Prevention of Infections Through Appropriate Staffing (PITAS)

Project Summary: Prevention of Infections Through Appropriate Staffing (PITAS) Study Nationally, healthcare-associated infections (HAIs) are a costly patient safety concern in acute care hospitals. Infection Preventionists (IPs) and infection prevention and control (IPC) departments play an integral role in implementing evidence-based policies and procedures to prevent, mitigate and control HAIs. However, evidence describing and validating appropriate IP staffing is lacking. In addition, the COVID-19 pandemic has placed an enormous strain on the healthcare system. Emerging evidence suggests that the pandemic has resulted in increased rates of HAI in the acute care setting. However, the impact of the pandemic on IPC departments, including staffing and resources, and on routine IPC activities is unknown. We designed a unique and innovative study to determine how IPC departments have responded to the pandemic and the effectiveness of IPC infrastructure and processes in preventing HAIs. Guided by Donabedian's framework of quality, we propose a 3-year mixed method study to: 1) Describe the evolution of IPC programs from 2011 to 2019 and determine the effectiveness of IPC staffing, infrastructure and processes in preventing HAI in acute care hospitals; 2) Quantify the impact of the COVID-19 pandemic on infection prevention and control departments, HAI rates and rates of antibiotic resistance in acute care hospitals; and 3) Develop an in-depth understanding of the impact of COVID-19 on infection preventionists, IPC resources and practices in acute care hospitals. In Aim 1, building upon our previous work, we will link hospital surveys to longitudinal National Healthcare Safety Network (NHSN) HAI and staffing data (2011-2019) to examine effectiveness of IPC staffing, infrastructure and processes on reducing HAI. In Aim 2, we will conduct a national survey of U.S. hospitals and link the survey to NHSN (2011-2022) and CMS data (2018-2022) to examine the impact of COVID-19. In Aim 3, we will conduct interviews with personnel involved in infection prevention and control in 20 hospitals. In our earlier federally-funded work, using a longitudinal sample of NHSN hospitals, we found that high clinician compliance with bundled care and positive organizational climate were associated with lower HAI rates in ICUs. We now propose to develop a more comprehensive examination of the impact of IPC staffing on HAI rates by expanding the analysis beyond the ICU and including other types of HAI. We will also evaluate the impact of the COVID-19 pandemic on IPC staffing and infrastructure, which is an area previously not studied. As Early Stage and New Investigators, we represent the epitome of interdisciplinary and intercollegiate research. We have designed an innovative study that builds upon our established relationship with internationally-renown researchers and NHSN hospitals, refines psychometrically sound instruments, and fills an important gap in the evidence. The results of this study will provide the evidence to strengthen IPC capacity and preparedness in acute care hospitals to more effectively respond to future infectious disease crisis.