The role of spirituality, religiosity, and self-care on infection preventionist well-being: Results from a national survey in the United States.

BACKGROUND: The degree to which religiosity, spirituality, and self-care practices can improve well-being among infection preventionists is not well understood. METHODS: We surveyed infection preventionists from a random sample of United States hospitals in 2021. Multivariable logistic regression models were used to examine the associations between measures of spirituality, religiosity, and self-care and well-being. RESULTS: Our response rate was 47% (415/881). A total of 49% of respondents reported burnout, 17% reported increased feelings of uncaring, and 69% would choose to become an infection preventionist again. Most respondents found importance in spiritual well-being (88%), religious beliefs (82%), and self-care practices (87%). Spiritual well-being was associated with increased odds of choosing to become an infection preventionist again (odds ratio = 2.32, 95% confidence interval = 1.19-4.53, P = .01). DISCUSSION: Our national survey provides evidence that spiritual importance is associated with career satisfaction among infection preventionists. Our findings contribute to a general body of evidence suggesting spiritual importance may translate to higher flourishing and well-being via serving a higher purpose. CONCLUSIONS: Promoting spiritual well-being may positively influence career satisfaction and overall well-being among infection preventionists.

Exploring the promise and reality of ward-based primary healthcare outreach teams conducting TB household contact tracing in three districts of South Africa.

BACKGROUND: Tuberculosis (TB) household contact tracing is a form of targeted active case-finding for which community health workers ('outreach teams') in South Africa are primarily responsible for its implementation. We conducted an exploratory qualitative study to understand the role of outreach teams in delivering TB household contact tracing. METHODS: The study took place in three districts of South Africa between May 2016 and February 2017. We conducted 78 in-depth interviews (IDI) (comprising 35 key stakeholders, 31 TB index patients and 12 HHCs) and five focus group discussions (FGD) (40 outreach team members in four FGDs and 12 community stakeholders in one FGD). RESULTS: Outreach teams contributed positively by working across health-related programmes, providing home-based care and assisting with tracing of persons lost to TB care. However, outreach teams had a limited focus on TB household contact tracing activities, likely due to the broad scope of their work and insufficient programmatic support. Outreach teams often confused TB household contact tracing activities with finding persons lost to TB care. The community also had some reservations on the role of outreach teams conducting TB household contact tracing activities. CONCLUSIONS: Creating awareness among outreach workers and clinic personnel about the importance of and activities related to TB household contact tracing would be required to strengthen the delivery of TB household contact tracing through the community-based primary health care teams. We need better monitoring and evaluation systems, stronger integration within a realistic scope of work, adequate training on TB household contact tracing and TB infection prevention control measures. Involving the community and educating them on the role of outreach teams could improve acceptance of future activities. These timely results and lessons learned should inform contact tracing approaches in the context of COVID-19.

Mental health status among Chinese healthcare-associated infection control professionals during the outbreak of coronavirus disease 2019: A national cross-sectional survey.

ABSTRACT: Recently, the coronavirus disease 2019 (COVID-19) epidemic has greatly threatened global public health. The responsibility of healthcare-associated infection control professionals (ICPs) is to prevent and control the nosocomial infections. The mental health status of ICPs deserves more attention, however, the correlational research is still lacking. This study aims to investigate the incidence and risk factors of mental health status among ICPs in China during the outbreak of COVID-19.A national cross-sectional survey was performed. The online questionnaire was completed by 9228 ICPs from 3776 hospitals throughout China. Data collection tools were used, including demographics data questionnaire, the Chinese version of the 12-item general health questionnaire (GHQ-12) and the Chinese version of the psychological capital questionnaire (PCQ) for medical staff. Univariate and multivariable analyses were conducted.The total score of mental health of Chinese ICPs was 3.45 ±â€Š2.57. 5608 (60.77%) ICPs might have mental health problems. The psychological capital was in the upper-middle level with an average score of 3.72 ±â€Š0.38. An increased mental health problem risk was associated with the greater self-efficacy and working in the public hospital; a significantly lower risk was obtained by working in the second-class hospital rather than in the third-class hospitals. Besides, mental health problem risk of ICPs working in hospitals of the western economic region or northeast economic region was more significant than that in hospitals of the central economic region. However, a lower risk was caused by the unmarried than married, and working years in department ≤1 year contributed to the lower risk than that >20 years. Moreover, fewer working hours per week, higher values of hope, and optimism each were contributed to a lower risk.Chinese healthcare-associated ICPs were under different levels of mental health problems in fighting against COVID-19. More importantly, we should actively deal with the mental health problem of ICPs and help them get rid of psychological disorders.

Infection preventionists role in antimicrobial stewardship: Survey of APIC members.

The primary job responsibility of infection preventionists (IPs) is to lead organizational initiatives that prevent and control health care-associated infections. Increasingly, IPs are participating in activities that support antimicrobial stewardship programs (ASPs). We conducted a survey of Association of Professionals in Infection Control and Epidemiology members practicing in acute care facilities to determine the degree of their involvement in ASP activities.

Lineamientos para el cuidado de la salud mental: dirigido a proveedores de salud. Pandemia COVID-19 / Mental Health Care Guidelines: For Health Providers. COVID-19 pandemic

El documento refleja la preocupación del MSPAS respecto a las necesidades psicológicas ante la gravedad de la pandemia, del personal de salud de todo el país. Da cuenta de que en algunos casos trabajan con los mínimos recursos personales para poder afrontar los retos del trabajo, así como otras circunstancias que les pueden generar estrés, soledad, inseguridad, etc. Por ello emite una serie de recomendaciones para apoyarlos. El documento en sí refleja los estados anímicos de los trabajadores de salud, especialmente en el personal de primera línea de atención a pacientes comprometidos con coronavirus. El objetivo es: fortalecer a proveedores de salud de recursos internos y estrategias de afrontamiento, para la mitigación de trastornos mentales en los proveedores de salud que atienden la pandemia de COVID ­ 19.

Exploring the role of infection preventionists in antimicrobial stewardship programs through several lenses: A brief report.

This study explored perceptions of the role of infection preventionists (IPs) in antimicrobial stewardship programs (ASPs) among IPs, pharmacists, infectious diseases physicians, and hospital executives. Expert telephone interviews, using a validated survey tool, were conducted from November 1, 2016 to December 12, 2016 (n = 28). Participants with clinical responsibilities reported modest expectations of the IP in ASPs. Competing IP job responsibilities and limited ASP role clarity were cited as common barriers to IP engagement.

Psychological safety and infection prevention practices: Results from a national survey.

BACKGROUND: Psychological safety is a critical factor in team learning that positively impacts patient safety. We sought to examine the influence of psychological safety on using recommended health care-associated infection (HAI) prevention practices within US hospitals. METHODS: We mailed surveys to infection preventionists in a random sample of nearly 900 US acute care hospitals in 2017. Our survey asked about hospital and infection control program characteristics, organizational factors, and the use of practices to prevent common HAIs. Hospitals that scored 4 or 5 (5-point Likert scale) on 7 psychological safety questions were classified as high psychological safety. Using sample weights, we conducted multivariable regression to determine associations between psychological safety and the use of select HAI prevention practices. RESULTS: Survey response rate was 59%. High psychological safety was reported in approximately 38% of responding hospitals, and was associated with increased odds of regularly using urinary catheter reminders or stop-orders and/or nurse-initiated urinary catheter discontinuation (odds ratio, 2.37; P = .002) for catheter-associated urinary tract infection prevention, and regularly using sedation vacation (odds ratio, 1.93; P = .04) for ventilator-associated pneumonia prevention. CONCLUSIONS: We provide a snapshot of psychological safety in US hospitals and how this characteristic influences the use of select HAI prevention practices. A culture of psychological safety should be considered an integral part of HAI prevention efforts.

Hospital epidemiologists' and infection preventionists' opinions regarding hospital-onset bacteremia and fungemia as a potential healthcare-associated infection metric.

OBJECTIVE: To ascertain opinions regarding etiology and preventability of hospital-onset bacteremia and fungemia (HOB) and perspectives on HOB as a potential outcome measure reflecting quality of infection prevention and hospital care. DESIGN: Cross-sectional survey. PARTICIPANTS: Hospital epidemiologists and infection preventionist members of the Society for Healthcare Epidemiology of America (SHEA) Research Network. METHODS: A web-based, multiple-choice survey was administered via the SHEA Research Network to 133 hospitals. RESULTS: A total of 89 surveys were completed (67% response rate). Overall, 60% of respondents defined HOB as a positive blood culture on or after hospital day 3. Central line-associated bloodstream infections and intra-abdominal infections were perceived as the most frequent etiologies. Moreover, 61% thought that most HOB events are preventable, and 54% viewed HOB as a measure reflecting a hospital's quality of care. Also, 29% of respondents' hospitals already collect HOB data for internal purposes. Given a choice to publicly report central-line-associated bloodstream infections (CLABSIs) and/or HOB, 57% favored reporting either HOB alone (22%) or in addition to CLABSI (35%) and 34% favored CLABSI alone. CONCLUSIONS: Among the majority of SHEA Research Network respondents, HOB is perceived as preventable, reflective of quality of care, and potentially acceptable as a publicly reported quality metric. Further studies on HOB are needed, including validation as a quality measure, assessment of risk adjustment, and formation of evidence-based bundles and toolkits to facilitate measurement and improvement of HOB rates.

Clinician perspectives of policy implementation: A qualitative study of the implementation of a national infection prevention policy in Australian hospitals.

BACKGROUND: Clinicians play an essential role in the implementation of infection prevention policy. Despite this, little is known about how infection control policy is implemented at an organizational level or what factors influence this process. In this study, we explore these factors and the policy implementation process in the context of the introduction of a national large-scale, government-directed infection prevention policy in Australia. METHODS: Focus groups with infection control professionals were held in 3 states to investigate the perspectives of infection control professionals involved in the implementation of aseptic technique policy requirements in Australian hospitals. Data were analyzed using an interpretive description approach, with themes mapped to the Consolidated Framework for Implementation Research. RESULTS: Common contextual factors were identified across all levels of the healthcare system that influenced implementation of the infection control policy, including external factors associated with the policy itself and the regulatory nature of government-directed policy. CONCLUSIONS: This study suggests that there may be particular constructs and contextual factors that are specific to policy implementation in the hospital setting. A better understanding of these factors and their influence on policy implementation would present an opportunity for improved implementation planning, resource allocation, and more effective policy development.

Revisiting the Association for Professionals in Infection Control and Epidemiology Competency Model for the Infection Preventionist: An evolving conceptual framework.

This article reviews 2 models of skill acquisition, 1 from nursing and the other from aviation, and compares them to the Association for Professionals in Infection Control and Epidemiology Competency Model for the Infection Preventionist (IP). The authors explore the mental activity associated with competence and provide usable examples for IPs to further assess their own competence, and competence of IPs in their charge. This was done for the purpose of advancing and expanding upon the career stages within the field of infection prevention. Further, we suggest a mechanism for expansion of the current Association for Professionals in Infection Control and Epidemiology Competency Model for the IP, as well as explore career stages and the evolution of professional practice self-assessment and recertification. The authors believe an expansion would better match the needs of current and future IPs in terms of career development and competency.

Health care system leaders' perspectives on infection preventionist and registered nurse engagement in antibiotic stewardship.

BACKGROUND: Infection preventionists (IPs) and registered nurses (RNs) have an important role to play in antibiotic stewardship programs (ASPs). Recent articles highlight their potential roles in practice, research, education, and policy; however, little is known about their actual ASP engagement. Leaders often have early knowledge of emerging trends and evolving health care worker roles. METHODS: A survey was developed using the Centers for Disease Control and Prevention's Core Elements of Hospital Antibiotic Stewardship Programs to assess health care system infection prevention and control leaders' perceptions of IP and RN engagement in hospital ASPs. RESULTS: Thirty-five leaders representing all regions of the United States completed the survey. Their organizations tended to have significant ASP leadership support, but lacked ASP policies indicating IP and RN roles and responsibilities. IPs were more likely than RNs to be members of the ASP team and have greater ASP knowledge. Neither discipline was conducting patient education related to proper use of antibiotics, but this was identified as a future ASP role. The 2017 Joint Commission Antimicrobial Stewardship Standard was accelerating ASP implementation. CONCLUSIONS: IPs and RNs are well-positioned to assume greater roles in ASPs, especially in educating patients about the safe and proper use of antibiotics. However, their roles must be clearly identified, defined, and quantified. In so doing, knowledge and skill gaps can be identified and specific educational programs developed to advance their successful engagement in ASPs.

Do Experts Understand Performance Measures? A Mixed-Methods Study of Infection Preventionists.

OBJECTIVE Central line-associated bloodstream infection (CLABSI) is associated with significant morbidity and mortality. Despite a nationwide decline in CLABSI rates, individual hospital success in preventing CLABSI is variable. Difficulty in interpreting and applying complex CLABSI metrics may explain this problem. Therefore, we assessed expert interpretation of CLABSI quality data. DESIGN: Cross-sectional survey PARTICIPANTS. Members of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) METHODS. We administered a 10-item test of CLABSI data comprehension. The primary outcome was percent correct of attempted questions pertaining to the CLABSI data. We also assessed expert perceptions of CLABSI reporting. RESULTS The response rate was 51% (n=67).Among experts, the average proportion of correct responses was 73% (95% confidence interval [CI], 69%-77%). Expert performance on unadjusted data was significantly better than risk-adjusted data (86% [95% CI, 81%-90%] vs 65% [95% CI, 60%-70%]; P<.001). Using a scale of 1 to 100 (0, never reliable; 100, always reliable), experts rated the reliability of CLABSI data as 61. Perceived reliability showed a significant inverse relationship with performance (r=-0.28; P=.03), and as interpretation of data improved, perceptions regarding reliability of those data decreased. Experts identified concerns regarding understanding and applying CLABSI definitions as barriers to care. CONCLUSIONS Significant variability in the interpretation of CLABSI data exists among experts. This finding is likely related to data complexity, particularly with respect to risk-adjusted data. Improvements appear necessary in data sharing and public policy efforts to account for this complexity. Infect Control Hosp Epidemiol 2018;39:71-76.

Perceptions of Clostridium difficile infections among infection control professionals in Taiwan.

BACKGROUND: High Clostridium difficile colonization and infection rates among hospitalized patients had been noted in Taiwan. Nevertheless, the cognition about clinical diagnosis and management of CDI among infection control professionals in Taiwan is not clear. MATERIAL AND METHODS: A 24-item survey questionnaire about the diagnosis, therapy, or infection control policies toward CDI was distributed in the annual meeting of the Infectious Disease Society of Taiwan (IDST) in October 2015 and Infectious Control Society of Taiwan (ICST) in April 2016. RESULTS: Totally 441 individuals responded to the survey, and 280 (63.5%) participants would routinely monitor the prevalence of CDI and 347 (78.7%) reported the formulation of infection control policies of CDI in their hospital, including contact precaution (75.7%), wearing gloves (88.9%) or dressing (80.0%) at patient care, single room isolation (49.7%), preference of soap or disinfectant-based sanitizer (83.2%) and avoidance of alcohol-based sanitizer (63.3%), and environmental disinfection with 1000 ppm bleach (87.1%). For the timing of contact precaution discontinuation isolation for CDI patients, most (39.9%) participants suggested the time point of the absence of C. difficile toxin in feces. To treat mild CDI, most (61.9%) participants preferred oral metronidazole, and for severe CDI 26.1% would prescribe oral vancomycin as the drug of choice. CONCLUSION: There were substantial gaps in infection control polices and therapeutic choices for CDI between international guidelines and the perceptions of medical professionals in Taiwan. Professional education program and the setup of guideline for CDI should be considered in Taiwan.

Understanding the current state of infection preventionists through competency, role, and activity self-assessment.

BACKGROUND: The Association for Professionals in Infection Control and Epidemiology (APIC) MegaSurvey, administered in 2015, was completed by approximately 4,079 APIC members. The survey sought to gain a better understanding the current state of 4 components of infection prevention practice: demographic characteristics, compensation, organizational structure, and practice and competency. METHODS: The data for this analysis come from the APIC MegaSurvey Practice and Competency domain. Descriptive statistics and χ2 analyses were conducted to examine differences in infection preventionist (IP) competency, roles, and activity self-assessments. RESULTS: The majority of IPs self-assessed their competency as Proficient compared with Novice or Expert for each of the 8 IP core competency activities. Forty percent of IPs self-rated their competency as Expert in the Preventing/Controlling the Transmission of Infectious Agents/HAIs component. IPs reported Novice competency in Employee/Occupational Health (29%); Cleaning, Sterilization, Disinfection, and Asepsis (23%); and Education and Research categories (22%). Differences in self-rated competency among IPs by discipline type (public health, nurse, and laboratory) were identified. CONCLUSIONS: Differences in self-rated competency were identified for each of the 8 IP core competency activities. IPs report using various resource types to gain competency. Future research is needed to identify opportunities to increase competency levels in the weakest-rated competency activities.

APIC MegaSurvey: Methodology and overview.

BACKGROUND: Infection preventionists (IPs) play key roles in preventing health care-associated infections and ensuring quality of care. To develop strategies to support comprehensive infection prevention practice, it is critical to understand key aspects of their practice. METHODS: A task force of expert IPs, staff representatives from the Association for Professionals in Infection Control and Epidemiology (APIC), and survey designers developed and pilot tested a survey addressing 4 components of infection prevention practice: demographic characteristics, compensation, organizational structure, and practice and competency. RESULTS: During mid- to late-2015, 4,078 APIC members (response rate 31%) participated in the study. Results indicated that all of the practice domains of the APIC Competency Model for the Infection Preventionist were rated as "important" or "very important" to supervisors or managers of IPs. Surveillance and investigation accounted for the most time in an IPs typical day, followed by prevention and control of transmission, identification of infection, and management and communication. DISCUSSION: Future analyses will examine the validity of the APIC Competency Model for the Infection Preventionist; factors related to professional development, including addressing the needs of IPs who may be ready for certification; and current compensation of IPs. CONCLUSIONS: The results of the APIC MegaSurvey can be used to guide development of programs and initiatives for the future of infection prevention.

Tensions inherent in the evolving role of the infection preventionist.

BACKGROUND: The role of infection preventionists (IPs) is expanding in response to demands for quality and transparency in health care. Practice analyses and survey research have demonstrated that IPs spend a majority of their time on surveillance and are increasingly responsible for prevention activities and management; however, deeper qualitative aspects of the IP role have rarely been explored. METHODS: We conducted a qualitative content analysis of in-depth interviews with 19 IPs at hospitals throughout the United States to describe the current IP role, specifically the ways that IPs effect improvements and the facilitators and barriers they face. RESULTS: The narratives document that the IP role is evolving in response to recent changes in the health care landscape and reveal that this progression is associated with friction and uncertainty. Tensions inherent in the evolving role of the IP emerged from the interviews as 4 broad themes: (1) expanding responsibilities outstrip resources, (2) shifting role boundaries create uncertainty, (3) evolving mechanisms of influence involve trade-offs, and (4) the stress of constant change is compounded by chronic recurring challenges. CONCLUSION: Advances in implementation science, data standardization, and training in leadership skills are needed to support IPs in their evolving role.

Infection preventionists' awareness of and engagement in health information exchange to improve public health surveillance.

BACKGROUND: Advances in electronic health record (EHR) systems and health information exchange (HIE) are shifting efforts in public health toward greater use of information systems to automate notifiable disease surveillance. Little is known about infection preventionists' (IPs) awareness, adoption, and use of these technologies to report information to public health. METHODS: To measure awareness and engagement in EHR and HIE activities, an online survey of IPs was conducted in states with HIE networks. A total of 63 IPs was invited to participate; 44 IPs (69%) responded. The survey asked about the adoption and use of EHR systems, participation in regional HIE initiatives, and IP needs with respect to EHR systems and public health reporting. RESULTS: Over 70% of responding IPs reported access to an EHR system, but less than 20% of IPs with access to an EHR reported being involved in the design, selection, or implementation of the system. Just 10% of IPs reported that their organizations were formally engaged in HIE activities, and 49% were unaware of organizational involvement in HIE. IPs expressed a desire for better decision support, paperless reporting methods, and situational awareness of community outbreaks. CONCLUSION: Many IPs lack awareness and engagement in EHR and HIE activities, which may limit IPs ability to influence or utilize key information technologies as they are implemented in health care organizations.