Infection Control Staffing, Time Use and Resources in California Hospitals

Background: An estimated 1.7 million healthcare associated infections occur in American hospitals each year.  In the context of increasing infection rates and public attention, infection prevention and control programs are also adapting to legislative, institutional, and technological changes. In California, these changes include recent requirements to increase surveillance and mandatory infection prevention procedures. 

Objective: The goal of this study was to evaluate infection prevention staffing, time use and department resources in California hospitals in the context of new state mandates.  Staffing was compared to a national sample.

Methods: In fall 2008, we sent a web-based survey to 350 infection prevention and control departments at eligible California acute-care hospitals. Respondents were department directors. Cross-sectional data were obtained on a number of department characteristics including staffing and resources.  Descriptive statistics (means and proportions) were computed. The staffing data were compared to a nationwide survey of National Healthcare Safety Network hospitals (NHSN) obtained in the spring of 2008. Chi square and t-tests were computed using SAS 9.2.

Results: The response rate of the California survey was 59% (n = 207 hospitals).  Data were available on 514 infection prevention and control professionals. Infection preventionists (IPs) spent 37% of their time on surveillance and 14% on policy development/meetings. Most (81%) IPs were nurses; half had less than 5 years experience.  Over half (n =110) of the departments had an MD hospital epidemiologist, but only 19% of those reporting hours worked full-time in infection control (n = 20/106). Department budgets and administrative structures varied widely.  Department directors in the NHSN sample had higher levels of education, experience, and rates of professional memberships (all p < 0.05) than directors at California hospitals. California infection prevention and control departments had lower staffing resources in an additional 10 of 12 measures, although these differences were not significant.

Conclusions:  In general, infection prevention and control departments in California had lower staffing resources than the national sample. Infection control directors in California had lower educational levels, less experience, and a lower proportion of professional memberships than directors at NHSN hospitals. Staff report devoting considerable time to surveillance and administrative activities, detracting from the time available for direct intervention in transmission of infections and staff education. California infection control departments appear under resourced for implementation of new state mandates.