Sara M. Reese, PhD, MPH, CIC, FAPIC, is the system director of infection prevention for SCL Health System in Broomfield, Colorado, and is a member of 

Sara M. Reese, PhD, MPH, CIC, FAPIC

The role and responsibilities of infection preventionists (IPs) have changed over the past 75 years.

 Initially, this role was established following recognition of the need for surveillance of nosocomial infections in the 1950s.

 Early IPs were nurses experienced in bacteriology and infection surveillance and understood the importance of personal hygiene and environmental cleanliness in health care.

 Typical tasks for the early IP included creating infection lists, reviewing infections and mortality rates, being aware of any staphylococcal epidemics or penicillin failures, and knowing isolation protocols and education on infection control.

With the implementation of the CDC’s National Healthcare Safety Network (NHSN) and the founding in 1972 of the IPs’ professional organization, the Association for Professionals in Infection Control and Epidemiology (APIC), the “era of expansion” for infection prevention began.

 With the advances in medicine, patients were at higher risk of infection with the use of devices that resulted in breaking down a body’s defense with entry through the skin or the use of an artificial airway.

 IPs were called upon to perform research to identify ways to prevent infections for the most vulnerable patient populations, coupled with increasing surveillance responsibilities in all units instead of only intensive care units.

 IPs also began learning about how the environment plays a role in transmitting pathogens in health care and the importance of cleaning and disinfection.3 Additionally, data from the CDC’s Study on the Efficacy of Nosocomial Infection Control Project indicated a strong association between prevention efforts and a reduction of nosocomial infections, along with decreases in treatment and length of hospital stay.

 It also suggested that one-third of all nosocomial infections could be prevented if the facility employed a minimum of 1 full-time IP for 250 beds.

The 1980s, the “era of reaction and response,” brought new levels of responsibility to the field of infection prevention with both the AIDS epidemic and the emergence of antibiotic-resistant microbes.3 Up to this point, IPs were traditionally performing surveillance; educating staff on the importance of hygiene, cleaning, and disinfection; and being the subject matter experts on processes to prevent infections. However, AIDS presented a risk of infection to the health care workers caring for the patients, and health care leaned upon IPs to determine best practices to keep workers safe.

 With the emergence of methicillin-resistant 

, IPs needed to determine screening protocols for new and colonized patients, cohorted patients, decontamination of health care workers identified as carriers, environmental disinfection, restriction of antibiotics, use of isolation precautions, and handwashing policies.

The 1990s ended up being the “era of regulation” after The Joint Commission on the Accreditation of Health Care Organizations released a plan called Agenda for Change in 1987, which defined how an infection prevention program would be implemented.

 Additionally, guidelines directed at infection prevention programs were released, including isolation guidelines and guidelines for preventing and controlling nosocomial infections from the CDC and APIC’s guidelines on numerous topics such as hand washing and disinfection. Following the increased visibility and responsibilities of the IP in the regulation era, the University of Minnesota released the results from a study called the Delphi project, which stated that the ratio of IPs to beds should be 1:100.

Between 2000 and 2020, infection control evolved into infection prevention, a significant change for the field. With the regulatory requirements, the new guidelines, and novel technology, the field of infection prevention took on a whole new life by preventing infections instead of controlling them.

 By 2010, the national data requirements with NHSN were significant, and electronic medical records were becoming increasingly popular, making IPs the data experts who needed to understand statistics, analytics, and information technology.

 As the field changed, so did the individuals performing the job. No longer were IPs nurses at the end of their careers who were going to coast into retirement. IP job descriptions were broadened to include other professional backgrounds, including public health and laboratory. Based on a national survey in 2019, the professional background of the IP workforce consisted of 65% nursing, 12% public health, 11% laboratory, and 12% other backgrounds.

 Additionally, many entry-level IPs were younger, being a part of Generation X or millennials, forcing the field to evolve even more. The younger generation was more tech-savvy and data-focused.

The evolution of infection prevention was driven by a change in focus and responsibility over the past 20 years. IPs were expected to know a significant amount of information about the hospital, including construction in a health care setting, the impacts of positive and negative airflow in critical and semicritical spaces, cleaning and disinfection of instruments, high-level disinfection of semicritical instruments, the impact of the environment on transmission of pathogens, state and federal regulations, employee health and exposures, and of course the chain of infection. IPs were expected to implement evidence-based practices and understand all the latest guidelines and recommendations to prevent infections. With these increasing responsibilities within this role, the recommendation for IP to bed ratio decreased again to 1:69.

However, as infection prevention was becoming increasingly important in health care, the COVID-19 pandemic hit. The pandemic changed everything again in the field of infection prevention. IPs were suddenly thrown into the limelight as the experts, and instead of protecting the patients from the staff, they were developing protocols to protect the staff from the patients. Most traditional infection prevention practices were cast by the wayside, while IPs made decisions on the fly about what made the most sense during a chaotic time. Once the pandemic began to fade, the IPs were forced to refocus health care workers and remind them of life before COVID-19.

Now, as we enter the middle of the 2020s, the numerous responsibilities of the IP continue to change.

COVID-19 demonstrated the importance of infection prevention outside the acute care setting. IPs are needed in ambulatory clinics, dialysis centers, and day care and long-term care facilities, as well as on cruise ships. There are federal regulations on surveillance and infection prevention in long-term care facilities. Over 75 years ago, the IP’s role was that of a nurse identifying hospital-acquired infections, and it has evolved into being an expert on multiple subjects in multiple settings. Still, the goal will always remain the same—to prevent infections for vulnerable patients in a vulnerable setting.

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Articles


The role of infection preventionists (IPs) has evolved significantly over 75 years, from early surveillance of nosocomial infections to becoming data-driven experts navigating pandemics like COVID-19.

The Shifting Responsibilities of Infection Preventionists

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Certifications and additional training demonstrate a validation of knowledge and skills; increased marketability, earning potential, confidence, and academic performance; and competitive advantage. In findings from one study, 91% of hiring managers report that certifications are an important consideration when hiring.

 Certifications can validate mastery of specific skills, knowledge, and abilities, and recertifications can meet ongoing learning and practice requirements.

In today’s challenging health care environment, certifications and training provide numerous advantages to the organization, health care workers, and patients. Certification is a vehicle for hospitals to differentiate themselves from competitors.

 Employers benefit from certifications and additional training by contributing to an environment of professionalism and retention and enhancing applications for Magnet Recognition per the American Nurses Credentialing Center.

 Health care workers can validate their expert knowledge and skill and receive recognition, advancement, and a sense of accomplishment and achievement, and they have reported higher job satisfaction.

 Patients benefit from certifications with better clinical outcomes, decreased rates of infections, and decreased odds of mortality.

 Examples of health care certifications include Certified Patient Care Technician, Certified EKG Technician, Certified Phlebotomy Technician, Certified Pharmacy Technician, Trauma Certified Registered Nurse, Critical Care Clinical Nurse, and Certified in Infection Control (CIC).

The CIC is a nationally accredited certification for infection preventionists (IPs) that demonstrates competency in infection prevention and control and is the leading certification for IPs. The CIC tests 8 different competencies, including identification of infectious disease processes, surveillance and epidemiology, transmission of infection agents and hospital-acquired infections, employee and occupational health, management and communication, education and research, environment of care, and cleaning, disinfecting, and sterilization. There are numerous advantages to acquiring a CIC, including salary increase and enhanced participation in infection prevention collaboratives and evidence-based practices.

 Evidence has also suggested hospitals with certified IPs have lower infection rates.

 Results from one study found that IPs who are certified make an average annual salary of $85,911 compared with noncertified IPs, who make an average annual salary of $68,817.

The certification of IPs in health care settings represents the individual’s and their institution’s dedication and commitment to infection prevention and control practices. Additionally, acquiring a CIC increases the marketability of IPs in the job market. Results from one study found that at least 46% of IP job openings in the United States required a CIC.

 State legislation in many states now requires certified IPs in hospitals and long-term care facilities, which increases the marketability of a certified IP.

The Certification Board of Infection Control and Epidemiology (CBIC) also offers other certification options, including the Associate - Infection Prevention Control (a-IPC), which targets entry-level IPs or others who want to learn about infection control but do not wish to be an IP. The a-IPC measures basic IP knowledge. Additionally, the CBIC offers the Long-Term Care Certification in Infection Prevention, which addresses infection prevention practices in the long-term care setting. The CBIC is also developing an advanced certification in infection prevention and control that will focus on the outer circle of future-oriented competencies such as research, leadership, and professional stewardship in infection prevention.

As an IP, certification and additional training offer many benefits at the professional and facility level. The diverse field of infection prevention allows many certification and training opportunities that validate their expert knowledge and skills. Many IPs benefit from additional training in leadership, performance improvement, project development, project management, research methodology, and health care administration. Other certifications besides the CIC that experienced IPs can seek include Certified Industrial Hygienist, Certified Professional in Patient Safety, or Certified Professional in Healthcare Quality.

Along with professionals in fields requiring time to study for certifications and additional training, IPs struggle with doing their day jobs and studying. Additionally, many IPs are a few years removed from their academic careers, and their study skills may need to be improved. For any certification, partnering with others studying for the same examination or completing the same training course would be recommended. IPs will also be more successful if they have support from their leadership to spend time preparing for the examinations or taking additional training to improve their skills and knowledge. Using resources for the certification examinations is important. For example, the CBIC and the Association for Professionals in Infection Control and Epidemiology (APIC) have numerous study guides, resources, and access to study groups.

 The APIC also offers scholarships and mentorships to encourage and support IPs in certification.

Professionals, especially health care professionals, benefit from certifications and additional training. They validate expert knowledge and skills along with recognition, advancement, and a sense of confidence. IPs can use certifications and training to advance their practice and career and have multiple options in the diverse field.

1. The value of certification. Certiport. Accessed December 19, 2023. 

https://certiport.pearsonvue.com/About/The-value-of-certification.aspx

2. Certification benefits patients, employers, and nurses. Accessed December 19, 2023. 

https://www.aacn.org/certification/value-of-certification-resource-center/nurse-certification-benefits-patients-employers-and-nurses

3. ANCC Magnet Recognition Program. American Nurses Credentialing Center. Accessed December 19, 2023. 

https://www.nursingworld.org/organizational-programs/magnet/

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6. Knighton SC, Gilmartin HM, Reese SM. Factors affecting annual compensation and professional development support for infection preventionists: implications for recruitment and retention. 

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7. Certification Board of Infection Control and Epidemiology, Inc. Accessed December 19, 2023. 

8. Association for Professionals in Infection Control and Epidemiology. Accessed December 19, 2023. 

The field of health care has placed a great emphasis on infection prevention in recent years, making it imperative for professionals in this domain to obtain certifications and additional training. These credentials verify their expertise and enable them to gain access to better job prospects and higher earning potential.

Sara M. Reese, PhD, MPH, CIC, FAPIC

Articles

The Shifting Responsibilities of Infection Preventionists

The Benefits of Achieving Certifications and Training in the Field of Infection Prevention