Infection Control and Leadership

By:  Barbara Soule, Practice Leader, Infection Prevention and Control

The 2009 Joint Commission Leadership standards have a direct impact on the infection prevention and control (IPC) program. Several of the standards and elements of performance clearly elucidate the leaders’ responsibilities to support this program as part of a culture of patient safety. This posting and others in the future will show the alignment of leadership and infection prevention and control standards.

LD .03.010.01 states that leaders create and maintain a culture of safety and quality throughout the hospital. Since preventing infections is one of the key strategies for promoting safe, high-quality care for patients or residents, in both the inpatient and outpatient settings, it is important for leadership and the IPC program team to collaborate to establish this culture and safe environment.

Infection preventionists (IPs) should take a proactive approach to keeping leaders apprised of the status of the IPC program goals and objectives, any significant changes, sentinel events, clusters or outbreaks and other issues. It is also important to communicate with leaders about the successes of the program, such as reductions in infection rates, new strategies that have proven effective and the financial implications of preventing infections.

Other LD standards outline leadership responsibilities for the IPC program. These include:

LD. 03.02.01: The organization uses data and information to guide decisions and to understand variation in the performance of processes supporting quality and safety.

This standard implies that the IPC program will supply the leaders with valid and reliable information to use in making care decisions. The data may come from internal surveillance information, the literature or regulatory agencies. IPs must take a hands-on approach to providing leaders with important and timely information.

LD .03.04.01: The hospital communicates information related to safety and quality to those who need it, including staff, licensed independent practitioners, patients, families and external interested parties.

One of the responsibilities of the IPC team is to have a communication strategy to share IPC information with the leaders, medical and clinical staff, support teams and patients and families. This may be in the form of a written newsletter, eNews, educational programs, podcasts, webcasts, videos or personal conversations. The role of the organizational leaders is to support the communication systems and provide the resources to get the need information to all persons.

Leadership standards are replete with roles and responsibilities for infection prevention. More of these standards and elements of performance will be discussed in future articles.