Florida infection preventionist successfully advocates for staff growth, keeping pace with hospital’s expanding service lines
Creative approach, diversified IPC roles create onramp for non-traditional staff
San Antonio, Texas, June 4, 2024 – In an era of hospital budget cuts and staffing freezes, a Florida hospital more than doubled staff positions for infection prevention and control (IPC) over a four-year period, reducing infections and creating opportunities for non-clinical team members to enter the field and excel.
By presenting a business case showing costs of excess healthcare-associated infections (HAIs), infection preventionist (IP) Luz Caicedo, MPH, CPH, CIC, CRCST, VA-BC at AdventHealth in Celebration, Florida was able to increase IPC staff from 2 to 4.8 full-time equivalents (FTEs) and decrease HAIs and communicable disease exposures between 2019 and 2023, according to an oral abstract being presented today at the 2024 APIC Annual Conference. She also created an IPC career ladder with diversified roles, outlining career progression and enhancing retention among the team.
When Caicedo joined AdventHealth in 2019, there were just two full-time equivalent IPs on staff and the 217-bed Florida hospital was in the midst of an expansion to accommodate 357 beds, in addition to bringing on more operating rooms, catheterization labs, interventional radiology, endoscopy, and ambulatory sites. Already understaffed and unable to visit operating rooms or ambulatory sites more than a few times a year, Caicedo knew she needed to expand IP capacity to adequately protect patients and staff from HAIs.
To assess the resources necessary to provide adequate coverage and build her business case, she based her ideal IP staffing ratio not just on the number of inpatient beds, but also on the hospital’s growing number of procedural areas and outpatient service lines, using the 2012 New York State Acute Care Bed equivalent as a model.
Starting with surgical site infections (SSIs), she was able to convince hospital leaders to let her hire a new IP to cover the surgical service. When SSIs decreased markedly, she received approval for additional staff. As a result of expanding the size of the IP team from 2 in 2019 to 4.8 FTEs in 2023, AdventHealth Celebration achieved a 37% decrease in CLABSIs, and a 45% decrease in healthcare-onset C. difficile as the hospital increased its operations.
“Our Chief Nursing Officer is very supportive of the IPC department because we've been able to show her results,” said Caicedo. “Every time that she has invested IPC staff positions, we’ve been able to lower our infection rates.”
With approval to grow the department came the challenge of determining the type of positions to bring on. To address this, Caicedo created an IPC career ladder and diversified the roles in the department to include an entry-level IP Associate and IP Coordinator, as well as Infection Preventionist, and IP Manager. This structured career progression has enhanced retention and has created pathways for non-clinical team members to enter the field.
Additional staffing has allowed the IPC team to introduce quality improvement initiatives like building dashboards to track device rounds, launching a ‘CAUTI bootcamp’ which has dramatically reduced catheter-associated urinary tract infections, and working with the lab to lower blood culture contamination rates.
“The work that the AdventHealth IPC team is undertaking and the success they have achieved would be impossible without proper staffing,” said Tania Bubb, PhD, RN, CIC, FAPIC, 2024 APIC president. “Their success is a testament to the support received from hospital leaders and also to Luz’s ability to demonstrate that investment in infection prevention can impact the whole facility. Tools like the APIC IP Staffing Calculator and the one that Luz used can help facilities quantify IPC staffing needs to make the case for adequate resources.”
The oral abstract, “Advancing Infection Prevention: Navigating Staffing Growth and Implementing a Career Ladder (LDPM 16)” is being presented at 1:41pm CT, June 4, at the APIC Annual Conference in San Antonio, Texas.
Surgical site infection rates and other secondary outcomes decrease dramatically at multi-state hospital system through standardized, preoperative, surgical, antibiotic practices
Improved outcomes for orthopedic, colorectal, and abdominal hysterectomy surgery patients
San Antonio, Texas, June 4, 2024 – Mortality, length of stay, readmissions, and surgical site infections (SSI) all declined after a six-state hospital system implemented a comprehensive surgical site infection (SSI) prevention bundle, according to a report presented today at the 2024 APIC Annual Conference.
Banner Health, which operates facilities in Arizona, California, Colorado, Nebraska, Nevada, and Wyoming, reported on the impact of a surgical antimicrobial prophylaxis (SAP) bundle on more than 57,000 surgical cases from January 2019 to December 2023. Four publicly reportable procedures were included in the analysis: hip and knee arthroplasty, colorectal surgery, and abdominal hysterectomy.
The infection prevention (IP) team at Banner Health began delving into an all-encompassing clinical practice for SSI prevention in 2019 with the goal of reducing their Standardized Infection Ratios (SIRs). It was determined that focusing on one bundle component, specifically SAP across all 30 of their facilities, could have the greatest impact on SSI reduction. As part of the intervention, they monitored adherence to the appropriate selection of preoperative antibiotics, dose, administration times, and redose. Starting from a baseline of 67.1% in 2019, adherence to this process measure increased to 82.2% by 2023.
During the same period, compliance with the SAP bundle produced the beneficial effect of shortening length of stay (LOS) by 4 days, decreasing overall mortality rates by 4.4%, and lowering the average 30-day readmission rates by 3.9%. Similarly, compliance with the SAP bundle in hip arthroplasty procedures evidenced a statistically significant (p<0.0001) reduction in average 30-day readmission rates from 11% to 7%.
“This work shows that a bundle of evidence-based interventions designed to reduce infections can also impact other important outcomes like mortality, length of stay, and readmissions,” said Aarikha D'Souza, BS, MPH, CIC, FAPIC, clinical practice lead and infection prevention regional director at Banner Health. “If we’re sending patients home earlier there’s a ripple effect as we also decrease the chances of them developing deep vein thrombosis, pneumonia, pressure injuries, or having a fall.”
Increased adherence to the SAP bundle illustrated the most benefit among orthopedic patients. Hip arthroplasty procedures resulted in a statistically significant 32.8% decrease in SSI rates and 48.3% drop in SIR, while knee arthroplasty procedures resulted in a 15.2% reduction in SSI rates and 33.1% decrease in SIR. Additionally, adherence to the SAP bundle in colorectal surgeries and abdominal hysterectomy procedures decreased SSI rates by 17.4% and SIR by 8.11%, respectively.
“This project shows the value of intense focus on a specific set of process measures to influence not just infection rates, but also other important quality metrics,” said Tania Bubb, PhD, RN, CIC, FAPIC, 2024 APIC president. “We are grateful to Banner Health for their exceptional patient safety work and for sharing their success at the APIC Conference.”
The oral abstract, “Effect of a Standardized Preoperative Prophylactic Antimicrobial Guideline on Improved Postoperative Surgical Site Infection (SSI) Outcomes,” (ISR 11) is being presented at 2:30 pm CT, June 4, at the APIC Annual Conference in San Antonio, Texas.
About APIC
Founded in 1972, the Association for Professionals in Infection Control and Epidemiology (APIC) is the leading association for infection preventionists and epidemiologists. With more than 15,000 members, APIC advances the science and practice of infection prevention and control. APIC carries out its mission through research, advocacy, and patient safety; education, credentialing, and certification; and fostering development of the infection prevention and control workforce of the future. Together with our members and partners, we are working toward a safer world through the prevention of infection. Join us and learn more at apic.org.
APIC’s Annual Conference, June 3-5, is one of the most comprehensive infection prevention conferences in the world, with programs led by experts from across the globe and attended by physicians, researchers, epidemiologists, educators, administrators, and medical technologists, with strategies that can be implemented immediately to improve prevention programs and make healthcare safer. Join the conversation on social media with the hashtag #APIC24.
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