American Journal of Infection Control 43 (2015) 165-6
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Brief report
Is accounting for acute care beds enough? A proposal for measuring infection prevention personnel resources Kathleen A. Gase MPH, CIC a, *, Hilary M. Babcock MD, MPH b a b
BJC HealthCare, St. Louis, MO Washington University School of Medicine, St Louis, MO
Key Words: Infection prevention Resources Staffing
There is still little known about how infection prevention (IP) staffing affects patient outcomes across the country. Current evaluations mainly focus on the ratio of IP resources to acute care beds (ACBs) and have not strongly correlated with patient outcomes. The scope of IP and the role of the infection preventionist in health care have expanded and changed dramatically since the Study on the Efficacy of Nosocomial Infection Control (SENIC Project) recommended a 1 IP resource to 250 ACB ration in the 1980s. Without a universally accepted model for accounting for additional IP responsibilities, it is difficult to truly assess IP staffing needs. A previously suggested alternative staffing model was applied to acute care hospitals in our organization to determine its utility. Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
BJC HealthCare is an 11-hospital system serving urban, suburban, and rural communities in Missouri and Illinois, with a mix of critical access, community, pediatric, and academic hospitals ranging from 35-1,315 licensed beds with 25 full-time equivalent (FTE) infection prevention (IP) resources spread across those facilities. Guidelines or recommendations for IP staffing have historically been set based on the ratio IP FTE to acute care beds (ACBs).1-5 The guideline of 1 IP professional for every 250 ACBs has been used by leadership at many facilities since the mid-1980s.1 That recommendation has been updated over the last 15 years, citing ideal IP staffing ratios ranging from 1 FTE per 100-167 ACBs.2,3 Little is known about how IP programs are actually staffed across the United States and how that ratio may influence patient outcomes. Data from 2008-2014 report that the average IP resource to ACBs ratio in responding U.S. hospitals ranges from 1:151 to 1:83.4-6 These studies were limited by small sample sizes and may not be representatives of the >4,000 acute care facilities in the United States. The role and scope of IP programs has expanded beyond the responsibilities of overseeing only ACBs in a facility; however, expected staffing ratios have not been adjusted.6,7 The objective of this study was to explore an alternative staffing ratio, previously developed by the New York State Department of Health and used in
* Address correspondence to Kathleen A. Gase, MPH, CIC, 8300 Eager Rd, Ste 400A, St Louis, MO 63144. E-mail address: [email protected] (K.A. Gase). Conflicts of interest: None to report.
their annual report, that accounts for intensive care beds, long-term care beds, dialysis facilities, ambulatory surgery centers, ambulatory clinics, and private physician offices covered by IP staff in addition to ACBs.8 This alternative ratio was then applied to the acute care facilities in BJC HealthCare for comparison. METHODS Internally available 2013 data for 11 acute care hospitals were gathered including the following: number of IP resources; number of ACBs; and number of intensive care unit beds, long-term care facility beds, dialysis facilities, ambulatory surgery centers, ambulatory clinics, and private physician offices that are covered by IP. Current IP staffing ratios were calculated using ACBs and New York State’s modified equation to estimate resource availability (Table 1).8 These ratios were then compared with the reported New York State IP staffing ratios. RESULTS Overall, BJC HealthCare has 1 IP resource per 164 ACBs, with facility-specific ratios ranging from 1:70 to 1:412 (Table 2). Using the adjusted ACB equivalent calculation, the system has an average of 1 IP resource per 286 ACB equivalents, with facility-specific ratios ranging from 1:84 to 1:475. New York State reports an average IP staffing ratio of 1:127 ACBs and an adjusted IP staffing ratio of 1:244 ACB equivalents.
0196-6553/$36.00 - Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2014.10.013
166
K.A. Gase, H.M. Babcock / American Journal of Infection Control 43 (2015) 165-6
Table 1 Acute care bed equivalents used to calculate infection prevention staffing ratios8 Variable Acute care bed Intensive care bed Long-term care bed Dialysis facility Ambulatory surgery center Ambulatory clinic Private physician office
Table 2 IP staffing results
Acute care bed equivalent 1 2 ½ 50 50 10 5
DISCUSSION There is a wide variation in IP personnel resources within the hospital system. The adjusted ACB calculation more fully captures the IP workload, but likely still has gaps and may not accurately represent the true scope of IP activities or responsibilities. Acuity of the patient population overall is still not accounted for in this model, but it is represented by acknowledging the need for additional resources to cover intensive care unit beds. Also not represented in the model is access to other resources (eg, hospital epidemiologist, administrative support, data management staff). Every facility in the United States has its own unique characteristics that must be taken into consideration when making the case for more IP resources. CONCLUSION There currently is not a universally accepted alternative to using ACBs to measure IP staffing ratios. It will be vital to continue to evaluate this proposed alternative to calculatingdand, ultimately, recommendingdIP staffing ratios. Adding other factors to the equation, such as types of other resources available (hospital epidemiologist, administrative support, etc), additional high-risk populations covered (oncology, transplant, etc), and active construction activities, may be necessary. The major challenge will be to maintain its simplicity while making it as meaningful as possible. Applying this methodology to a larger sample of health care facilities in the future would allow for broader evaluation of the utility of using an ACB equivalent calculation. The Centers for Disease Control and Prevention may be able to capture the required elements via the annual facility survey in the National Healthcare Safety Network. This would also
Facility
IP resources
Acute care beds
IP staffing ratio
Adjusted acute care beds
Adjusted IP staffing ratio
½ 1.5 9 1 1 2 2.5 ½ 1 1 2 22
206 360 1,315 127 113 485 489 35 133 72 264 3,599
1:412 1:240 1:146 1:127 1:113 1:243 1:196 1:70 1:133 1:72 1:132 1:164
237.5 510 2,941 211 179 657 599 93 185 84 588 6,284.5
1:475 1:340 1:327 1:211 1:179 1:329 1:240 1:186 1:185 1:84 1:294 1:286
A B C D E F G H I J K Total
NOTE. New York State reports an average IP staffing ratio of 1:127 and an adjusted IP staffing ratio of 1:244. IP, infection prevention.
potentially allow for assessment of infection-related outcomes in relation to staffing.
References 1. Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infection in US hospitals. Am J Epidemiol 1985;121:182-205. 2. O’Boyle C, Jackson M, Henly SJ. Staffing requirements for infection control programs in US health care facilities: Delphi project. Am J Infect Control 2002;30: 321-33. 3. Morrison J, Health Canada, Nosocomial and Occupational Infections Section. Development of a resource model for infection prevention and control programs in acute, long term, and home care settings: conference proceedings of the Infection Prevention and Control Alliance. Am J Infect Control 2004;32:2-6. 4. Stone PW, Dick A, Pogorzelska M, Horan TC, Furuya EY, Larson E. Staffing and structure of infection prevention and control programs. Am J Infect Control 2009;37:351-7. 5. Stone PW, Pogorzelska-Maziarz M, Herzig CT, Weiner LM, Furuya EY, Dick A, et al. State of infection prevention in US hospitals enrolled in the National Health and Safety Network. Am J Infect Control 2014;42:94-9. 6. Stricof RL, Schabses KA, Tserenpuntsag B. Infection control resources in New York State hospitals, 2007. Am J Infect Control 2008;36:702-5. 7. Nguyen GT, Proctor SE, Sinkowitz-Cochran RL, Garrett DO, Jarvis WR. Status of infection surveillance and control programs in the United States, 1992-1996. Association for Professionals in Infection Control and Epidemiology, Inc. Am J Infect Control 2000;28:392-400. 8. New York State Department of Health. Hospital-acquired infections e New York State 2012. Available from: http://www.health.ny.gov/statistics/facilities/hospital/ hospital_acquired_infections. Accessed June 26, 2014.
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Brief report
Is accounting for acute care beds enough? A proposal for measuring infection prevention personnel resources Kathleen A. Gase MPH, CIC a, *, Hilary M. Babcock MD, MPH b a b
BJC HealthCare, St. Louis, MO Washington University School of Medicine, St Louis, MO
Key Words: Infection prevention Resources Staffing
There is still little known about how infection prevention (IP) staffing affects patient outcomes across the country. Current evaluations mainly focus on the ratio of IP resources to acute care beds (ACBs) and have not strongly correlated with patient outcomes. The scope of IP and the role of the infection preventionist in health care have expanded and changed dramatically since the Study on the Efficacy of Nosocomial Infection Control (SENIC Project) recommended a 1 IP resource to 250 ACB ration in the 1980s. Without a universally accepted model for accounting for additional IP responsibilities, it is difficult to truly assess IP staffing needs. A previously suggested alternative staffing model was applied to acute care hospitals in our organization to determine its utility. Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
BJC HealthCare is an 11-hospital system serving urban, suburban, and rural communities in Missouri and Illinois, with a mix of critical access, community, pediatric, and academic hospitals ranging from 35-1,315 licensed beds with 25 full-time equivalent (FTE) infection prevention (IP) resources spread across those facilities. Guidelines or recommendations for IP staffing have historically been set based on the ratio IP FTE to acute care beds (ACBs).1-5 The guideline of 1 IP professional for every 250 ACBs has been used by leadership at many facilities since the mid-1980s.1 That recommendation has been updated over the last 15 years, citing ideal IP staffing ratios ranging from 1 FTE per 100-167 ACBs.2,3 Little is known about how IP programs are actually staffed across the United States and how that ratio may influence patient outcomes. Data from 2008-2014 report that the average IP resource to ACBs ratio in responding U.S. hospitals ranges from 1:151 to 1:83.4-6 These studies were limited by small sample sizes and may not be representatives of the >4,000 acute care facilities in the United States. The role and scope of IP programs has expanded beyond the responsibilities of overseeing only ACBs in a facility; however, expected staffing ratios have not been adjusted.6,7 The objective of this study was to explore an alternative staffing ratio, previously developed by the New York State Department of Health and used in
* Address correspondence to Kathleen A. Gase, MPH, CIC, 8300 Eager Rd, Ste 400A, St Louis, MO 63144. E-mail address: [email protected] (K.A. Gase). Conflicts of interest: None to report.
their annual report, that accounts for intensive care beds, long-term care beds, dialysis facilities, ambulatory surgery centers, ambulatory clinics, and private physician offices covered by IP staff in addition to ACBs.8 This alternative ratio was then applied to the acute care facilities in BJC HealthCare for comparison. METHODS Internally available 2013 data for 11 acute care hospitals were gathered including the following: number of IP resources; number of ACBs; and number of intensive care unit beds, long-term care facility beds, dialysis facilities, ambulatory surgery centers, ambulatory clinics, and private physician offices that are covered by IP. Current IP staffing ratios were calculated using ACBs and New York State’s modified equation to estimate resource availability (Table 1).8 These ratios were then compared with the reported New York State IP staffing ratios. RESULTS Overall, BJC HealthCare has 1 IP resource per 164 ACBs, with facility-specific ratios ranging from 1:70 to 1:412 (Table 2). Using the adjusted ACB equivalent calculation, the system has an average of 1 IP resource per 286 ACB equivalents, with facility-specific ratios ranging from 1:84 to 1:475. New York State reports an average IP staffing ratio of 1:127 ACBs and an adjusted IP staffing ratio of 1:244 ACB equivalents.
0196-6553/$36.00 - Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2014.10.013
166
K.A. Gase, H.M. Babcock / American Journal of Infection Control 43 (2015) 165-6
Table 1 Acute care bed equivalents used to calculate infection prevention staffing ratios8 Variable Acute care bed Intensive care bed Long-term care bed Dialysis facility Ambulatory surgery center Ambulatory clinic Private physician office
Table 2 IP staffing results
Acute care bed equivalent 1 2 ½ 50 50 10 5
DISCUSSION There is a wide variation in IP personnel resources within the hospital system. The adjusted ACB calculation more fully captures the IP workload, but likely still has gaps and may not accurately represent the true scope of IP activities or responsibilities. Acuity of the patient population overall is still not accounted for in this model, but it is represented by acknowledging the need for additional resources to cover intensive care unit beds. Also not represented in the model is access to other resources (eg, hospital epidemiologist, administrative support, data management staff). Every facility in the United States has its own unique characteristics that must be taken into consideration when making the case for more IP resources. CONCLUSION There currently is not a universally accepted alternative to using ACBs to measure IP staffing ratios. It will be vital to continue to evaluate this proposed alternative to calculatingdand, ultimately, recommendingdIP staffing ratios. Adding other factors to the equation, such as types of other resources available (hospital epidemiologist, administrative support, etc), additional high-risk populations covered (oncology, transplant, etc), and active construction activities, may be necessary. The major challenge will be to maintain its simplicity while making it as meaningful as possible. Applying this methodology to a larger sample of health care facilities in the future would allow for broader evaluation of the utility of using an ACB equivalent calculation. The Centers for Disease Control and Prevention may be able to capture the required elements via the annual facility survey in the National Healthcare Safety Network. This would also
Facility
IP resources
Acute care beds
IP staffing ratio
Adjusted acute care beds
Adjusted IP staffing ratio
½ 1.5 9 1 1 2 2.5 ½ 1 1 2 22
206 360 1,315 127 113 485 489 35 133 72 264 3,599
1:412 1:240 1:146 1:127 1:113 1:243 1:196 1:70 1:133 1:72 1:132 1:164
237.5 510 2,941 211 179 657 599 93 185 84 588 6,284.5
1:475 1:340 1:327 1:211 1:179 1:329 1:240 1:186 1:185 1:84 1:294 1:286
A B C D E F G H I J K Total
NOTE. New York State reports an average IP staffing ratio of 1:127 and an adjusted IP staffing ratio of 1:244. IP, infection prevention.
potentially allow for assessment of infection-related outcomes in relation to staffing.
References 1. Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infection in US hospitals. Am J Epidemiol 1985;121:182-205. 2. O’Boyle C, Jackson M, Henly SJ. Staffing requirements for infection control programs in US health care facilities: Delphi project. Am J Infect Control 2002;30: 321-33. 3. Morrison J, Health Canada, Nosocomial and Occupational Infections Section. Development of a resource model for infection prevention and control programs in acute, long term, and home care settings: conference proceedings of the Infection Prevention and Control Alliance. Am J Infect Control 2004;32:2-6. 4. Stone PW, Dick A, Pogorzelska M, Horan TC, Furuya EY, Larson E. Staffing and structure of infection prevention and control programs. Am J Infect Control 2009;37:351-7. 5. Stone PW, Pogorzelska-Maziarz M, Herzig CT, Weiner LM, Furuya EY, Dick A, et al. State of infection prevention in US hospitals enrolled in the National Health and Safety Network. Am J Infect Control 2014;42:94-9. 6. Stricof RL, Schabses KA, Tserenpuntsag B. Infection control resources in New York State hospitals, 2007. Am J Infect Control 2008;36:702-5. 7. Nguyen GT, Proctor SE, Sinkowitz-Cochran RL, Garrett DO, Jarvis WR. Status of infection surveillance and control programs in the United States, 1992-1996. Association for Professionals in Infection Control and Epidemiology, Inc. Am J Infect Control 2000;28:392-400. 8. New York State Department of Health. Hospital-acquired infections e New York State 2012. Available from: http://www.health.ny.gov/statistics/facilities/hospital/ hospital_acquired_infections. Accessed June 26, 2014.
