Poll Answers: Education Requirements for Infection Preventionists: A Debate Within Health Care”

Infection preventionists (IP) play a crucial role in safeguarding patients, health care workers, and the public from the risks of health care-associated infections. Their primary responsibility is to mitigate the spread of infections, but what should be the minimum educational requirement for these professionals? Is it a matter of earning a registered nurse (RN) or a bachelor of science in nursing (BSN) degree, pursuing higher education like a bachelor or master of public health, or holding a Certified in Infection Control (CIC) certification from the Certification Board of Infection Control and Epidemiology (CBIC)?

In search of answers, Infection Control Today® (ICT®) conducted an informal survey on October 3, 2023, which revealed a divided opinion among readers. In addition to the online survey, some respondents wrote to the senior editor of ICT to give further input.

The Survey and Its Respondents

The survey involved 242 respondents, each contributing a single response. Their answers were categorized into various educational backgrounds, including RN or BSN, bachelor or master of public health, a CIC from CBIC, laboratory science, and “Other.” In addition, there was an ”Any of the Above” category for those who believed that multiple educational paths should be acceptable.

“This division has implications for the field, as it calls into question the unity and standardization of education and training for IPs. The discrepancy in educational and disciplinary backgrounds among professionals who share similar responsibilities can lead to inconsistencies in their practice and approach to infection control.

However, these variations can also offer different viewpoints and lead to greater success rates.”

The Options: A Breakdown

The first group, which comprised 42 respondents, argued that an RN or BSN degree should be the minimum requirement for IPs. This perspective is rooted in the belief that health care expertise should form the foundation for infection control responsibilities. It is the traditional path to becoming an IP.

• Bachelor or Master of Public Health

Thirty-one respondents favored candidates with a bachelor or master of public health degree. This viewpoint emphasizes a broader understanding of public health and its role in infection control.

• Must have a CIC from CBIC

A total of 28 respondents upheld the value of the CIC certification from CBIC, emphasizing that specialized knowledge is paramount for effective infection prevention.

• Emergency Medical Services

Interestingly, no respondents endorsed Emergency Medical Services as a primary educational requirement for IPs. A secondary degree—that not all EMS personnel have—seemed to be required.

• Laboratory Science

A small but notable group of 7 respondents believed that a background in laboratory science (bachelor of science) should be the minimum educational requirement, emphasizing the importance of understanding pathogens at a molecular level.

A total of 26 respondents opted for the ‘Other’ category, suggesting a diverse range of qualifications, such as clinical microbiology, health care management, or clinical epidemiology.

• Any of the Above

The largest group of respondents, comprising 108 individuals, believed there was no one-size-fits-all solution. Instead, they advocated for flexibility, arguing that any of the above qualifications could suffice under the right conditions and the multidisciplinary nature of infection prevention, and having multidiscipline could lead to better collaboration within the infection prevention field.

The Divide and Its Implications

The survey’s findings underscore a clear division of opinions within the infection prevention community regarding the minimum educational requirement. On one side, there is the belief that a foundation in nursing or healthcare, symbolized by RN or BSN qualifications, is essential. On the other side, the view is that a broader education in public health or specialized knowledge gained through the CIC certification is the key to effective infection prevention.

This division has implications for the field, as it calls into question the unity and standardization of education and training for IPs. The discrepancy in educational and disciplinary backgrounds among professionals who share similar responsibilities can lead to inconsistencies in their practice and approach to infection control. However, these variations can also offer different viewpoints and lead to greater success rates.

Respondents’ Shared Their Thoughts

One respondent wrote in to support a diverse background for IPs. “I am writing to respectfully advocate for the extension of infection control privilege to nonnurse certified infection control personnel from other medical fields, as well as the formal inclusion of the “infection preventionist” title within the health care sectors Professional Qualifications Register (PQR).”

The respondent continued, “I want to begin by expressing appreciation for the diligent efforts put forth by the Association for Professionals in Infection Control and Epidemiology (APIC) in recognizing the pivotal role nurses play in infection control through the provision of infection control privilege. It is undeniable that infection prevention and control are crucial components of health care delivery, profoundly affecting patient safety, public health, and overall health care quality. This privilege undoubtedly strengthens the health care system’s capacity to deliver safe and proficient care.”

The respondent explains that many points of view can benefit IPs. “However, I am writing to bring to your attention that the realm of infection prevention and control encompasses a multidisciplinary approach involving professionals from diverse medical domains. The expertise of nonnurse-certified infection control personnel, including microbiologists, epidemiologists, clinical laboratory scientists, and other allied health care professionals, is indispensable in orchestrating comprehensive and efficacious infection control strategies. These experts bring distinct perspectives and competencies that can substantially enhance efforts to curtail the transmission of infections within health care facilities.”

Another respondent agreed with the first and suggested that having other professionals besides nurses could help address other issues faced by the medical community. “I am a director of safety & quality, providing support to up to 140 different hospitals across the Pacific Northwest. I currently support all the hospitals in the state of Washington. I have done this job for 5 years now, helping IPs with all kinds of challenges, including helping them through the COVID-19 pandemic.”

This respondent continued: “[However,] I cannot apply for a CIC because I do not have a clinical background. I completed all but my dissertation for a PhD in medical anthropology, focusing on epidemiology, disaster planning and mitigation, and medical systems. Although I do not have direct clinical experience, I have also supervised many public health programs and clinics—state and local. Many of the programs included communicable diseases. I also have been a senior social science researcher. My training includes more advanced epidemiology classes and research courses than many of the nurses ever get during their training. I also understand the evolution of communicable diseases and the social/cultural context of diseases inside and outside of the community health care setting.”

This respondent had been working in and around the infection prevention field for a long time, so she believed she should be allowed to take the CIC exam. “I feel that I have indeed proven myself by my work and engagement with so many hospitals and others involved in IPC [infection prevention and control], perhaps excelling in some areas of behavioral understanding than most IPs. Because APIC and the CIC were set up by nurses, there is a natural bias towards these health care professionals, and indeed their expertise is critical to and [ambulatory medical services]. However, some of us have other pathways, and I need a way to demonstrate my worth where I am not left out. Many other certificates do not require so much specificity, eg CPPS [certified professional in patient safety] and CPHQ [certified professional in healthcare quality]. This [point] may be particularly important given the nursing shortage and international considerations.”

Some respondents noted they would have answered multiple options in the poll had they been able to, and others suggested adding or changing options.

Conclusion

The debate over the minimum educational requirement for IPs continues to divide opinions. While the absence of demographic data from the survey is a significant limitation, it highlights the need for further exploration and discussion within the infection prevention community to address this topic.

Traditionally, only nurses were considered eligible for the role of IPs, but this rule has evolved. Allowing individuals with different qualifications to contribute their unique skills and perspectives could encourage collaboration and improve infection control efforts while recognizing the value of diverse educational backgrounds.