Advancing the Practice of Infection Preventionists: Development of a Competency – Based Professional
Development Program using the APIC Competency Model
Heather L. Bernard, DNP, RN, CIC, FAPIC
June 16, 2017
Objectives• Discuss the Burden of Healthcare Associated Infection’s
• Describe the Stressors on Infection Prevention Departments
• Outline the Evolution of Infection Prevention
• Describe Evidence Based Practices to Enhance Competency
• Discuss MVHS Infection Prevention Department Structure & Characteristics
• Describe the Steps of Development and Implementation of Professional Development Program
• Describe the Progress of IP Program Since Implementation
Burden of Healthcare Associated Infections (HAI’s)
2011 HICPAC Multi –State Prevalence Study -
183 Hospitals (26)
(25)
Conclusions: • 722,000 HAI’s• 75,000 Deaths• > ½ HAI’s – not in Critical
Care• 1/25 inpatients with HAI
(25)
Recommendations: • Shift Focus: • Expand to Other HAI’s • Non – Device Associated • Procedure Related
Infections • Areas Outside of Critical
Care(25)
Stressors on Infection Prevention Departments
Mandatory Reporting (29) Multiple Responsibilities (10)
Limited Formal Training (1, 17, 23,
33)
Multiple Recurring Challenges (10)
Limited Certification (1, 17, 23, 33) Reliance on Behavior Change (1)
Department Resources (1) Varying Backgrounds (29)
Surveillance Bias (29) Varying Experience (29)
Limited Succession Planning (1)
Vacant Positions (33)
Policy Stressors
• Public Report Cards
• Public Reporting Requirements
• Federal Laws: • Pay for Performance (24)
• Hospital Acquired Conditions/Value Based Purchasing Requirements (24)
• HAI National Action Plan (18)
• Antibiotic Stewardship Executive Order (34)
Time for Change
• Outcomes improve with competent IP’s (7, 21, 32, 31)
• IP’s must practice within their defined roles and responsibilities
• Communicate what those roles and responsibilities are to health care leaders – role clarity is a necessity!!!
Evolution of the Infection Preventionist
•Professional & Practice Standards (23)
1999
•APIC Strategic Plan (28)
2007•Professional &
Practice Standards (17)
2008
•CBIC Practice Analysis Survey (12)
2009 •APIC Competency Model (29)
2012
•CBIC Practice Analysis Survey (22)
2015•Professional
and Practice Standards (5)
2016
(30)(29)
Evidence – Based Practice: Enhance Competency
• Certification in a Specialty Area
• Core Competencies (10)
• Certification in Infection Control and Epidemiology (CIC) (9, 31, 21, 32, 8, 11, 14)
• Individual Learning Plans (29)
• Competency Models (29)
• Continuous Professional Development (4)
Processes Shown to Enhance Professional Development
• Standardized Approach to Orientation (23)
• Consistent Training (23)
• Job Descriptions (26)
• Professional Portfolio (2, 8, 10)
• Competency – Based Performance Evaluation Process (30)
• Professional and Practice Standards (7)
Mohawk Valley Health System Project Site
(16)
Mohawk Valley Health System Project Site
2 Acute Care
Hospitals –570 Beds
Long Term Care – 202
Beds
Primary Care – 40 Clinics
Dialysis Program
Inpatient Rehabilitation
Facility
Oncology Program
Home Care Program
(16)
MVHS IP Program Structure – Under Quality
Infection Prevention Officer, ID MD
Director of Infection Prevention: 13 Years, BS, RN, CIC
Infection Preventionist: 2.5 Years, BS, RN
Infection Preventionist: 2.5 Years, BS, RN
Infection Preventionist: 3 Years, ASN
Infection Preventionist: 1 Years, MSN, RN
Infection Preventionist: 1.5 Years, MPH, RN
Infection Preventionist: 0.5 Years, BS, RN
Infection Preventionist: 13 Years, BS, RN
2015 Director Proposal: As a Condition of Employment in IP
Require CIC 3rd year in IP
Baccalaureate Degree
Accepted & Implemented
June 2015
Gap Analysis of Current Professional Development Tools
• 7 Infection Preventionists at Health System Project Site
• Compared their current daily workflow to currentJob Description & Performance Evaluation
• Time Period: 10 business days
• Review of current tools against CBIC core competencies, Professional & Practice Standards, & APIC Competency Model
Current Job Descriptions and Performance Evaluation
Project Goal: Professional Development Program for IP Department guided by the APIC Competency Model
Project Objectives
1. Validate the Career Stages within the Model
2. Develop a Crosswalk of the CBIC Core Competencies, the Professional and Practice Standards, and the APIC Competency Model
3. Develop a Job Description Aligned with the APIC Competency Model
4. Implement a Professional Portfolio Program as Part of the Performance Appraisal Process
5. Develop a Performance Evaluation Process based on the Job Description Outlining Competencies in Each Level of Practice
6. Develop a Toolkit for Managers in Order to Ensure Sustainability of the Project
PERFORMANCE DEVELOPMENT PROGRAM FOR
INFECTION PREVENTIONISTS:
Steps of Development
Validate the ModelDoes the APIC Competency Model Differentiate between the Novice and More Advanced Career Stages of the Infection Preventionist?
(3)
IPAC Canada Novice Self Assessment Tool (21)
(19)
Included Demographics
Sex Years in IP
State of Employment Age
Highest Degree Specialty/Background
Certification Status Years in Healthcare
Purpose of Survey: Assess IP’s self assessed
competency to determine if the tool and core competencies used in the APIC Competency Model
differentiate between the novice and more advanced career stages
of Infection Prevention
(3)
Survey Participant Details
(3)
Demographic Characteristics of Survey Participants
COUNT %
Education_RC Less than
Bachelor's degree
14 12.60%
Bachelor's degree 59 53.20%
Graduate degree 38 34.20%
Background Nursing 70 66.00%
Not nursing 36 34.00%
Years in IP <= 2 years 24 21.60%
3-5 years 17 15.30%
> 5 years 70 63.10%
Certification Status
Yes 63 57.80%
No 46 42.20%
Survey Findings (3)
IP Employment Length and Self-Assessed Competency: Total Score on Survey
P < .001
IP Employment Length and Self-Assessed Competency
in Each 6 Sections of Survey
P < .001P < .001P < .001P < .001P < .001P < .001
Comparison of Nurses to Non-Nurses on Self Assessed Competency: Total Score on Survey
P .02
Comparison of Nurses to Non-Nurses on Self Assessed Competency in Each 6 Sections of Survey
P .28P .09P .04P .11P .001P .003
Education Level and Self Assessed Competency: Total Score
P .004
Education Level and Self Assessed Competency in Each 6 Sections of Survey
P .08P .02P .051P .008P .004P < .001
Overall Self Assessed Competency By Demographics
N Mean (SD) SD p
Field .02
Nursing 67 123.92 31.20
Non-Nursing 36 140.05 32.20
Education .004
Less than a Bachelor’s Degree 14 115.07 36.92
Bachelor’s Degree 58 125.38 31.36
Graduate Degree 35 144.08 27.06
IP Certification <.001
Yes 60 148.57 20.69
No 45 106.59 28.71
Employment Length <.001
<= 2 Years 24 91.68 24.34
3-5 Years 16 116.63 21.91
>5 Years 67 147.16 21.79
Note: N=103. Significance determined using an ANOVA.
Crosswalk Analysis
AP
IC C
om
pete
ncy M
od
el
Gap Analysis Results
CBIC Core Competencies (8)
Identification of Infectious Disease Process
Surveillance & Epidemiologic Investigation
Preventing/Controlling the Transmission of Infection
Employee/Occupational Health
Management & Communication
Education & Research
Environment of Care
Cleaning/Sterilization/Disinfection/Asepsis
Practice Standards (12)
Infection Prevention & Control
Surveillance
Epidemiology
Consultation
Occupational Health
Program Administration and Evaluation
Fiscal Responsibility
Performance Improvement
Research
Education
APIC Model Future Oriented Domains/Suggested Career Stage Competencies (29)
Leadership & Program Management
Infection Prevention and Control
Technology
Performance Improvement & Implementation Science
Novice, Proficient, & Expert suggested competencies
Competency Based Job Description
DevelopmentNovice, Proficient, & Expert
Final Job Description - Novice
• Minimum Education/Licensure: Baccalaureate Degree in a Health Related Field (Nursing, Microbiology, Public Health, Medical Technologist)
• Supervisor: Director of Infection Prevention
• Minimum Yrs. Experience: at least 3 years in health related field as described above
Novice Major Responsibilities (partial):
Incorporates infection prevention activities that are specific to the practice setting.
Conducts surveillance for healthcare associated infections aimed at improving safety and quality of care.
Applies epidemiologic principles to conduct surveillance through basic case finding methods.
Utilizes basic information technology and systems applications.
Interprets diagnostic and laboratory reports, and differentiates between colonization, infection, and contamination.
Job Description – Proficient
• Minimum Education/Licensure: Baccalaureate Degree in a Health Related Field (Nursing, Microbiology, Public Health, Medical Technologist); Certified in Infection Control and Epidemiology (CIC) by the Certification Board of Infection Control and Epidemiology (CBIC)
• Supervisor: Director of Infection Prevention
• Minimum Yrs. Experience: 2 years in Infection Prevention
Proficient Major Responsibilities:
(All Level 1 - Novice Major Responsibilities Plus) (Partial)
Applies epidemiologic principles and statistical methods to analyze trends and evaluate processes.
Conducts surveillance and epidemiologic investigations to monitor the effectiveness of prevention and control strategies.
Evaluates significance of findings and makes recommendations.
Performs electronic surveillance and integrates findings for comprehensive reporting.
Regularly uses NHSN surveillance and may validate surveillance conducted by others.
Job Description – Expert
• Minimum Education/Licensure: Minimum Education/Licensure: Post - Baccalaureate Education/Graduate Degree in a Health Related Field (Nursing, Microbiology, Public Health, Medical Technologist); Certified in Infection Control and Epidemiology (CIC) by the Certification Board of Infection Control and Epidemiology (CBIC)
• Supervisor: Director of Infection Prevention
• Minimum Yrs. Experience: >5 years in Infection Prevention
Expert Major Responsibilities:
(All Proficient Major Responsibilities Plus) (Partial)
Serves as the champion for a safety culture
Mentors and develops Infection Preventionists
Directs the organization’s infection prevention and control improvement activities.
Serves as the Co-Chair to the Infection Prevention Committee.
Drives change through the use of situational awareness and verbal and written communication skills and influence and persuasion.
Exhibits strong critical thinking skills and a willingness to challenge the status quo and consider alternative perspectives.
For the Infection Preventionist
Professional Portfolio (2, 6, 9)
Effective tool used to promote competency• Assists in keeping knowledge, skills, and
competence up–to–date in the profession• Ensure ongoing tracking of progress towards
goals • Provide validation of professional growths and
development • Increase satisfaction • Improve recognition of the profession• Demonstrates professional development
Examples of Documents that are included in the Professional Development Portfolio
Professional Development Program Supporting Documents
Competency checklists
Individualized education plan
Certificates of attendance for hospital-based inservice classes, nursing grand rounds, or unit based journal clubs
Presentation outlines and evaluations
Hospital/department committee work, such as agendas, meeting minutes, and a sample of the final project
National specialty certifications (CBIC)
Publications
Project work such as policy and procedure development, critical pathway development, or research projects
Outcomes studies and data
Quality Improvement Projects
Performance Evaluation Development
Novice, Proficient, & Expert
Performance Evaluation Rating Scale
Instructions for Completing Performance Evaluation
Novice – Performance Evaluation
Proficient – Performance Evaluation
Additional Performance Steps included in the Appraisal Review
Summary of Accomplishments throughout the Appraisal Period
Individual Professional Development Plan Based onEvaluation Scoring - <2 required to be on plan
Career Stage and Certification Review
Consistent Scoring of 4 – 5 in a majority of the Behavioral Statement Required to Advance
Professional Development Plan
Toolkit – Consistent Application of Professional Development Program (4, 30)
• Assist the program director in the appraisal process• Ensure sustained application of the process• Ensure consistent ongoing appraisals• Contains:
• Professional Development Resources • Guides for Completing Appraisals • Guideline for writing performance goals • Examples of behavior expectations • Certification information
IP Manager’s Professional Development Toolkit Job Descriptions Orientation Checklist
Performance Evaluations Annual competency Lists
Sample Professional Development Plan
Instructions for Updating Job Descriptions/ Performance Evaluations
CBIC Core Competencies Qualifications for Novice, Proficient, and Expert
IP Professional and Practice Standards
Instructions for Completing the Performance Evaluation
APIC Competency Model Instructions for Developing Performance Development Plan
Novice Roadmap Example of Documents to include in the Portfolio
IPAC Self Assessment Case Study of Interventions at each Career Stage
APIC Self Assessment CIC Resources
Final Presentation - Stakeholders
Present: CMQO, AVP Quality & Outcomes Management, AVP Human Resources, Infection Prevention Officer, 7 IP’s in Health System
Presented all Elements of Professional Development Program and Process Changes from Current Structure
Overall Acceptance and Agreement with the Program
Excitement and Motivation to Advance in Career
Implemented July 2016
Implications for Practice
Improving Professional Development of IP’s
Improve Infection Prevention Programs
Improve Patient Outcomes
Support IP Competency to Respond to Rapidly Evolving Healthcare System
Improved Job Satisfaction and Retention
Reduce HAI’s
Improvements in Pay for Performance Measures
Current MVHS IP Progress
Infection Prevention Officer, ID MD
Director of Infection Prevention: 14 Years, DNP, RN, CIC, FAPIC
Infection Preventionist: 4.5 Years, BS, RN, CIC 12/15
Infection Preventionist: 4.5 Years, BS, RN, CIC 12/15 – Pursuing MSN IP
Infection Preventionist: 5 Years, ASN, CIC 12/15– Pursuing BSN
Infection Preventionist: 3 Years, MSN, RN, CIC 6/16 – Pursuing DNP PIPES
Infection Preventionist: 3.5 Years, MPH, RN CIC 10/16
Infection Preventionist: 2.5 Years, BS, RN
Infection Preventionist: 1 Years, BS, RN– Pursuing MSN
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