Responsibility for Risk Reduction

Infection Control Department’s Program Responsibilities

In 1985, the Study of the Efficacy of Nosocomial Infection Control (SENIC) project was published, validating the cost-benefit savings of infection control programs.⁸ Infection control programs were proven to be effective as hospitals with certain practices reduced their infection rates by 32 percent, compared with an increase of 18 percent in hospitals without these components over a 5-year period.^{8, 26} Essential components of effective infection control programs included conducting organized surveillance and control activities, a trained infection control physician, an infection control nurse for every 250 beds, and a process for feedback of infection rates to clinical care staff. These programmatic components have remained consistent over time and are adopted in the infection control standards of the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations, JCAHO). The evolving responsibility for operating and maintaining a facility-wide effective infection control program lies within many domains. Both hospital administrators and health care workers are tasked to demonstrate effectiveness of infection control programs, assure adequate staff training in infection control, assure that surveillance results are linked to performance measurement improvements, evaluate changing priorities based on ongoing risk assessments, ensure adequate numbers of competent infection control practitioners, and perform program evaluations using quality improvement tools as indicated.

Infection Control Personnel

It has been demonstrated that infection control personnel play an important role in preventing patient and health care worker infections and preventing medical errors. An infection control practitioner²⁷ (ICP) is typically assigned to perform ongoing surveillance of infections for specific wards, calculate infection rates and report these data to essential personnel, perform staff education and training, respond to and implement outbreak control measures, and consult on employee health issues. This specialty practitioner gains expertise through education involving infection surveillance, infection control, and epidemiology from current scientific publications and basic training courses offered by professional organizations or health care institutions.^{28, 29} The Certification Board of Infection Control offers certification that an ICP has the standard core set of knowledge in infection control.^{30, 31, 32}
Over time, the workload responsibilities of the ICP have significantly increased to encompass additional administrative functions and regulatory compliance reporting, sometimes covering prevention of infection activities in other facilities that belong to the health care system (e.g., long-term care, home care, and outpatient settings). The expanding scope of ICP responsibilities being performed with limited time and shrinking resources has created an imbalance in meeting all tasks, leading to regular completion of only essential functions and completing less essential functions when time permits. In a 2002 ICP survey examining resource allocations, the activity consuming the greatest amount of mean estimated time was surveillance, followed by education, prevention strategies to control transmission, infection control program communication, and outbreak control. In examining the tasks and the time allocations necessary to complete essential infection control responsibilities, a recent expert review panel recommended new and safer staffing allocations: 1 full-time ICP for every 100 occupied beds. Further staffing levels and recommendations are included for different types of health care facilities by bed size.³³ To maximize successful completion of current reporting requirements and strategies for the prevention of infection and other adverse events associated with the delivery of health care in the entire spectrum of health care settings, infection control personnel and departments must be expanded.³⁴

Nursing Responsibilities

Clinical care staff and other health care workers are the frontline defense for applying daily infection control practices to prevent infections and transmission of organisms to other patients. Although training in preventing bloodborne pathogen exposures is required annually by the Occupational Safety and Health Administration, clinical nurses (registered nurses, licensed practical nurses, and certified nursing assistants) and other health care staff should receive additional infection control training and periodic evaluations of aseptic care as a planned patient safety activity. Nurses have the unique opportunity to directly reduce health care–associated infections through recognizing and applying evidence-based procedures to prevent HAIs among patients and protecting the health of the staff. Clinical care nurses directly prevent infections by performing, monitoring, and assuring compliance with aseptic work practices; providing knowledgeable collaborative oversight on environmental decontamination to prevent transmission of microorganisms from patient to patient; and serve as the primary resource to identify and refer ill visitors or staff.

Prevention Strategies

 Multiple factors influence the development of HAIs, including patient variables (e.g., acuity of illness and overall health status), patient care variables (e.g., antibiotic use, invasive medical device use), administrative variables (e.g., ratio of nurses to patients, level of nurse education, permanent or temporary/float nurse), and variable use of aseptic techniques by health care staff. Although HAIs are commonly attributed to patient variables and provider care, researchers have also demonstrated that other institutional influences may contribute to adverse outcomes.^{35, 36} To encompass overall prevention efforts, a list of strategies are reviewed that apply to the clinical practice of an individual health care worker as well as institutional supportive measures. Adherence to these principles will demonstrate that you H.E.L.P. C.A.R.E. This acronym is used to introduce the following key concepts to reduce the incidence of health care–associated infections. It emphasizes the compassion and dedication of nurses where their efforts contribute to reduce morbidity and mortality from health care–associated infections.