BACKGROUND: Consultative Infection Control Assessment and Response (ICAR) visits at Acute Care Hospitals (ACH), performed by the Tennessee Department of Health (TDH), found gaps in education in various areas of infection control. The ICAR results showed there is often no consistent competency validation, or auditing being performed. In order to determine the needs of Tennessee ACHs and provide the most useful resources to address these gaps, TDH created a survey about the infection control training and auditing practices in ACHs.
METHODS: TDH developed a survey on infection control training and competency for the following domains: hand hygiene, personal protective equipment (PPE), injection safety and environmental cleaning. Competency-based training was defined as the education of a process or skill with return demonstration under supervision. The survey was distributed via e-mail to the ACH Infection Preventionists in Tennessee. The survey was open for a two-week period; 28 (25%) facilities completed it. Data analysis was performed in SAS 9.4.
RESULTS: Forty-six percent of facilities required any personnel to demonstrate competency with hand hygiene following each training; all of these facilities required nursing staff to demonstrate competency compared to 23% for physicians. Fifty- three percent of facilities required any personnel to demonstrate competency with PPE selection and use. Among these facilities, all required the nursing staff to demonstrate competency, but only 20% required physicians to do so. For preparation and administration of injections, 52% of facilities required personnel to demonstrate competency; all facilities required nursing staff but only 14% for physicians. A majority of facilities (85%) required competency with environmental cleaning following each training with 91% requiring environmental services and 26% requiring nursing staff to demonstrate competency. Overall, facilities that didn’t require personnel to demonstrate competency reported lack of staff and lack of support from the education staff as their biggest barriers.
CONCLUSIONS: Return demonstration is the best way to show competency and provide staff an opportunity to learn in a non-threatening method. There was an overwhelming lack of competency training across the different infection control domains in acute care hospitals in Tennessee. These data also show differences in training across healthcare personnel roles, with physicians infrequently required to demonstrate competency. The facilities reported a lack of staff as a barrier to implement adequate training, but did not express a lack of support from hospital leadership. TDH will use this information to provide trainings and tools to facilities to address these gaps.