Strengthening Local Health Departments: The Impact of Certification in Infection Control

Infection prevention and control (IPC) is a cornerstone of public health, especially in the context of emerging infectious diseases and emergencies. Local health departments are vital in managing IPC efforts, yet many struggle to ensure staff have the specialized skills needed, particularly in healthcare settings. Recognizing this gap, the National Association of County and City Health Officials (NACCHO) has supported Certification in Infection Control (CIC) scholarships. The CIC® examination, offered by the Certification Board of Infection Control and Epidemiology, Inc. is the standardized measure of the basic knowledge, skills, and abilities expected of professionals working in the field of infection prevention and control. Since 2023, NACCHO has funded hundreds of local health departments for exam fees, study materials, and professional development resources, with the understanding that certifying staff enhances both individual expertise and organizational effectiveness. In 2023, 164 local health departments were awarded scholarships, and in 2024, 111 local health departments were awarded. To assess the impact of CIC, NACCHO surveyed local health department staff recipients and discovered that obtaining the certification is crucial for enhancing professional capabilities and improving local health departments’ ability to prevent and manage infectious diseases in healthcare settings. The certification is not just an individual milestone; it is a strategic investment in public health infrastructure. It empowers local health department staff by boosting their credibility and confidence, fostering stronger collaboration with healthcare facilities, and ensuring they have the latest knowledge and best practices in IPC. The certification strengthens public health capacity at the local level, contributing to better health outcomes and more resilient public health systems. Methods Each year, CIC scholarship recipients completed a post-assessment survey. In 2023, 275 responses from recipients were received, representing 164 awarded health departments. In 2024, 68 of 105 participants (65%) completed the survey. The 26-item survey included questions on participants’ experience with the exam preparation and pass rates, perceived benefits, grant administration, and future needs. Descriptive statistics were completed using Microsoft Excel. Focus groups were conducted in 2024 with volunteers from survey respondents. Participants were grouped by occupation: epidemiologists (four attendees of 11 invited), public health nurses (three attendees of 12 invited), and infectious disease/other staff (seven attendees of 8 invited). Transcripts were coded thematically based on evaluation goals. Themes observed in at least two groups are included below. Findings Professional motivations for pursuing CIC Participants pursued CIC to deepen IPC knowledge, boost confidence, and enhance professional credibility. Whether as a refresher or a way to formalize expertise, the CIC aligned with professional goals for career advancement (see Figure 1). For experienced professionals, earning the CIC provided a sense of accomplishment, pride, and validation after years of experience in the field. For those newer to IPC, the certification supported their transition from COVID-focused response to a broader understanding of infection and prevention control.Figure 1: Motivations for Taking the Exam (2024 Survey). This figure is available in color online (www.JPHMP.com). Participants pursued certification to strengthen their capacity to train and mentor new public health staff, including interns and early-career professionals. The certification served as a tool to ensure continuity of infection prevention expertise when key staff transitioned out of their roles. Local health department staff reported feeling better equipped to support public health nursing teams in daily tasks and professional development. In most cases, leadership, such as directors of nursing, encouraged staff to pursue CIC to improve team expertise in infection control. Enhancing professional credibility and collaboration with healthcare and state partners Local health department staff were perceived as more credible and competent regarding policies and recommendations because clinical staff recognized what it takes to get certified. Healthcare facility staff familiar with CIC were aware of the effort and expertise needed to earn the certification and immediately recognized the accomplishment of local health department staff. Participants noted that this recognition strengthened relationships and allowed for greater influence in healthcare settings when providing recommendations and speaking with healthcare leadership. The certification made less of an impact with long-term healthcare facilities and similar settings where staff were not as familiar with the CIC. Survey respondents also anticipated enhanced credibility (2023: 79%/2024: 89%) and stronger relationships with other professionals (2023: 73%/2024: 90%) as well as improved ability to implement infection prevention and control activities (2023: 79%/2024: 84%) (see Figure 2).Figure 2: Anticipated Benefit for Health Department. This figure is available in color online (www.JPHMP.com). Epidemiology staff at state health departments and certified staff at local health departments now have streamlined conversations and have built trust. Local health departments with staff certified in infection control have fewer clarification questions about labs or state health department recommendations during an outbreak response or case investigation, which keeps everyone focused on the response. Certified local health department staff also felt that their state counterparts viewed them as having more expertise and were trusted to manage IPC in their own jurisdictions, allowing state resources to be focused on other areas that did not have the same capacity. Improving infectious disease prevention and mitigation The CIC exam equipped local health department staff (eg, epidemiologists and public health nurses) with terminology and best practices which improved the overall efficiency of their work. Having a shared language with clinical staff made conversations clearer, more efficient, and easier to have with fewer explanations required and less second-guessing of local health department staff expertise. The certification strengthened outbreak response, disease prevention, and interdisciplinary communication, particularly between epidemiologists, nurses, and healthcare providers. Certified local health department staff also spent less time researching recommendations or needing to search for reliable information because they knew the trusted sources and standard recommendations. For example, participants noted higher confidence making recommendations about cleaning supplies that prevent and mitigate the spread of specific bacteria. They also discussed confidence reading and interpreting lab results. A substantial portion of survey respondents also noted they anticipated feeling more confident in their infection prevention work (2023: 90%/2024: 94%) and having increased knowledge (2023: 85%/2024: 96%) (see Figure 3).Figure 3: Anticipated Benefit for Individual. This figure is available in color online (www.JPHMP.com). Becoming certified also allowed local health department staff to provide more comprehensive recommendations that better account for the procedures and constraints faced by healthcare facilities. Local health departments and healthcare facilities often have different priorities and operational barriers, and through the CIC process, local health department staff became more attuned to these challenges. As a result, certified local health department staff were better equipped to frame their recommendations with practical day-to-day implementation in mind, rather than relying on general textbook answers. This improvement has enhanced communication with both clinical and non-clinical staff, ensuring that recommendations are not only more relevant, but also more actionable. Conclusion As infectious disease threats continue to evolve, strengthening the local public health workforce remains critical. The CIC credential has proven to be a valuable tool for enhancing IPC capacity, and NACCHO’s scholarship program has helped expand access to certification. From building individual confidence and professional credibility to improving organizational efficiency and healthcare collaboration, the impact of certification extends beyond the individual. Certified staff are better equipped to provide evidence-based recommendations and serve as trusted IPC resources within their communities. While the scholarship program reduced barriers by covering exam costs and study materials, staff still faced challenges, including limited support for dedicated study time and access to resources. Some participants noted a lack of institutional backing, and in one case, certification created internal concerns about staff leaving. Without NACCHO’s support, many would not have had the opportunity to pursue certification at all – underscoring the need for ongoing investment in workforce development. This initiative demonstrated that if local health department leadership prioritizes staff development, it strengthens individual capabilities, enhances organizational capacity, and improves community health. Certified staff are better equipped to lead IPC efforts, build trust with healthcare partners, and respond swiftly and effectively to infectious disease threats – translating to more coordinated outbreak responses, stronger healthcare collaboration, and improved infection control practices. The findings from this evaluation emphasize the importance of support for training, resources, and certification pathways that empower the frontline public health workforce to protect the health of the communities they serve. Call to Action Local health department leadership should promote certification by including institutional support for staff to have exam preparation time, provide financial assistance, and encourage the use of peer study networks. A supportive workplace culture – where leaders champion professional development – can help ensure that local health departments continue to build strong, resilient teams capable of managing complex IPC needs. NACCHO offers recommended study resources and advocacy materials to help make the case for certification at https://bit.ly/cicresources.