Intervention site

Boston Medical Center (BMC) is a 514-bed, tertiary-care, teaching hospital in an urban setting, and it is New England’s largest safety-net hospital. Many patients come from underserved and structurally minoritized groups, as reflected by racial and ethnic identification, housing insecurity, immigration status, and socioeconomic status. The BMC Department of Hospital Epidemiology and Infection Control (HEIC) supports the acute-care hospital and 24 affiliated ambulatory-care sites. In 2021, the demographics for patients treated at the hospital were 32% Black, 24% Hispanic or Latinx, and 25% white. Registered nurses employed by the hospital were 18% Black, 4% Hispanic or Latinx, and 71% white. During the past several years, nursing leadership has made increasing racial and ethnic diversity of the nursing workforce a focus, with strategic goals to hire underrepresented group candidates for at least 40% of new graduate positions and at least 30% of nursing leadership positions.

In 2020, the BMC HEIC was staffed with 4 practicing IPs, with 3 anticipated to leave their position within 2–3 years. After efforts to hire experienced IPs externally were unsuccessful, approval was granted for 3 nursing IP fellowship positions.

Intervention description

Facing staffing shortages that were particularly urgent in the setting of the COVID-19 pandemic, the BMC Nursing Department aimed to stabilize the IP work force, meet additional capacity needs, and increase its diversity through the creation of an Infection Prevention Fellowship (IPF). The fellowship was targeted to experienced nurses who identified as underrepresented racial and ethnic groups interested in pursuing careers in infection prevention. Applicants were required to have a bachelor’s degree, with a master’s degree preferred. The fellowship provided a 12-month program of hands-on training following the structure of the APIC Professional Practice Roadmap for Novices, ⁷ an outline for knowledge, skill, and abilities needed to sit for the exam conveying Certification in Infection Prevention and Control (CIC). Of the IPF applicants, 7 were selected for interviews. Of these, 3 individuals—1 Latinx and 2 Black nurses—were offered the fellowship. They had work experience in critical care, inpatient wards, and occupational health.

The IP fellows began in spring 2021 under supervision of senior IP staff mentors. Initial orientation included shadowing, learning the basics of infection prevention, and joining professional groups and associations, including APIC and the National Healthcare Safety Network (NHSN). In addition to their learning responsibilities, the fellows’ specifically designated tasks included healthcare-associated infection (HAI) surveillance and reporting, outbreak investigations, task-group participation related to HEIC initiatives, and coordination with occupational health, as well as other domains identified in the Fellowship Roadmap.

The prior work experience and connections of the IP fellows allowed for their rapid incorporation into rounding in clinical spaces and real-time reinforcement of optimal infection control practices. Their presence also enabled HEIC to institute an initiative focused on review of central lines and indwelling urinary catheters and direct outreach to providers regarding possible device removal. Over the first year, the fellows reviewed ∼120 active devices per day and initiated queries regarding continued need on ∼5% of these, many of which were able to be removed within 1–2 days.

Outcomes

As of fall 2022, all 3 IP fellows had completed IPF training. Presently, 2 have passed the CIC exam and the third fellow has scheduled an exam date for spring 2023. All 3 remain employed at BMC within HEIC. Following the success of the IPF program in achieving training goals and addressing existing vacancies, a fourth fellowship position was posted and filled in 2022.