Differences in infection prevention and control staffing between free-standing and system-affiliated hospitals: A...

Infection prevention and control (IPC) staffing varies across US hospitals, and traditional bed-based benchmarks may no longer reflect contemporary workloads or organizational structures. With most hospitals now system-affiliated, understanding how affiliation influences infection preventionist (IP) staffing is critical for modernizing guidance.

A national survey was distributed to US acute care hospitals participating in the National Healthcare Safety Network (NHSN) from August to December 2023, assessing IPC staffing, resource availability, and organizational structure. Hospitals were categorized as free-standing or system-affiliated; differences were assessed with Wilcoxon rank-sum and chi-square tests.

Of 741 responding hospitals, 550 (74%) were system-affiliated and 191 (26%) free-standing. Free-standing hospitals had higher IP staffing intensity (median 2.0 vs 1.2 FTE/100 beds; P < .01), while system-affiliated hospitals employed larger overall IPC teams. System-affiliated hospitals reported greater access to electronic surveillance (89% vs 55%; P < .01), analytic support (40 vs 20 hours/week; P < .01), and administrative support (P < .01). Free-standing hospitals spent more time on office-based work (50% vs 40%; P < .01). An inverse relationship between hospital size and IP FTEs per 100 beds was observed across groups.

IPC staffing patterns differed by system affiliation. Free-standing hospitals maintained higher per-bed staffing ratios, while system-affiliated hospitals relied on larger teams supplemented by centralized resources. These findings support the need for updated staffing models that account for organizational structure and the expanded scope of contemporary IPC practice.