APIC, CDC surveys find ICPs doing more with less
JCAHO regs viewed as critical to job security
Two unrelated surveys of infection control professionals underscore that many ICPs are doing more with less as duties expand and budgets shrink in the managed care era, officials report.
The Association for Professionals in Infection Control and Epidemiology (APIC) mailed out questionnaires to 1100 APIC members last April. The survey drew 406 (37%) responses for an initial report released at the APIC conference, but now has reached more than 40% in final results that will be published in an upcoming issue of the association’s publication, the American Journal of Infection Control. In preliminary results presented at APIC, 75% of respondents reported their responsibilities had increased during the last three years, but only 15% reported corresponding staff increases and only 26% reported increased program funding during the period. (See chart, p. 141.)
Likewise, reflecting nationwide trends reported in other health care polls, 85% of the ICPs reported increasing patient acuity for the period while overall census dropped (45%) or held steady (23%).
"Census is what hospital administrators use to make FTE decisions," says Marguerite Jackson, RN, PhD, CIC, FAAN, one of the designers of the APIC survey and administrative director of the medical center epidemiology unit at the University of California in San Diego. "The effect of falling census on infection control is that ICP positions are being restructured. That means that either the traditional ICP role is being combined with other functions, or positions are being eliminated or not being [filled] when people leave."
In addition, 75% of respondents agreed or strongly agreed that the Joint Commission on Accreditation of Healthcare Organizations standards for infection control are critical to retaining their positions. In other opinion questions on the issue, about half of respondents thought their job might be eliminated if the Joint Commission dropped the standard or its requirement for a "qualified" ICP.
"We wanted to know how strongly the respondents felt the Joint Commission’s requirements ensured that they had a job," explains Jackson. "Many [ICPs] feel with varying degrees of strength that if it weren’t for the Joint Commission, they wouldn’t have a job."
Still, 35% of respondents said the perceived valued of the infection control program had increased in the last three years. Another 46% said value in the eyes of administration was about the same, and 13% said it had decreased. As many as 86% of the respondents reported managed care penetration in their geographic area, but nearly half of all respondents disagreed with a statement that managed care improves quality. Still, more than a third of respondents to another question said managed care offers ICPs new opportunities and nearly half were neutral.
Respondents in all types of facilities spend far more time in surveillance activities than in any other component of their jobs. On average, surveillance both routine and direct observation of patient care practices consumed about 30% of ICP time, APIC reported. Education of staff, patients, and others ranked second across all groups, followed by development of infection control policies in community hospitals and government hospitals.
In general, infection control responsibilities are extending to other settings, but a corresponding increase in program support may not follow. Results from a separate survey by the Centers for Disease Control and Prevention yielded similar findings.
"It confirmed what people are saying: The number of acute care beds and the census at the respondent institutions are decreasing," says William Jarvis, MD, acting director of the CDC hospital infections program.
The CDC survey, which is continuing, yielded APIC member responses from 189 hospitals nationally. In preliminary results presented at APIC, the CDC survey tracked changes over the last five years. The average number of licensed beds in the responding facilities significantly decreased between 1992 and 1996, and the average daily census declined from 160 patients to about 130 patients.
"Surveillance activities are expanding beyond just acute care to the outpatient setting, surgery centers, and home care," Jarvis tells Hospital Infection Control. "Infection control activities and responsibilities are increasing, whereas their numbers and support are not increasing."
The survey, however, revealed no statistically significant decline in the number of ICPs employed at the facilities, but did show an increase in those working part-time, he said.
"We don’t see a significant decrease in the nurse-to-patient ratio overall," he told APIC attendees. "However, I suspect if you look at your own institution and you look at specific areas such as ICUs and NICUs, you may be seeing a decrease in your nurse-to-patient ratios."
In the CDC survey, a surprising number of ICPs reported good administrative support for their programs, with only 10% reporting relatively little support from administration.
"I was surprised at this," Jarvis told APIC attendees. "I keep hearing from practitioners that administrative departments are not supportive of infection control."
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