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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