Hands-free water faucets found to
hinder hospital infection control
of newly installed, hands-free faucets at The Johns Hopkins Hospital,
all equipped with the latest electronic-eye sensors to automatically
detect hands and dispense preset amounts of water, shows they were
more likely to be contaminated with one of the most common and
hazardous bacteria in hospitals compared to old-style fixtures with
separate handles for hot and cold water.
Although the high-tech faucets cut daily water consumption by well
over half, Johns Hopkins researchers identified Legionella growing in
50 percent of cultured water samples from 20 electronic-eye faucets in
or near patient rooms on three different inpatient units, but in only
15 percent of water cultures from 20 traditional, manual faucets in
the same patient care areas. Weekly water culture results also showed
half the amount of bacterial growth of any kind in the manual faucets
than in the electronic models.
While the precise reasons for the higher bacterial growth in the
electronic faucets still need clarification, the researchers say it
appears that standard hospital water disinfection methods, which
complement treatments by public utilities, did not work well on the
complex valve components of the newer faucets. They suspect that the
valves simply offer additional surfaces for bacteria to become trapped
Infection control experts behind the latest study, believed to be
the first detailed analysis to show how and why these new fixtures
pose a problem in preventing Legionella infections in hospitals, say
the electronic devices were widely introduced in patient care and
public areas of hospitals across the United States, including in The
Johns Hopkins Hospital, more than a decade ago. The idea was to
prevent bacterial spread from people touching the faucet’s water
handles with their dirty hands.
As a result of the study, conducted over a seven-week period from
December 2008 to January 2009, Johns Hopkins facilities engineers
removed all 20 newer faucets from patient care areas and replaced them
with manual types. A hundred similar electronic faucets are also being
replaced throughout the hospital, and hospital leadership elected to
use traditional fixtures –The original goal of the research team, says
co-investigator Gregory Bova, senior engineer at Johns Hopkins, was to
test the new faucets to determine how often and for how long treated
water needed to be flushed through the hospital’s taps to keep
Legionella and any other bacteria at nearly undetectable levels. Study
results showed Legionella bacteria levels between 0 and 3,000
bacterial colony forming units per milliliter of water from electronic
Researchers say their next steps are to work with manufacturers of
electronic and manual faucets to help remedy their flaws and to design
components that can be cleaned more easily and save water.
This Month's Advertisers
IP Salary Survey reveals need for
by Susan Cantrell, ELS
wants to be average? Average is mediocre. Average is halfway to the bottom.
No, average is not something to which to aspire. While there is no such
thing as perfect, it is, nevertheless, an ideal to work toward. Infection
control professionals (ICPs) are doing just that on a daily basis.
Using statistics gleaned from Healthcare Purchasing
News’ 2011 Infection Prevention Salary Survey, we can paint a
picture of the "average" ICP. However, make no mistake: there is nothing
average about the average ICP. Infection control and prevention is not work
for the faint of heart, it is not for those whose theme song is "it’s not
fair"; it is not for those who can be content with the status quo. This is a
Who she is
The 2011 Infection Prevention Salary Survey doesn’t hold big surprises
this year. Again, statistics show that the average ICP is female (88.5%);
Only 8.8% are male. Apparently 2.8% of respondents only reveal their gender
on a need-to-know basis, because they chose not to share it with us. Her age
is about 54, again similar to last year’s at 52.7 years. She holds a
bachelor’s (45%), is a registered nurse (78%), and is certified by the
Certification Board of Infection Control and Epidemiology (51%).
Mostly commonly, our average ICP’s title is infection preventionist. At
32%, this represents a slight rise from 2010’s 27%. The next most common
title is infection control coordinator (21% in 2011 versus 20% in 2010). Our
ICP most often reports to the vice president or director of quality or risk
management (43%, compared to 39% in 2010).
The average ICP has worked in infection prevention between 5 to 9 years
(24%, compared to 23% in 2010). She also has worked in infection prevention
at her current facility between 5 and 9 years (27%, compared to 29% in
Salary vs. Job Function
Our average ICP is employed, overwhelmingly so, by a nonprofit (66%)
hospital (54%) that is a standalone but part of a group purchasing
organization (37%) or part of an integrated delivery network (36%). The
location most often is rural (41%), with suburban trailing close behind at
31%, followed by urban at 28%. Twenty-four percent of respondents work in a
100- to 199-bed hospital, which is similar to 2010’s at 23%. Her department
likely includes only 1 to 2 employees (83%), which is similar to 2010 (80%).
Thirty-eight percent of respondents said they spend 100% of their time on
infection prevention and control, which is up a little from last year’s 35%.
From there, the numbers take a dramatic drop: 9.5% (11% in 2010) say they
spend 90% to 99% of their time on infection prevention and control, and 13%
say they spend 80% to 89% of their time on infection prevention and control.
From that point, the numbers drop depressingly low.
Salary vs. Education
Time not spent on infection prevention and control is spent on other
duties such as employee health, 43% (2010: 42%); education, 27% (2010: 22%);
disaster preparedness, 26% (2010: 24%); patient safety, 19% (2010: 13%); and
quality-performance management, 15%, (2010: 15%).
The majority of respondents (79%), serve on a product-evaluation
committee. Their responsibilities include the following: determine need,
65%; safety evaluation, 52% (2010: 57%); product testing, 45% (2010: 49%);
education, 44% (2010: 44%); process improvement, 43% (2010: 48%); cost
analysis, 36% (2010: 27%); define usage, 32% (2010: 34%).
Product areas for which supplies are purchased or specified by her
department include but are not limited to hand sanitizers, 82%; needlestick/sharps
safety devices, 64%; disinfectants/sterilants, 62%; masks/respirators, 61%;
cleaning equipment and supplies, 55%; gloves, 55%; handwashing systems, 51%;
and protective wear, 48%. The numbers deviate very little from the previous
Salary vs. Region
At our average ICP’s hospital, they have stocked supplies to prepare for
a possible flu pandemic (90.5%). They also are preparing procedures for
mandatory reporting of infections (89.7%). Methicillin-resistant
Staphylococcus aureus (MRSA) is getting attention, too, with 62%
currently employing screening for MRSA at patient admission; another 7% are
in the planning stages; 30% do not have such plans; and less than 1% do not
know their facility’s plans for MRSA screening upon admission. None of these
numbers deviate significantly from 2010’s.
This year, survey questions also included whether respondents’ facilities
have instituted or plan to adopt a handwashing surveillance program: 81%
answered "yes"; 9% are considering it; 8% are not; and less than 2% don’t
know their facility’s plans.
How’s the money?
Our average ICP’s annual base salary in 2011 is $72,045 as compared to
$69,419 in 2010. Fifty-three percent of the survey respondents indicated
they received a raise, which is better than last year’s 45%. Salary remained
the same for 40% of respondents (2010: 47%). A decrease affected 8%, the
same as last year. For those who received an increase, it ranged from 3% to
3.99% for 27.5% of respondents (2010: 25%); 2% to 2.99% for 35.5% of
respondents (2010: 37%); and 1% to 1.99% for 25% of respondents (2010: 20%).
Salary vs. Number of Beds
Thirteen percent of respondents expect to receive a bonus as part of
their 2011 compensation, which is 5.5% more than in 2010. There was a
correspondent slight decrease in those who do not expect to receive a bonus
this year (77%; 2010: 82%). Those who do not know if they will receive a
bonus remain almost exactly the same at 10%. For those who expect a bonus or
incentive based on current salary, 38% expect to receive 1% to 2% (2010:
33%), and 32% expect to receive 3% to 4% (2010: 37%).
Still good news on the job-security front: Most feel somewhat secure
(48.6%; 2010: 46.5%) or very secure (41.5%; 2010: 47%). Fortunately, only a
small percent (10%) feel somewhat insecure, but the percentage is slightly
up from last year (2010: 6%).
What does it all mean?
How we got here
The results of the 2011 Infection Prevention Salary Survey were shared by
HPN with a few working in the field to help explain things happening
in the background that led to the current results and to put the results in
Brinsko, director, Infection Control and Prevention, Vanderbilt Medical
Center, Nashville, TN, offered an interesting observation on the evolution
of the ICP: "I think ICPs are going through a metamorphosis, much like the
caterpillar changes to a butterfly. The ICP changed their title from
infection control practitioners to infection preventionists (IPs) because
that is the focus: prevention."
"Traditionally, ICPs have been in the shadows, behind the scenes," said
Brinsko, "doing their thing to check the box for the Joint Commission.
Today, they find themselves in the spotlight. More and more states are
electing to become transparent in sharing infection control data with the
public. More demands are also coming from internal customers as departments,
department chairs, nursing units, etc, want to see their data."
of the ICP have evolved over the past 5 to 10 years. Patricia Heath, RN,
BSN, Infection Prevention, St. Luke’s Magic Valley Medical Center, Twin
Falls, ID, explained why: "ICPs are being forced to spend more of their time
gathering data rather than spending time developing strategies to reduce
infections. The pressure from regulatory agencies, Centers for Medicare and
Medicaid Services (CMS), and other payer sources is requiring time being
spent to write reports, enter data into the National Healthcare Safety
Network (NHSN), and present data in multiple formats."
Russell N. Olmsted
N. Olmsted, MPH, CIC, 2011 Association for Professionals in Infection
Control and Epidemiology Inc. (APIC), president, and epidemiologist,
Infection Prevention and Control Services, Saint Joseph Mercy Health System,
Ann Arbor, MI, expounded: "There has been an unprecedented level of focus
and concern on the part of consumers of health care on healthcare-associated
infections (HAIs). Commensurate with this scrutiny has been legislative
mandates for public disclosure of facility-specific HAI data, a move toward
value-based purchasing by CMS and an increasing number of third-party
payers, and newly emergent regulatory and accreditation requirements. The
primary source of this data is from surveillance findings collected by
infection preventionists (IPs). These factors have placed increasing
responsibilities and demands on IPs. Over this same time period, there is
clear evidence that HAI data, when shared with direct-care personnel, can be
an effective mechanism to prevent infection. The ‘engine’ that runs on this
data is the collaborative model that implements prevention bundles."
ICP's Influence Purchasing
purchased/specified by IPs
Needlestick/Sharps Safety Devices
Disinfectants & Sterilants
Cleaning Equipment & Supplies
Disposable Kits and Trays
Sterilization Supplies & Equipment
Sterility Assurance Products
Sterilization Wraps & Containers
Air Purification Systems/Filters
Test Kits/Bacterial Typing Products
Patient Warming Equipment
Pressure Management Systems
Doing more=getting more? Not so much
Unfortunately, noted Olmsted, whereas IPs’ responsibilities have
expanded, "compensation of IPs has not differed significantly from other
health disciplines over this time period."
Heath’s experience at her 144-bed medical center echoes Olmsted’s
observation. "Salaries are not being increased and workloads are increasing.
Budgets are stretched due to the need of other positions being created to
meet the ever-increasing requests for explanations of actions, data
collection, [and] constant chart reviews gathering information to submit to
multiple agencies. There is no money available for more personnel or
increased salaries. There are just more expectations of the ICP in her
current hours. Everyone in healthcare is expected to do more with less. I
don’t see any changes in the near future, especially with healthcare reform
looming with no clear definition."
Brinsko’s experience at a much larger facility is a little different. "As
more demands are placed on the traditionally tiny infection control
department, these small departments have experienced growth. With growth
comes an increase in budget, whether for additional personnel or increasing
education, travel, etc. Our department went from 3 ICPs in 2000 to 9 ICPs in
2011. Our hospital also grew in size, and we went one step further in
creating a new position for an outpatient ICP, which hopefully could become
a model for other institutions."
"Mandatory reporting and CMS pay-for-performance have spotlighted
infection control activity in a way that 10 years ago was unfathomable,"
continued Brinsko. "To imagine hospitals posting their
central-line–associated bloodstream infection (CLABSI) rates on a public
website, let alone on a poster on a unit in their hospital, was something
beyond imagination; so, infection control and prevention departments had to,
and have to, grow to accommodate the data demands. Infection control and
prevention departments not only collect and analyze the data they are the
content experts on strategies to reduce the infections. The Centers for
Disease Control and Prevention (CDC) is leading the way with the mantra of
‘Chasing Zero’ and rightly so. Infections cause harm to patients. Prevention
is what infection control and prevention departments specialize in. Along
with budget increases, salaries also tend to increase, although admittedly,
some areas may be slower to respond than others."
Olmsted also offered insight into how CMS changes in reimbursement and
mandatory reporting have affected infection control and prevention
departments’ budgets and staffing. "I think changes in regulations and
reimbursement have had a significant impact on awareness of the problem of
HAIs and the risks these represent to patient safety. These changes have
opened the door to the C-Suite, and there is increasing interest in
prevention strategies. However, there has not been a notable increase in
staffing levels for IPs. Krein et al1 conducted two nationwide
surveys of practices aimed at prevention of HAIs in US hospitals in 2005 and
again in 2009. The average level of staffing dedicated to IPs had not
changed between these time periods. By contrast, the percentage of hospitals
that have a hospitalist program grew from about 50% to almost 80%. Another
survey by Stone et al2 found staffing levels were higher in
smaller facilities. There was a median staffing of 1 IP per 167 beds."
Unfortunately, while more demands are made of ICPs, Olmsted said it has
"not demonstrably" resulted in additional resources and fatter budgets. He
did note, however, that "there has been some increase in support of
surveillance technology. Given the increasing demands for HAI data,"
continued Olmsted, "there has been an increased interest in, and use of,
surveillance technology to increase efficiency of surveillance of HAIs. A
study by Grota3 identified this trend, albeit use of surveillance
technology remained at a prevalence of just over 20% in hospitals studied."
Product Evaluation Committee
As a member of a Product Evaluation Team, in
which of these categories do you play a role?
On the positive side, ICPs’ role in patient safety, and costs saved as a
result of their efforts, is now better recognized and appreciated. Olmsted
observed that prevention bundles and collaboratives have raised awareness
and appreciation of the "team approach to prevention, meaning the IP is the
subject matter expert but the implementation of prevention strategies comes
from engaging direct-care personnel."
He cited an example: "There was a recent report, based on CDC’s NHSN
published in the Morbidity and Mortality Weekly Report that described
substantial reductions in frequency of CLABSIs among patients in intensive
care units (ICUs) across the U.S. There has been ample success in preventing
CLABSIs and ventilator-associated pneumonia in ICUs. The prevention bundles
are largely the reason for these successes. There is no doubt the work of
IPs and their direct-care colleagues are preventing infections and saving
Brinsko related how recognition of, and appreciation for, ICPs’ role in
patient safety and cost reduction affected her department. "After mandatory
reporting and CMS changes, ICPs moved to the ‘big table.’ Suddenly, ICPs–in
my hospital–were requested to be at more top-level meetings. The C-suite was
suddenly aware of our department and actually wanted to meet with us and
hear what we had to say. Infection control and prevention has been preaching
the same message for years, for decades, but now the right people are
hearing the message and acting on the recommendations. The C-suite has read
the business case for a dedicated infection-prevention program and has
Heath’s experience is a little different: "I think that the role of the
ICP is being recognized, but everyone is so busy chasing the next data set
or verbal reporting process that there is no time for recognition."
When asked about the survey results on preparing for a flu pandemic,
screening for MRSA, and mandatory reporting of infections, Olmsted had this
to say: "These are all important potential issues, but IPs at each facility
need to conduct a facility-specific risk assessment as a foundation for
developing an infection prevention and control plan that makes the most
sense for a particular facility. Some of this is driven by legislative
mandates involving select pathogens such as MRSA and Clostridium
difficile or certain types of HAIs like CLABSI. The reporting mandates
are important for transparency and awareness, but reporting alone is not
sufficient for driving prevention. It is use of this data by providers to
change and improve safety of care that is the real ‘secret sauce.’ Emergency
preparedness is important, and last year’s pandemic was a good opportunity
to test our level of preparedness."
Salary by Years in IP vs. Years at
"Some of these may or may not rank as high as others. Another point of
reference is the HAI prevention plan that was published by U.S. Department
of Health and Human Services in 2009. This did identify MRSA and C
difficile but also highlighted other important targets such as
catheter-associated urinary tract infection, surgical-site infection, and
Surgical Care Improvement Project measures aimed at prevention."
Olmsted talked further about the disturbing trend presented by certain
pathogens and the correlating need for good stewardship of antibiotics. "C
difficile continues to be a problem for many facilities, and this is
increasingly involving patients in the community. Another concern is the
growing problem of multidrug-resistant gram-negative bacteria. Both of these
issues highlight the need for antimicrobial stewardship to improve use of
antibiotics." Brinsko suggested that, for the next survey, "It would be
interesting to see if multidrug-resistant organisms (MDROs), including
gram-negative MDROs, are an issue in their facility."
Brinsko also highlighted the importance of each facility conducting an
infection control risk assessment. "The 2009 pandemic flu experience was a
lesson, a field experience so to speak. MRSA is certainly an important
pathogen; however, it is not the only pathogen. C difficile is
certainly an issue in acute-care facilities, long-term–care facilities, and
in the community. The main areas the IP should focus their work is in areas
uncovered by their own infection control risk assessment. This is where they
take their own data, look at it, analyze it, and determine what areas are
‘hot spots’ for them. A giant teaching hospital will likely have different
hot spots from a small, rural, community hospital."
Surveillance is surfacing as an important issue. Olmsted suspects that
may account for respondents’ answers on the survey question concerning the
percentage of time they spend on infection control. "I’m not sure this
interpretation is quite right. I suspect the 38% is related to surveillance
of HAIs. There have been other studies that found up to 45% of the IP’s time
is spent on surveillance. While I don’t think it’s reached 100%, there is no
doubt that the escalating venues requiring HAI data has likely increased
this part of the IP’s time. As a result, there is palpable tension between
need for accurate HAI data and the desire to participate with direct-care
personnel at the points-of-care delivery."
Heath added: "CMS, regulatory agencies, and other payer sources are
focusing on infections that occur in the healthcare setting. Many of the
decreases in payment, and pressure to submit data to get full payment, force
the ICP to spend more time gathering the information to ‘feed the hunger’ of
these agencies. Again, because of the need to submit the data, the work
needed to make lasting changes is being rushed or not being as well educated
as it could be."
Olmsted commented on what he thinks are currently the greatest obstacles
and challenges that ICPs face in performing their work as they would like to
ideally: "Increases in the scope and breadth of HAI data and a growing
number of organizations and payers who want this data. Much of this is done
using manual methods, which are tedious and time-consuming. This is layered
on top of a relatively static level of human resources for infection
prevention and control programs. One strategy to address the burden of
surveillance is use of surveillance technology. In addition, there is
emerging evidence that some of the case finding can be automated by use of
algorithmic detection of possible HAIs."
The survey results revealed that 59% of respondents would, in fact, like
to see more on infection tracking and reporting systems in HPN. "I’d
recommend adding questions on surveillance technology," said Olmsted in
regard to next year’s survey. "Other metrics of possible interest would be
full-time employees per number of beds, extent of services and units [for
which] the IP has responsibility, and perhaps some other volume indicators."
Brinsko also weighed in on data collection as a challenge faced by ICPs.
"The greatest obstacle is non-automation of data. Manual data entry is
tedious and time-consuming. Data mining is an excellent way to automate, but
there are also drawbacks to some of the data-mining systems as well. The
ideal system would be a software program that could cull data from the lab
system, apply CDC definitions and rules for the four major infections
(surgical-site, CLABSI, catheter-associated urinary tract infection,
ventilator-associated pneumonia), and plug demographics into one user
interface ... nirvana!"
Brinsko, too, would like to see next year’s survey include questions
about automated surveillance. "Ask if the IP has a data-mining system or
some sort of data-extraction tool. Automation increases efficacy and moves
the IP out from behind the computer and onto the floors, the ICUs, into the
operating rooms as a consultant, observer, and team member."
Olmsted wrapped up his observations with this: "IPs
have always been able to accomplish a great deal with limited resources. One
reason for this is their superb use of networking with their colleagues at
their facility as well as via local APIC chapters. This drive is derived
from knowledge that their work does make a huge difference in the lives of
patients we care for, and that’s what really matters."
1. Krein SL, et al. What U.S. hospitals are doing to
prevent hospital-acquired infection: 2005 to 2009 [abstract # 674]. Fifth
Decennial International Conference on HAIs. Atlanta, GA: March 20, 2010.
2. Stone PW, Dick A, Pogorzelska M, Horan TC, Furuya EY,
Larson E. Staffing and structure of infection prevention and control
programs. Am J Infect Control 2009;37:351-357. Epub 2009 Feb 8.
3. Grota PG, Stone PW, Jordan S, Pogorzelska M, Larson E.
Electronic surveillance systems in infection prevention: o
support, program characteristics, and user satisfaction. Am J Infect Control
2010;38:509-514. Epub 2010 Feb 21.