission.

Metrics and management: Two unresolved problems on the pathway to health care-associated infection elimination.

Surveillance and management of health care-associated infections (HAIs) has traditionally relied on analyses of outcome data to elucidate trends in HAI incidence, discover host or treatment risk factors, and facilitate comparisons of HAI rates within and among licensed providers or facilities. This paper explores residual gaps and shortcomings associated with outcome reporting and possible sources of bias that may invalidate intra- and interfacility comparisons. As an alternative to outcome surveillance and reporting, real-time process monitoring and control is proposed. To address the need for uncompromising conformity with preventive measures, the concepts of social entropy, authority, responsibility, and accountability are explored and linked to process control at the bedside.

Preventing infections to improve wound care outcomes: an epidemiological approach.

Measuring and tracking wound complications and associated risk factors are powerful tools in managing wound outcomes. The authors review fundamental epidemiological approaches to clinical investigation, beginning with some basic study designs, and their relative strengths and weaknesses, with respect to the usefulness of the findings. Examples of methods to calculate rates and proportions and ways to measure significant change over time are presented. A conceptual model that is universally used by infection prevention professionals in the development and implementation of prevention strategies is also described. Risk stratification systems that have been derived through the analysis of thousands of patients are presented. These systems help predict those patients who are at risk for developing adverse outcomes (eg, infections or pressure ulcers), and therefore, should help caregivers address those risks by applying scientifically derived prevention strategies. Finally, various prevention strategies and how they relate to the conceptual model of infection prevention are discussed.