Elevating infection prevention programs

Since 1986, hospitals have been required to comply with regulations for infection prevention and control (IPC) as a condition of participation from the Centers for Medicare & Medicaid Services (CMS), requirements that have evolved through multiple rulemaking and administrative refinements over time, including expansion to other healthcare facility types.CMS's condition of participation (CoP) for IPC notes the expectation that acute care hospitals " : : : must have active hospital-wide programs for the surveillance, prevention and control of healthcareassociated infections (HAIs) and other infectious diseases, and for the optimization of antibiotic use through stewardship."(42 CFR 482.42.)The interpretative guidance for implementing the CoP provides some parameters for determining what is an "active" IPC program; however, there is significant variability in IPC practice in healthcare facilities across the U.S.In addition, IPC programs are now threatened with major workforce challenges.With approximately 40% of the infection preventionist workforce eligible to retire within the next 10 years and a shrinking population of physicians who are choosing to specialize in infectious diseases, we are at a critical crossroads where inadequate staffing will not only strain healthcare organization IPC programs, but place patients in harm's way for greater risk of infection.Under workforce shortage conditions, the definition of an "active" IPC program has the potential to be relegated to the bare minimum of what is required to qualify for CMS CoP.APIC and SHEA believe that striving for what is minimally required under federal regulation is antithetical to our societies' collective goals of reducing preventable harms and improving the quality of care in the U.S. healthcare system.Inadequate staffing and resources also risk efforts to achieve our national goals in the United States to reduce HAIs (https://www.hhs.gov/oidp/topics/health-careassociated-infections/hai-action-plan/index.html) which are part of a larger global effort to prioritize IPC programs to ensure that they are staffed with trained and experienced experts.We cannot advance our collective goals for harm reduction and quality improvement without elevating expectations for IPC programs to strive to be effective and not merely "active."Raising this bar can only be achieved through investments that recognize IPC programs adequately supported by qualified teams as foundational to healthcare facility infrastructure.