A useful US study has explored the ratio between infection prevention staffing levels, facility size, and HCAI-related outcomes. The reassuring news is that there was some correlation between IPC staffing levels in HCAI-related outcomes, suggesting that we are doing something right as a profession!

The question of the optimal IPC team size to facility size ratio continues to vex us. In the 1970, ratios like 1 IPC practitioner per 250 or even per 500 beds were discussed. But now those ratios are very out of kilter. More and more is being asked of IPC teams than in those days, with the profession developing new skills around the clinical governance, organisational leadership, build environment, applied research, and many other areas. So is there a ‘model’ IPC staffing to facility size ratio?

In order to have a reasonable go at answer this question, we need to consider not only facility size, but also IPC team skill mix, speciality services (e.g. paeds, burns, transplant etc), community services, and supporting roles from other related professionals (occupational health, ID/microbiology, infection pharmacy, facilities & estates, health & safety, vascular access, tissue viability, data & epidemiology).

A recent publication in AJIC has had a go at creating a staffing calculator, which comes out with a recommended IPC staffing level based on a number of facility-level variables. As part of the exploration of this calculator, the team surveyed almost 400 healthcare facilities to find out their IPC staffing levels, and measured these against HCAI-related outcomes as per standardised infection ratios.  

Here are some of the key findings and discussion points:

• The median staffing ratio was 1 IPC practitioner per 121 beds.
• The staffing calculator came out as a recommended 1 IPC practitioner per 65 beds, so almost double the actual median staffing level!
• Almost 80% of hospitals were below the recommended staffing levels, and >85% of hospitals considered their staffing level inadequate.
• It’s great to see that there was a correlation between IPC staffing levels and CLABSI, CAUTI, C. difficile, and colon SSI. It’s true that other factors may confound this association, but it’s compelling, isn’t it!

This US based study may be less relevant in other parts of the world, but I think the headline finding is an important principle – that investment in IPC reduces the risk of HCAI!