Project Summary: Prevention of Infections Through Appropriate Staffing (PITAS) Study
Nationally, healthcare-associated infections (HAIs) are a costly patient safety concern in acute care hospitals.
Infection Preventionists (IPs) and infection prevention and control (IPC) departments play an integral role in
implementing evidence-based policies and procedures to prevent, mitigate and control HAIs. However,
evidence describing and validating appropriate IP staffing is lacking. In addition, the COVID-19 pandemic has
placed an enormous strain on the healthcare system. Emerging evidence suggests that the pandemic has
resulted in increased rates of HAI in the acute care setting. However, the impact of the pandemic on IPC
departments, including staffing and resources, and on routine IPC activities is unknown. We designed a unique
and innovative study to determine how IPC departments have responded to the pandemic and the
effectiveness of IPC infrastructure and processes in preventing HAIs. Guided by Donabedian’s framework of
quality, we propose a 3-year mixed method study to: 1) Describe the evolution of IPC programs from 2011 to
2019 and determine the effectiveness of IPC staffing, infrastructure and processes in preventing HAI in acute
care hospitals; 2) Quantify the impact of the COVID-19 pandemic on infection prevention and control
departments, HAI rates and rates of antibiotic resistance in acute care hospitals; and 3) Develop an in-depth
understanding of the impact of COVID-19 on infection preventionists, IPC resources and practices in acute
care hospitals. In Aim 1, building upon our previous work, we will link hospital surveys to longitudinal National
Healthcare Safety Network (NHSN) HAI and staffing data (2011-2019) to examine effectiveness of IPC
staffing, infrastructure and processes on reducing HAI. In Aim 2, we will conduct a national survey of U.S.
hospitals and link the survey to NHSN (2011-2022) and CMS data (2018-2022) to examine the impact of
COVID-19. In Aim 3, we will conduct interviews with personnel involved in infection prevention and control in
20 hospitals. In our earlier federally-funded work, using a longitudinal sample of NHSN hospitals, we found that
high clinician compliance with bundled care and positive organizational climate were associated with lower HAI
rates in ICUs. We now propose to develop a more comprehensive examination of the impact of IPC staffing on
HAI rates by expanding the analysis beyond the ICU and including other types of HAI. We will also evaluate
the impact of the COVID-19 pandemic on IPC staffing and infrastructure, which is an area previously not
studied. As Early Stage and New Investigators, we represent the epitome of interdisciplinary and intercollegiate
research. We have designed an innovative study that builds upon our established relationship with
internationally-renown researchers and NHSN hospitals, refines psychometrically sound instruments, and fills
an important gap in the evidence. The results of this study will provide the evidence to strengthen IPC capacity
and preparedness in acute care hospitals to more effectively respond to future infectious disease crisis.