The Role of Infection Prevention Department Structure in Maintaining Program Resiliency

BACKGROUND: Infection Prevention (IP) department structures vary in how responsibilities are assigned. During the COVID-19 pandemic IP program workload significantly increased and healthcare-associated infections (HAI) performance declined. This study assessed whether department structures that reassign administrative tasks away from hospital-based IPs are able to recover quickly from the effects of increased program demand and hospital surge. METHODS: The IP department structure of a 13-hospital system was modified in March 2020 with the creation of a centralized surveillance (CS) team. The CS team was assigned responsibility for communicable disease reporting, healthcare associated infection (HAI) surveillance, and maintenance of HAI-specific line listings. Line listing data entry included electronic health record review for potential performance improvement (PI) opportunities. Hospital-based IPs remained responsible for site-based functions. PI efforts were initiated during 2020 targeting abdominal hysterectomy (HYST), Clostridoides difficile (CDI) and catheter-associated urinary tract infection (CAUTI) using data gathered by the CS team both during and between surges of COVID-19. RESULTS: The standardized infection ratio (SIR) of HAIs where PI efforts were initiated were compared from 2019 to 2021 to assess department resilience during periods of increased program demand. The CAUTI SIR decreased from 1.02 in 2019 to 0.485 in 2021. (p = 0.001). The CDI SIR decreased from 0.683 in 2019 to 0.457 in 2021. (p = 0.003). The HYST SIR decreased from 1.483 in 2019 to 0.00 in 2021. (p = 0.005). There was no statistical difference in central line-associated bloodstream infection (CLABSI) or methicillin-resistant Staphylococcus aureus (MRSA) performance from 2019 to 2021. CONCLUSIONS: IP program structure can create resiliency during periods of increased IP program demand. Decoupling surveillance and administrative tasks from hospital-based IPs is one approach hospitals and healthcare systems can consider helping ensure critical performance improvement activities continue regardless of demands within hospitals.