Infection Preventionists and Competency
By Diane Cullen, RN, MSN, MBA, CIC, associate director, Standards Interpretation Group, Division of Healthcare Improvement
Sterilization and High-Level Disinfection (HLD) breaches are some of the most common Infection Prevention (IP)-related findings associated with Adverse Decisions for health care organizations. Many times, this is related to staff incorrectly performing these activities and is often associated with a lack of training, competence and oversight. When asked what Joint Commission Standards address questions about training, education and competence, I often refer my colleagues to these three Standards in the Human Resources Chapter of The Joint Commission’s Comprehensive Accreditation Manuals:
- HR.01.01.01: The organization defines and verifies staff qualifications.
- HR.01.05.03: Staff participate in ongoing education and training.
- HR.01.06.01: Staff are competent to perform their responsibilities.
What qualifies someone to be an Infection Preventionist?
Organizations must define staff qualifications specific to job responsibilities. Qualifications for infection control may be met through ongoing education, training, experience and/or certification (such as that offered by the Certification Board for Infection Control). Certification in Infection Prevention and Control (CIC®) is an example of evidence that an individual is qualified to perform Infection Preventionist job responsibilities, as this individual must recertify every 5 years.
Examples of other acceptable ways that organizations may define qualifications of an Infection Preventionist include:
- Ongoing experience practicing in the infection prevention and control field
- Infection prevention-specific in-person education on an ongoing basis
- Initial and continued infection prevention-specific training courses
What is the relationship between training, education and competence?
Staff participate in ongoing education and training to maintain or increase their competency and, as needed, when staff responsibilities change. Staff participation is documented.
The requirements for this standard speak to both ‘education’ and ‘training’ that provide the foundation for competency. Education is the process of receiving systematic instruction resulting in the acquisition of theoretical knowledge. Training differs from education in that ‘training’ focuses on gaining specific – often manually performed – technical skills.
Competency requires a third attribute – Ability. Ability is simply described as being able to ‘do something’. The ability to do something competently is based on an individual’s capability to synthesize and correctly apply the newly acquired knowledge and technical skills to a task.
Competency differs from education and training in that competency incorporates all three attributes: Knowledge, technical skills, and ability - all are required to deliver safe care, correctly perform technical tasks, etc. Assessing competency, then, is the process by which the organization confirms an individual has the ability to perform a task, consistent with the education and training provided. The APIC Competency Model is a wonderful example of a profession-specific model which describes the knowledge, skills and behaviors important in becoming a competent Infection Preventionist.
Is an Infection Preventionist competent to assess the competency of someone performing High-level Disinfection or Sterilization?
Competence assessment lets the organization know whether its staff has the ability to use specific skills and employ the knowledge necessary to perform job functions. Organizations must define the competencies they require of their staff who provide care, treatment or services. When organizations define specific competencies, they should consider the:
- Needs of its patient population
- Types of procedures conducted
- Conditions or diseases treated
- Type of equipment it uses
An individual with the educational background, experience or knowledge related to the skills being reviewed must assess staff competence. When a suitable individual cannot be found to assess this competence, the organization may utilize an outside individual. If a suitable individual inside or outside the organization cannot be found, the organization may consult the competency guidelines from an appropriate professional organization to make its assessment.
An individual may be a qualified IP who is competent to perform infection prevention and control tasks such as identifying infectious disease processes or conducting surveillance; however he or she may not be qualified/competent to perform (or assess the competency of others who perform) high-level disinfection or sterilization. Many IPs have knowledge about the concepts and theory behind decontamination and sterilization along with a general understanding of the steps involved in both processes, but this does not- in and of itself- demonstrate the IP has the technical skills and ability to perform or oversee those processes. If, however, the IP has the appropriate background knowledge, technical skills, and ability associated with high-level disinfection and sterilization, then that IP would be considered competent to assess the competence of others who perform those specific tasks.
An organization would want to ensure that minimally, whoever is assessing competence- be it supervisor, manager or Infection Preventionist- is qualified.
The difference between qualifications and competency of an infection preventionist are often misunderstood. Organizations, and the IP, need to make sure that they are competent to perform the job duties that they are assigned. In some cases, this may mean additional education and training is needed to ensure that the IP has the knowledge, technical skills, and ability to perform an assigned job-related task such as oversight of high-level disinfection and sterilization.