Educating frontline health care workers on infection prevention and control (IPC) actions is an essential component of the infection preventionist’s (IP’s) role, included within multiple domains of the Association for Professionals in Infection Control and Epidemiology (APIC) IP competency model¹ and Centers for Medicare and Medicaid Services Conditions of Participation for all US hospitals.² A critical goal of IPC training is to empower frontline health care workers with the knowledge and tools needed to take action to minimize health care occupational exposures and prevent health care–associated infections (HAI).

There is no standardized program or approach to providing IPC training to frontline health care workers, which creates challenges for IPs attempting to deliver IPC training. In addition, the COVID-19 pandemic created new demands on IPs and diverted resources away from IPC training to pandemic response.^3,4 A 2021 study found that IPs perceived pandemic-related setbacks in the prevention of HAIs resulting in the need for IPs to re-teach foundational IPC principles to frontline health care workers.⁵ Epidemiological data supports this perception, with multiple studies noting increased rates of HAIs during the pandemic.^5,6 Further, IPs’ workload and stress levels increased during the pandemic due to the need to aid in response, such as developing and reviewing COVID-related protocols.⁷ This resulted in a large IP turnover, with many new IPs entering the field at a time when there was a lack of experienced IPs to mentor and train them.⁷ Additionally, IPs entering the field during the pandemic may not have had the knowledge, skills, or resources necessary to develop and implement IPC training. The primary objectives of this study were to understand the frequency with which IPs provide IPC training to health care workers, the approaches and methods used for training, and to better understand which technologies and resources they believe are needed to empower frontline health care workers to take IPC action. Secondary objectives were to describe training preferences as reported by IP position, certification, formal education, years of experience, and geographic location of practice.

A cross-sectional study was conducted using an online survey administered via Qualtrics between May and June 2023. Participants included APIC members working as an IP in a US health care setting or public health department. Vendors, retirees, APIC staff members, or those not currently working in a health care setting or public health were excluded. Recruitment was conducted through (1) an initial email, followed by biweekly emails; (2) survey promotion in the weekly APIC eNewsletter; and (3) an advertisement published in the Infection Prevention Strategist.

A 36-item survey was developed using the Theoretical Domains Framework, an implementation-science framework aimed at assessing multilevel factors contributing to intervention implementation and uptake.⁸ The survey was pilot-tested with 8 APIC National Committee members who were also practicing IPs; results were used to inform the finalized instrument, which assessed IPs’ current, preferred, and desired health care worker training approaches. This analysis focuses on a subset of 21 survey items related to the frequency with which IPs: educate different groups of frontline health care workers (4 items); engage in various training activities (5 items); use a variety of teaching methods (5 items); implement different teaching tools (5 items); preferred teaching method (1 item); and teaching technologies, methodologies, or resources desired by IPs (1 unlimited, open-text field item). Demographics were also collected. The Western Institutional Review Board approved this study. This activity was reviewed by Centers for Disease Control and Prevention (CDC) and was conducted consistent with applicable federal law and CDC policy (see eg, 45 C.F.R. part 46.102(1)(2), 21 C.F.R. part 56; 42 U.S.C. §241(d); 5 U.S.C. §552a; 44 U.S.C. §3501 et seq.).

Overall, 2,432 (21.9%) of 11,130 eligible IPs participated. Respondent demographics are described in Table 1. Of the 2,432 respondents, 1,606 (66.0%) reported being frontline, practicing IPs; 1,991 (81.8%) had a bachelor’s degree or higher; 1,214 (49.9%) had ≤5 years of experience; and 1,371 (56.4%) reported being IP staff versus an IP leader; and 1,156 (47.5%) were CIC-certified. Nearly equal portions of respondents reported working in rural (36.1%), suburban (31.6%), and urban (32.3%) communities, while 1,738 respondents (71.5%) worked in a hospital setting.

This study found that IPs frequently train diverse frontline health care worker groups on IPC actions, and they use a variety of teaching approaches and tools when doing so. IPs reported that they spend much more of their time engaged in JIT and preferred impromptu training of health care staff compared to using planned, formal training sessions. The need to provide high-quality effective impromptu training is included in the APIC IP Competency Model.¹ In contrast to providing formal training, JIT and impromptu training require IPs to think critically, advance their knowledge of IPC, and effectively communicate the scientific rationale behind the guidance. Incorporating strategies for providing effective JIT and impromptu training into education and support provided to IPs may help them deliver effective messages.

IPs in this study identified many types of teaching tools and strategies that they would like to use but to which they do not currently have access. Simulation or demonstration was ranked as the most preferred method for teaching and the most frequently desired strategy for the training of health care workers but was one of the least likely to be in use. Past research on the use of simulation as a method of IPC training found this method to be effective in most situations.^10–13 Incorporation of simulation-based techniques into IPC training seems advisable given IPs’ desire to use this teaching methodology and evidence that it is generally more effective than traditional lecture-based training. Incorporation of simulation and apps into IPC training is likely to be delivered through planned formal education approaches because these methodologies often require setup and physical resources versus impromptu training that can often be accomplished through conversation or verbal interaction alone. Project Firstline, a national collaborative for health care infection prevention training initiated during the COVID-19 pandemic, offers free educational materials in multiple languages and formats.¹⁴ It is now situated within a new branch, the Healthcare Systems Strengthening Resilience Training Branch within the Division of Healthcare Quality Promotion at CDC. This branch will remain focused on the creation of accessible, ready-to-use training for all levels of health care personnel.

The need for more interactive teaching tools was also apparent in the study results. IPs expressed the desire to receive interactive training experiences and learn how to create more interactive training experiences to implement with health care workers. Apps desired by IPs might be one example of interactive training. Existing research on IPC-related apps is limited, and results are mixed, with studies showing gains in knowledge and confidence.^15–17 Multiple health training and assessment apps were developed during the COVID-19 pandemic, but they focused on contact tracing or personal health assessment for public health settings versus health care.¹⁸

Some limitations should be noted. This study only involved APIC members working in the United States and may not be generalizable to IPs who are not APIC members or who work outside of the United States. The response rate for this study was nearly 22%; however, this rate is not unusual for online surveys across disciplines, as they tend to have response rates approximately 12% lower than phone, mail, or in-person surveys.¹⁹ There may be selection bias, with IPs who are most interested in IPC training more likely to have participated in the study. This potential bias may result in a falsely high percentage of IPs currently engaging in IPC training of health care workers and different preferences for teaching approaches and methodologies. Nevertheless, this is, to our knowledge, the first national survey of IPs to assess current approaches and preferences for IPC-related training and resources for frontline health care workers and reflects practice during the third year of the COVID-19 pandemic.

IPs frequently provide IPC-related training to various groups of frontline health care workers, and they use a variety of teaching approaches and tools. IPs spend more of their training time engaged in impromptu versus planned training sessions and need assistance learning how best to implement the JIT training approach. IPs expressed the desire for app-based training programs as well as tools and resources to aid in incorporating simulation and interactive learning. The development of IPC-related training apps, especially those that involve an interactive component, may be beneficial and should be considered. Future studies using qualitative methodologies could help elicit more detailed information about IPs’ needs related to tools that provide interactive learning or training apps. To improve an IP’s ability to provide quality IPC training for frontline health care workers, the development of future IPC-related tools should take these expressed needs and preferences into account.