- Email: [email protected]
APIC 1963: Is the honeymoon over?
George W. Counts, M.D. Seattle,
Washington
The Association for Practitioners in Infection Control (APIC) celebrated the tenth anniversary of the Annual Educational Conference in San Diego May l-5, 1983. It was a meaningful event because 1983 year marks the occurrence of striking accomplishments for the organization. Certification in infection control, a process initiated by members of the APIC-New England chapter, has become a reality. First established as a subcommittee of the Education Committee, the Certification Committee was later approved as a standing committee of APIC. In 198 1 APIC established the totally independent Certification Board of Infection Control (CBIC). In the short time since its inception, CBIC has performed a task analysis, carried out an extensive survey of tasks performed by practitioners, and developed a certifying examination given for the first time November 19, 1983. A second project that came to fruition in 198 3 was The APZC Curriculum for Infection Control Practice. This document was initially planned as a practical study guide to assist persons preparing for the certification examination. In 1980 APIC approved eight standards of knowledge felt to be essential to the practice of infection control. Following this, The Curriculum changed from a study guide into a comprehensive document embodying those standards to serve as a resource document for practitioners, health care institutions, and schools and as a self-assessment tool for practitioners and others interested in the field. The Curriculum and certification represent important milestones toFrom the Infectious Diseases Center, University of Washington Presented nual APIC 1983.
Division,
in part as the Presidential Educational Conference,
Reprint requests: WA 98104
Dr. George
Harborview
Medical
Address at the Tenth AnSan Diego, Calif., May 2,
W. Counts,
325 9th Ave.,
Seattle,
ward one of the long-desired goals of our organization-standardization of the practice of infection control and of knowledge possessed by those persons who perform it. One could legitimately question why APIC should change its focus. Why not simply continue with the goals that have brought us to our current position? The key word is “evolution.” The field of infection control has changed. It is now receiving the attention and benefit of carefully performed scientific studies that are helping to dispel old myths and rituals of infection control practice. Economic, political, and social factors affecting the field of infection control have likewise changed. We are now squarely in the world of quality assurance, risk management, cost containment, cost-benefit analysis, and increasing frequency of litigation, all of which exert some impact on the practice of infection control. A third facet of evolution in infection control is that people in the field have, themselves, changed. As we consider the persons who practice infection control, we are concerned with the reasons for entering the field, the reasons for remaining in the field, and perhaps most important the reasons for leaving it. Infection control might attract persons for a variety of reasons, including the challenge of a relatively new patient care discipline, the opportunity to teach in different settings, the excitement of pursuing solutions to the riddles of epidemiologic investigations, and the opportunity to exert an impact on the health of a larger number of persons, both patients and employees, than in the usual individualized patient care interaction, As for persons electing to remain in the field, some do so for professional reasons, including satisfaction with the job situation and with infection control as a challenging role within the institution. Often, however, personal reasons, including the economic realities of
Volume 12 Number April, 1984
2
Commentary
Table 1. Selected key events in the history of APIC YSSr
6000 1 5oooj
Event
1972
Meeting held in Research Triangle Park, North Carolina, to establish APIC Newsletter started First educational conference held Chapters formed Chapter Update started Management firm hired; national office established Contract established with The C. V. Mosby Co. to publish the American Journal of Mection Control Certification Board of Infection Control formed Task analysis performed by CBIC; AHC News started The Curriculum published; certifying examination offered
1973 1973 1975 1977 1978 1980
1981 1982 1983
2. APIC membership trends according to discipline
Table
Yssr 1980
1982
8%
82% 6% 5% 2% 1% 4%
74% 6% 4% 2% 1% 4% 9%
3036
5794
5977
Dlrcipline
1977
Registered nurse Physician Medical technologist Microbiologist Epidemiologist Industry Other/unknown
81% 5% 4% 2% -
Total
membership
101
pay, status, and working conditions, become primary considerations. Undoubtedly multiple reasons exist for leaving the field. One possibility might be dissatisfaction with infection control itself. The challenge may have disappeared and the position become what some envision as a “dead end” job. Other reasons for leaving might include a return to more direct patient care, promotion to a different position (e.g., directors of quality assurance or risk management programs), and pursuit of more favorable financial rewards. Changes and trends among persons in the field of infection control may be reflected in trends in the membership of APIC. The membership growth curve for the first decade of APIC’s existence is shown in Fig. 1. The rate of
-9 3 4000b 1 3000F g 2000IOOO-
0I Years Fig. 1. Changes in the total membership of APIC for the years 1973 through 1982. (* = % change compared to previous year.)
growth in 198 1 and 1982 did not keep pace with that of previous years. For purposes of comparison, selected key events in APIC’s history are listed in Table 1. The composition of APIC membership for the years 1977 to 1982 is shown in Table 2. The data are derived from information submitted on membership applications and renewal forms. Although percentages remained unchanged, between 1980 and 198 2 a modest increase occurred in the number of physician members and a 12% decrease in the number of persons identifying themselves as medical technologists or microbiologists. The 7% decrease in the number of persons listing their discipline as registered nurse represented 328 nurses. Assuming the changes in membership are real, the significance is far from certain. One possibility is that the change in the number of nurse members may only be reflective of the larger and more general issue of turnover among nursing personnel in all levels of professional activities. Results of a questionnaire sent to 465 persons failing to renew their membership in APIC revealed that 8 1% of responders were no longer in the field of infection control. A second possibility is that after the initial excitement members leave APIC because they feel that it does not address their professional and personal needs. In this same questionnaire, 3% indicated that dissatisfaction with APIC played a role in the decision
American
lop TWla voting
Counts
INFECTION
8. Regional breakdown of membership in the 1982 APIC national election Region 1 2 3 4 5 6
No.of
%
lll9ltlbSW
Voting
1388 871 1117
42 42 43
586
40 38 29
299 1289 185
7
80 41
Total % *Membership
totals as of April 1, 1983.
not to renew. A third possibility is that the target pool of potential members is becoming increasingly smaller. It is just as important today as in 1972 to examine reasons for joining APIC. A major goal for APIC during its formative years was to establish a communication network among persons similarly involved in the relatively new field of infection control. Education and standardization of practice were additional goals. Today a major reason for belonging to APIC, and a goal of the organization, is the provision of a stronger voice to address those issues and practices that may have an impact on our field. APIC is the largest infection control organization in the world and its members can and should use that strength to influence the scope and direction of changes in the field. While education is still an important goal today, the lack of assurance of standardization among the many educational offerings presented around the country, including thoSe developed by APIC, is a real concern. The Association has tried to address this concern by establishing educational standards and producing a learning tool that is based on them. APiC will pre-
The
Ameri~en
Jouml
issue. It i&s poMons
of Infe~#on
#deble
offers a dassitied advertisingsection in each desired. Rates for atwoun~ of 30 words and #8.OO for tbme or more im. Eech additional Control
word is $1.20 and $1.05, resptaetlveiy.Thereisa$B,QO~forboxserviceforthefirst insertion only. Payment must amy insertion orders. !3emJ cragsif@ ads to the Journal Adverlislng I3rqmtmant, AnMoan Journal d tnfedon Contvol, The C. V. Mosby Company, 11830
Westthe
hdu8thl
Drive,
St. Louis
MO
of
sent educational programs that adhere to those standards. Today the goal of improved communication among members is met by the American Journal of Infection Control, Chapter Update, and APIC News. For APIC to continue to survive and grow, members must be actively involmved in the organization. Among the various methods of involvement, one of the most important is to contact the elected APIC leaders, providing~ them with input on vital issues and making certain that they are responsive and responsible to the membership. Other methods include seeking and holding local and national offices, participating on national committees, and expressing opinions by voting in AFIC elections. Tab-le 3 shows a regional breakdown of membership voting records for the 1982 election. Since the margin of victory for some of the various contested positions was as narrow as O.% of the votes cast, it is obvious that each vote has the potential for exerting a profound impact on the outcome. A final method of involvement is to continue self-education through participation in APIC educational programs such as workshops, seminars, and conferences, in&ding the Annual Educational Conference. One look at the membership growth curve (Fig. 1) shows clearly that the “honeymoon” may indeed be over. The unbridled influx of new members that typified the early years of APIC’s history seems to have ended. Apparently APIC now, like any other organization or institution in these difficult economic times, must aggressively compete for the loyalty of the ers and for their professional, personal, and financial support. APIC’s future will be much affected by how adept it is in forecasting and “marching in tune” with the changes and trends in the field of infection control.
and m
or less are [email protected] for one inrsertkrn
Journal CONTROL
63146.
Washington
The Association for Practitioners in Infection Control (APIC) celebrated the tenth anniversary of the Annual Educational Conference in San Diego May l-5, 1983. It was a meaningful event because 1983 year marks the occurrence of striking accomplishments for the organization. Certification in infection control, a process initiated by members of the APIC-New England chapter, has become a reality. First established as a subcommittee of the Education Committee, the Certification Committee was later approved as a standing committee of APIC. In 198 1 APIC established the totally independent Certification Board of Infection Control (CBIC). In the short time since its inception, CBIC has performed a task analysis, carried out an extensive survey of tasks performed by practitioners, and developed a certifying examination given for the first time November 19, 1983. A second project that came to fruition in 198 3 was The APZC Curriculum for Infection Control Practice. This document was initially planned as a practical study guide to assist persons preparing for the certification examination. In 1980 APIC approved eight standards of knowledge felt to be essential to the practice of infection control. Following this, The Curriculum changed from a study guide into a comprehensive document embodying those standards to serve as a resource document for practitioners, health care institutions, and schools and as a self-assessment tool for practitioners and others interested in the field. The Curriculum and certification represent important milestones toFrom the Infectious Diseases Center, University of Washington Presented nual APIC 1983.
Division,
in part as the Presidential Educational Conference,
Reprint requests: WA 98104
Dr. George
Harborview
Medical
Address at the Tenth AnSan Diego, Calif., May 2,
W. Counts,
325 9th Ave.,
Seattle,
ward one of the long-desired goals of our organization-standardization of the practice of infection control and of knowledge possessed by those persons who perform it. One could legitimately question why APIC should change its focus. Why not simply continue with the goals that have brought us to our current position? The key word is “evolution.” The field of infection control has changed. It is now receiving the attention and benefit of carefully performed scientific studies that are helping to dispel old myths and rituals of infection control practice. Economic, political, and social factors affecting the field of infection control have likewise changed. We are now squarely in the world of quality assurance, risk management, cost containment, cost-benefit analysis, and increasing frequency of litigation, all of which exert some impact on the practice of infection control. A third facet of evolution in infection control is that people in the field have, themselves, changed. As we consider the persons who practice infection control, we are concerned with the reasons for entering the field, the reasons for remaining in the field, and perhaps most important the reasons for leaving it. Infection control might attract persons for a variety of reasons, including the challenge of a relatively new patient care discipline, the opportunity to teach in different settings, the excitement of pursuing solutions to the riddles of epidemiologic investigations, and the opportunity to exert an impact on the health of a larger number of persons, both patients and employees, than in the usual individualized patient care interaction, As for persons electing to remain in the field, some do so for professional reasons, including satisfaction with the job situation and with infection control as a challenging role within the institution. Often, however, personal reasons, including the economic realities of
Volume 12 Number April, 1984
2
Commentary
Table 1. Selected key events in the history of APIC YSSr
6000 1 5oooj
Event
1972
Meeting held in Research Triangle Park, North Carolina, to establish APIC Newsletter started First educational conference held Chapters formed Chapter Update started Management firm hired; national office established Contract established with The C. V. Mosby Co. to publish the American Journal of Mection Control Certification Board of Infection Control formed Task analysis performed by CBIC; AHC News started The Curriculum published; certifying examination offered
1973 1973 1975 1977 1978 1980
1981 1982 1983
2. APIC membership trends according to discipline
Table
Yssr 1980
1982
8%
82% 6% 5% 2% 1% 4%
74% 6% 4% 2% 1% 4% 9%
3036
5794
5977
Dlrcipline
1977
Registered nurse Physician Medical technologist Microbiologist Epidemiologist Industry Other/unknown
81% 5% 4% 2% -
Total
membership
101
pay, status, and working conditions, become primary considerations. Undoubtedly multiple reasons exist for leaving the field. One possibility might be dissatisfaction with infection control itself. The challenge may have disappeared and the position become what some envision as a “dead end” job. Other reasons for leaving might include a return to more direct patient care, promotion to a different position (e.g., directors of quality assurance or risk management programs), and pursuit of more favorable financial rewards. Changes and trends among persons in the field of infection control may be reflected in trends in the membership of APIC. The membership growth curve for the first decade of APIC’s existence is shown in Fig. 1. The rate of
-9 3 4000b 1 3000F g 2000IOOO-
0I Years Fig. 1. Changes in the total membership of APIC for the years 1973 through 1982. (* = % change compared to previous year.)
growth in 198 1 and 1982 did not keep pace with that of previous years. For purposes of comparison, selected key events in APIC’s history are listed in Table 1. The composition of APIC membership for the years 1977 to 1982 is shown in Table 2. The data are derived from information submitted on membership applications and renewal forms. Although percentages remained unchanged, between 1980 and 198 2 a modest increase occurred in the number of physician members and a 12% decrease in the number of persons identifying themselves as medical technologists or microbiologists. The 7% decrease in the number of persons listing their discipline as registered nurse represented 328 nurses. Assuming the changes in membership are real, the significance is far from certain. One possibility is that the change in the number of nurse members may only be reflective of the larger and more general issue of turnover among nursing personnel in all levels of professional activities. Results of a questionnaire sent to 465 persons failing to renew their membership in APIC revealed that 8 1% of responders were no longer in the field of infection control. A second possibility is that after the initial excitement members leave APIC because they feel that it does not address their professional and personal needs. In this same questionnaire, 3% indicated that dissatisfaction with APIC played a role in the decision
American
lop TWla voting
Counts
INFECTION
8. Regional breakdown of membership in the 1982 APIC national election Region 1 2 3 4 5 6
No.of
%
lll9ltlbSW
Voting
1388 871 1117
42 42 43
586
40 38 29
299 1289 185
7
80 41
Total % *Membership
totals as of April 1, 1983.
not to renew. A third possibility is that the target pool of potential members is becoming increasingly smaller. It is just as important today as in 1972 to examine reasons for joining APIC. A major goal for APIC during its formative years was to establish a communication network among persons similarly involved in the relatively new field of infection control. Education and standardization of practice were additional goals. Today a major reason for belonging to APIC, and a goal of the organization, is the provision of a stronger voice to address those issues and practices that may have an impact on our field. APIC is the largest infection control organization in the world and its members can and should use that strength to influence the scope and direction of changes in the field. While education is still an important goal today, the lack of assurance of standardization among the many educational offerings presented around the country, including thoSe developed by APIC, is a real concern. The Association has tried to address this concern by establishing educational standards and producing a learning tool that is based on them. APiC will pre-
The
Ameri~en
Jouml
issue. It i&s poMons
of Infe~#on
#deble
offers a dassitied advertisingsection in each desired. Rates for atwoun~ of 30 words and #8.OO for tbme or more im. Eech additional Control
word is $1.20 and $1.05, resptaetlveiy.Thereisa$B,QO~forboxserviceforthefirst insertion only. Payment must amy insertion orders. !3emJ cragsif@ ads to the Journal Adverlislng I3rqmtmant, AnMoan Journal d tnfedon Contvol, The C. V. Mosby Company, 11830
Westthe
hdu8thl
Drive,
St. Louis
MO
of
sent educational programs that adhere to those standards. Today the goal of improved communication among members is met by the American Journal of Infection Control, Chapter Update, and APIC News. For APIC to continue to survive and grow, members must be actively involmved in the organization. Among the various methods of involvement, one of the most important is to contact the elected APIC leaders, providing~ them with input on vital issues and making certain that they are responsive and responsible to the membership. Other methods include seeking and holding local and national offices, participating on national committees, and expressing opinions by voting in AFIC elections. Tab-le 3 shows a regional breakdown of membership voting records for the 1982 election. Since the margin of victory for some of the various contested positions was as narrow as O.% of the votes cast, it is obvious that each vote has the potential for exerting a profound impact on the outcome. A final method of involvement is to continue self-education through participation in APIC educational programs such as workshops, seminars, and conferences, in&ding the Annual Educational Conference. One look at the membership growth curve (Fig. 1) shows clearly that the “honeymoon” may indeed be over. The unbridled influx of new members that typified the early years of APIC’s history seems to have ended. Apparently APIC now, like any other organization or institution in these difficult economic times, must aggressively compete for the loyalty of the ers and for their professional, personal, and financial support. APIC’s future will be much affected by how adept it is in forecasting and “marching in tune” with the changes and trends in the field of infection control.
and m
or less are [email protected] for one inrsertkrn
Journal CONTROL
63146.