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Survey of infection control training program graduates: Long-term care facility and small hospital practitioners
practice forum
Survey of infection control training program graduates: Long-term care facility and small hospital practitioners Philip W. Smith, MD Virginia Helget, RN Dorothy Sonksen, RN Omaha, Nebraska
Graduates of a 2-day basic training course in infection control were surveyed. Respondents were generally from Midwestern long-term care facilities and small hospitals. These infection control practitioners had multiple roles in addition to infection control, most notably employee health and quality assurance. Infection control practitioners demonstrated significant job stability. The vast majority of institutions where survey respondents were employed followed recommended infection control practices. (Am J Infect Control 2002;30:311-3.)
In 1985, the Nebraska Infection Control Network developed an intensive 2-day infection control training program designed to provide regionally available training for infection control practitioners (ICPs). Approximately 1000 trainees have taken the course since 1985. We conducted a survey of course graduates regarding the value and relevance of the course and certain aspects of their ICP roles. Applicable results were compared with those in a previously published survey of course graduates.1
METHODS We were able to contact 639 of the approximately 1000 course graduates, and questionnaires were sent to all of these individuals. In the questionnaire, From the Nebraska Infection Control Network and University of Nebraska Medical Center. Reprint requests: Phillip W. Smith, 985400 Nebraska Medical Center, Omaha, NE 68198-5400. Copyright © 2002 by the Association for Professionals in Infection Control and Epidemiology, Inc. 0196-6553/2002/$35.00 + 0 17/49/122437 doi:10.1067/mic.2002.122437
we requested an assessment of the benefit of the course generally and specific course modules. We also asked a number of demographic questions regarding the role of respondents in infection control, including whether they were still active in infection control and whether they had changed institutions since completing the course, and a number of questions regarding institutional infection control practices.
RESULTS Twenty-two percent (142 of 639) of the course graduates we contacted responded to the survey. The following are the number of attendees who returned the questionnaire and the year they took the course: 1 (1987), 2 (1989), 1 (1990), 1 (1991), 4 (1992), 1 (1995), 5 (1996), 16 (1997), 21 (1998), 37 (1999), 38 (2000), and 15 (2001). There were 94 long-term care facility (LTCF) respondents (66%) and 48 small hospital respondents (34%). The median number of beds in the LTCF response group was 68 (range, 12 to 404), whereas the median number of beds in the hospital group was 25 (range, 12 to 400). ICPs tended to have multiple roles. In fact, only 2% reported doing exclusively infection control. The 311
Smith, Helget, and Sonksen
312 Vol. 30 No. 5 Table 1. Leading additional roles for ICPs LTCFs (n = 94) Quality assurance Employee health Staff nursing Administration Staff development Safety Inservice coordinator Minimum data set coordinator
Table 2. Infection control practices
Small hospitals (n = 48)
61 48 43 31 9 8
(65%) (51%) (46%) (33%) (10%) (9%)
8 (9%) 8 (9%)
Employee health Quality assurance Staff nursing Administration Staff education Operating room nurse Risk management
37 21 14 14 9 8
(77%) (43%) (29%) (29%) (19%) (17%)
7 (15%)
median number of other roles was 2.9 for both the LTCF and the small hospital groups. The most common additional duties overall were employee health (60%), quality assurance (58%), staff nursing (40%), and administration (32%). The leading additional roles for LTCF and small hospital ICPs are noted in Table 1. Other duties noted included wound care nursing, safety, utilization review, director of nursing, charge nursing, worker’s compensation, and medical technology. When asked whether they were still active in their field, 96% of the course respondents stated that they were still in infection control and had been in their current positions for a mean of 4.5 years. We asked respondents about the usefulness of specific course lectures on their roles as ICPs. The most useful sessions were on surveillance/data analysis (65%), resistant organisms (64%), isolation/Standard Precautions (63%), antibiotic overview (59%), components of an infection control program (57%), regulations (53%), employee health (52%), and policies/ procedures (50%). We assessed self-reported infection control practices, as shown Table 2. We also compared the prevalence of infection control practices with our previous survey of Midwest LTCFs from 1986 to 1990 (see Table 2).
DISCUSSION Education is a critical element for both hospital2 and LTCF3 infection control programs. Surveys have demonstrated variable training opportunities and a need for training programs in infection control,
Practice
Small LTCFs LTCFs hospitals 1986-1990 2001 2001
Perform infection surveillance Use infection definitions Calculate infection rates Give employees influenza vaccine Give employees tuberculosis skin tests Give patients/residents influenza vaccine Give patients/residents pneumococcal vaccine Give patients/residents tuberculosis skin tests
72% 52% 23% 46% 54%
97% 92% 94% 98% 100%
100% 98% 87% 98% 100%
77%
98%
80%
47%
91%
67%
25%
94%
76%
especially for those in LTCFs.4,5 The Nebraska Infection Control Network training program was previously studied and found to effectively transmit knowledge that led to improvement in infection control practices.1,4 These improvements continued throughout the 1-year study period. The ratio of small hospital respondents was 2:1. Respondents believed that the course was helpful in their role as ICP, especially the training modules on surveillance, resistant organisms, isolation, antibiotics, and components of a program. In a field that is believed to have a significant turnover rate, it is interesting that a vast majority (96%) of the ICPs were still involved in infection control and that only 6% had changed institutions since taking the course. The average number of years at the current institution was 4.5. As might be expected at small institutions (median beds 68 for LTCFs and 25 for hospitals), ICPs had many other roles in addition to infection control, most commonly employee health (60%), quality assurance (58%), staff nursing (46%), and administration (32%). The most common ancillary role in LTCFs was quality assurance (65%), whereas in small hospitals it was employee health 77%. Only 2% of respondents performed infection control exclusively. We also asked whether the institutions performed common infection control measures, and these are listed in Table 2. We compared the responses from the LTCF ICPs with the responses we obtained from Midwest LTCF course participants in our 1986 to 1990 survey of infection control practices.1 Both
August 2002 313
Smith, Helget, and Sonksen
groups were comparable (eg, ICP course attendees), although the lower response rate in this (unprompted) survey may introduce a bias toward better programs. In all categories, infection control practices improved. For both hospitals and LTCFs, employee tuberculosis skin testing showed the highest compliance and resident/patient pneumococcal vaccine the lowest. The improvement in standard infection control practice compliance is encouraging but not unexpected in view of the emphasis given to infection control in the LTCF setting in the last decade,6,7 including development of LTCF infection definitions, demographic studies of nosocomial infections in that setting, and publication of LTCF-specific infection control guidelines.
References 1. Daly PB, Smith PW, Rusnak PG, Jones MB, Giuliano D. Impact on knowledge and practice of a multiregional long-term care facility infection control training program. Am J Infect Control 1992;20:225-33. 2. Scheckler WE, Brimhall D, Buck AS, Farr BM, Friedman C, Garibaldi RA, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: a consensus panel report. Infect Control Hosp Epidemiol 1998;19:114-24. 3. Smith PW, Rusnak PG. Infection control guideline. Infection prevention and control in the long-term care facility.Am J Infect Control 1997;25:488-512. 4. Smith PW, Daly PB, Rusnak PG, Roccaforte JS. Design and dissemination of a multiregional long-term care infection control training program. Am J Infect Control 1992;20:275-7. 5. Leinbach RM, English AJ. Training needs of infection control professionals in long-term care facilities in Virginia. Am J Infect Control 1995;23:73-7. 6. Nicolle LE. Infection control in long-term care facilities. Clin Infect Dis 2000;31:752-6. 7. Smith PW. Nursing home infection control: a status report. Infect Control Hosp Epidemiol 1998;19:366-9.
Survey of infection control training program graduates: Long-term care facility and small hospital practitioners Philip W. Smith, MD Virginia Helget, RN Dorothy Sonksen, RN Omaha, Nebraska
Graduates of a 2-day basic training course in infection control were surveyed. Respondents were generally from Midwestern long-term care facilities and small hospitals. These infection control practitioners had multiple roles in addition to infection control, most notably employee health and quality assurance. Infection control practitioners demonstrated significant job stability. The vast majority of institutions where survey respondents were employed followed recommended infection control practices. (Am J Infect Control 2002;30:311-3.)
In 1985, the Nebraska Infection Control Network developed an intensive 2-day infection control training program designed to provide regionally available training for infection control practitioners (ICPs). Approximately 1000 trainees have taken the course since 1985. We conducted a survey of course graduates regarding the value and relevance of the course and certain aspects of their ICP roles. Applicable results were compared with those in a previously published survey of course graduates.1
METHODS We were able to contact 639 of the approximately 1000 course graduates, and questionnaires were sent to all of these individuals. In the questionnaire, From the Nebraska Infection Control Network and University of Nebraska Medical Center. Reprint requests: Phillip W. Smith, 985400 Nebraska Medical Center, Omaha, NE 68198-5400. Copyright © 2002 by the Association for Professionals in Infection Control and Epidemiology, Inc. 0196-6553/2002/$35.00 + 0 17/49/122437 doi:10.1067/mic.2002.122437
we requested an assessment of the benefit of the course generally and specific course modules. We also asked a number of demographic questions regarding the role of respondents in infection control, including whether they were still active in infection control and whether they had changed institutions since completing the course, and a number of questions regarding institutional infection control practices.
RESULTS Twenty-two percent (142 of 639) of the course graduates we contacted responded to the survey. The following are the number of attendees who returned the questionnaire and the year they took the course: 1 (1987), 2 (1989), 1 (1990), 1 (1991), 4 (1992), 1 (1995), 5 (1996), 16 (1997), 21 (1998), 37 (1999), 38 (2000), and 15 (2001). There were 94 long-term care facility (LTCF) respondents (66%) and 48 small hospital respondents (34%). The median number of beds in the LTCF response group was 68 (range, 12 to 404), whereas the median number of beds in the hospital group was 25 (range, 12 to 400). ICPs tended to have multiple roles. In fact, only 2% reported doing exclusively infection control. The 311
Smith, Helget, and Sonksen
312 Vol. 30 No. 5 Table 1. Leading additional roles for ICPs LTCFs (n = 94) Quality assurance Employee health Staff nursing Administration Staff development Safety Inservice coordinator Minimum data set coordinator
Table 2. Infection control practices
Small hospitals (n = 48)
61 48 43 31 9 8
(65%) (51%) (46%) (33%) (10%) (9%)
8 (9%) 8 (9%)
Employee health Quality assurance Staff nursing Administration Staff education Operating room nurse Risk management
37 21 14 14 9 8
(77%) (43%) (29%) (29%) (19%) (17%)
7 (15%)
median number of other roles was 2.9 for both the LTCF and the small hospital groups. The most common additional duties overall were employee health (60%), quality assurance (58%), staff nursing (40%), and administration (32%). The leading additional roles for LTCF and small hospital ICPs are noted in Table 1. Other duties noted included wound care nursing, safety, utilization review, director of nursing, charge nursing, worker’s compensation, and medical technology. When asked whether they were still active in their field, 96% of the course respondents stated that they were still in infection control and had been in their current positions for a mean of 4.5 years. We asked respondents about the usefulness of specific course lectures on their roles as ICPs. The most useful sessions were on surveillance/data analysis (65%), resistant organisms (64%), isolation/Standard Precautions (63%), antibiotic overview (59%), components of an infection control program (57%), regulations (53%), employee health (52%), and policies/ procedures (50%). We assessed self-reported infection control practices, as shown Table 2. We also compared the prevalence of infection control practices with our previous survey of Midwest LTCFs from 1986 to 1990 (see Table 2).
DISCUSSION Education is a critical element for both hospital2 and LTCF3 infection control programs. Surveys have demonstrated variable training opportunities and a need for training programs in infection control,
Practice
Small LTCFs LTCFs hospitals 1986-1990 2001 2001
Perform infection surveillance Use infection definitions Calculate infection rates Give employees influenza vaccine Give employees tuberculosis skin tests Give patients/residents influenza vaccine Give patients/residents pneumococcal vaccine Give patients/residents tuberculosis skin tests
72% 52% 23% 46% 54%
97% 92% 94% 98% 100%
100% 98% 87% 98% 100%
77%
98%
80%
47%
91%
67%
25%
94%
76%
especially for those in LTCFs.4,5 The Nebraska Infection Control Network training program was previously studied and found to effectively transmit knowledge that led to improvement in infection control practices.1,4 These improvements continued throughout the 1-year study period. The ratio of small hospital respondents was 2:1. Respondents believed that the course was helpful in their role as ICP, especially the training modules on surveillance, resistant organisms, isolation, antibiotics, and components of a program. In a field that is believed to have a significant turnover rate, it is interesting that a vast majority (96%) of the ICPs were still involved in infection control and that only 6% had changed institutions since taking the course. The average number of years at the current institution was 4.5. As might be expected at small institutions (median beds 68 for LTCFs and 25 for hospitals), ICPs had many other roles in addition to infection control, most commonly employee health (60%), quality assurance (58%), staff nursing (46%), and administration (32%). The most common ancillary role in LTCFs was quality assurance (65%), whereas in small hospitals it was employee health 77%. Only 2% of respondents performed infection control exclusively. We also asked whether the institutions performed common infection control measures, and these are listed in Table 2. We compared the responses from the LTCF ICPs with the responses we obtained from Midwest LTCF course participants in our 1986 to 1990 survey of infection control practices.1 Both
August 2002 313
Smith, Helget, and Sonksen
groups were comparable (eg, ICP course attendees), although the lower response rate in this (unprompted) survey may introduce a bias toward better programs. In all categories, infection control practices improved. For both hospitals and LTCFs, employee tuberculosis skin testing showed the highest compliance and resident/patient pneumococcal vaccine the lowest. The improvement in standard infection control practice compliance is encouraging but not unexpected in view of the emphasis given to infection control in the LTCF setting in the last decade,6,7 including development of LTCF infection definitions, demographic studies of nosocomial infections in that setting, and publication of LTCF-specific infection control guidelines.
References 1. Daly PB, Smith PW, Rusnak PG, Jones MB, Giuliano D. Impact on knowledge and practice of a multiregional long-term care facility infection control training program. Am J Infect Control 1992;20:225-33. 2. Scheckler WE, Brimhall D, Buck AS, Farr BM, Friedman C, Garibaldi RA, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: a consensus panel report. Infect Control Hosp Epidemiol 1998;19:114-24. 3. Smith PW, Rusnak PG. Infection control guideline. Infection prevention and control in the long-term care facility.Am J Infect Control 1997;25:488-512. 4. Smith PW, Daly PB, Rusnak PG, Roccaforte JS. Design and dissemination of a multiregional long-term care infection control training program. Am J Infect Control 1992;20:275-7. 5. Leinbach RM, English AJ. Training needs of infection control professionals in long-term care facilities in Virginia. Am J Infect Control 1995;23:73-7. 6. Nicolle LE. Infection control in long-term care facilities. Clin Infect Dis 2000;31:752-6. 7. Smith PW. Nursing home infection control: a status report. Infect Control Hosp Epidemiol 1998;19:366-9.