How many infection control staff members are needed in acute care hospitals? A Delphi approach

Introduction: The Dutch recommendation on infection prevention and control (IPC) staffing in acute care hospitals from 2007 is outdated due to evolving hospital care, including shorter admissions, more complex and day-care procedures, more vulnerable patients, increasing antimicrobial resistance, and enhanced regulatory demands. Therefore, an updated staffing norm for IPC is needed. Methods: Minimum weekly hours required for IPC activities was determined by a Delphi method across three model hospitals: academic, large non-academic, and small non-academic. Four questionnaire rounds were conducted among infection prevention and control practitioners (IPCPs) and clinical microbiologists (CMs). Staffing needs per role and hospital type were calculated. After three rounds, a core expert team focus group formulated a new full-time-equivalent (FTE) norm which was proposed in the final round. Results: For academic hospitals, 100% consensus was achieved for a minimum of 0.15 FTE CM and 1.23 FTE IPCP per 5000 annual hospital admissions, plus 0.05 FTE CM and 0.41 FTE IPCP per 5000 annual day admissions. For non-academic hospitals, 92% supported the proposed norm for CMs (same values) and 89% agreed with the proposed norm for IPCPs: 1.10 FTEs per 5000 hospital admissions and 0.37 FTE per 5000 day admissions. Conclusion: A new consensus-based staffing norm, endorsed by most Dutch IPC professionals, recommends an increase in IPCPs. This reflects increased demands on IPC teams and suggests diversification of professionals working in IPC teams, not accounted for in the previous norm. This minimum norm is needed to effectively protect patients and healthcare workers from infections. Although this consensus was achieved in a Dutch setting, the method applied and overall outcome can be useful for other settings.