Impressive performance reflected inside pandemic

April 26, 2021
2021 Salary Survey: COVID-19 unable to stem professional progress

What a difference a year can make. According to the results of the 2021 Healthcare Purchasing News Infection Prevention Salary Survey, the average annual salary for a U.S. infection preventionist (IP) is $95,752, an 11 percent increase ($9,700 more) over the average reported pay of $86,052 in 2020. Although higher pay can come at a price. During the past 12 months of the COVID-19 pandemic, IPs report taking on additional roles and responsibilities and working longer hours while struggling with staff shortages and high patient volumes.

“COVID-19 has been a ruthless adversary and profound reminder that we must work in earnest every single day to inculcate best and effective principles of infection control and prevention,” said Fatima R. Muriel, MT (ASCP), CIC, Infection Preventionist, Women & Infants’ Hospital, Providence, R.I. “IPs have endured the fight day to day, making sure we bring education and timely and accurate information to key stakeholders for the protection of patients and healthcare workers.”

2021 Snapshot

This year’s composite IP is female, and she is 54 years old. Her title is Infection Preventionist, and she is certified by the Certification Board of Infection Control and Epidemiology (CBIC). She reports to the Vice President/Director, Quality/Risk Management/Chief Quality Officer. She has been in infection prevention an average of 17 years and has worked at her current facility for 12 years. She is employed at a nonprofit, standalone hospital with 341 beds. There are three employees in her department.

Most IPs see pay rise, at many levels

When examining pay raises by position, the following titles reported the most significant leaps in compensation:

• Infection Preventionists: $92,019 in 2021, up from $75,512 in 2020, a 22% increase

• Infection Prevention/Control Coordinator: $88,612 in 2021, up from $74,444 in 2020, a 19% increase

• Infection Prevention Directors: $114,177 in 2021, up from $97,463 in 2020, a 17% increase

“Since entering the IP profession nine years ago, I have definitely seen the compensation for IPs improve,” said Brenda L. Bassett, MBA, MLS(ASCP), CPHQ, CIC, Infection Prevention Practitioner II, Epidemiology Department, who works for a large healthcare system in the Dallas Fort Worth area. “I think Value-Based Purchasing has really helped to enhance the value an IP brings to the table since a large chunk of reimbursement to healthcare providers is tied to the reduction and elimination of hospital-acquired infections.”

Those holding the position of Infection Prevention Manager report a less than 1% increase, with an average annual salary of $99,655 in 2021, up from $98,880 in 2020. The same holds true for Infection Prevention Nurses, with an average salary of $80,037 in 2021, up less than 1% in 2020 at $79,614.

There were too few respondents in the Infection Prevention Practitioner, Employee Health, Quality/Risk Management and Educator categories to accurately report on 2021 salaries in these positions.

The vast majority of respondents (96%) were female, with an average yearly salary of $95,755, compared with men (4%) at $91,687 annually, the remainder of respondents (2%) chose not to reveal their gender.

A secure profession with increased recognition

The number of IPs who feel their jobs are “very secure” was up, at 53% in 2021 compared with 47% in 2020. An additional 38% of respondents feel their jobs are “somewhat secure.” Those who feel “somewhat insecure” or “very insecure” in their positions changed little, at 9% in 2021, compared with 10% in 2020.

“There is job security in this role due to the Centers for Medicare & Medicaid Services (CMS) and state health department reporting requirements,” said Jessica L. Swain, MBA, MLT, CIC, Senior Infection Preventionist, Regional Resource, Quality Assurance and Safety, Dartmouth-Hitchcock, Lebanon, N.H. “Additionally, many infection preventionists work in dual roles with numerous responsibilities.”

Recruiter websites are full of open IP positions and interim positions, according to Andrea Harper, MS, MLS, CIC, CPPS, CPHQ, Infection Control Manager, LRGHealthcare, in Laconia, N.H. She notes that IPs who are willing to travel or relocate often have an opportunity to increase their salaries. Harper also points out that IP burnout is extremely high, with many IPs retiring early because of the strain of the pandemic.

“When COVID hit, it felt like 200% of your job was dedicated to COVID infection prevention/communicable disease reporting and emergency preparedness mitigation strategies,” Harper commented.

“I see job postings listed often and it sometimes takes months to fill positions,” Bassett added.  “The need for experienced IPs is great but the supply is limited since it is a fairly niche specialty within the healthcare world and takes quite a bit of time to become familiar with all aspects of an IP’s role and obtain competence in all facets of infection prevention.”

When asked if they believe their facility’s’ C-suite appreciates and understands their role in providing good patient care while managing costs, nearly half (49%) responded “yes,” similar to last year (51%).

“Overall, I feel that the IP role is not completely understood by most administrations,” said Harper. “If CMS and other accreditation agencies did not require infection prevention oversight, I fear that IP positions would be reduced or cut.”

“Infection preventionists work hard to engage healthcare leaders and healthcare workers in infection prevention practices, but the connection of these practices to quality care, positive patient outcomes and cost avoidance is not always apparent,” said Swain. “Our team has spent years building relationships with departments throughout the hospital and ambulatory clinics in order to engage healthcare leaders and healthcare workers in infection prevention best practices, but prior to these engagement efforts most healthcare workers thought that IPs were the hand hygiene police. Now we are seen by most as a resource available to help.”

“Our role as subject matter experts increased exponentially during the pandemic and we were seen as the ‘go-to’ with many decisions healthcare organizations had to make, which elevated the importance of infection preventionists across the country,” said Ashley Conley, MS, CIC, CPH, CHEP, Director, Infection Prevention, Catholic Medical Center in Manchester, N.H., and President, New Hampshire Infection Control and Epidemiology Professionals.

Education and certification on the rise

As in past years, salary is tied to education, with pay increasing alongside level of education achieved. Those with high school diplomas as their highest education level report earning $57,500 on average annually, Associate degrees $75,340, Bachelor’s degrees $90,544 and post-graduate degrees $108,794.

Continuing education and certification spiked among survey respondents in 2021. More than three-quarters (76%) of IPs surveyed are Registered Nurses (RNs), up from 49% in 2020, and 17% are Medical Technologists, compared with 8% last year. There was also a huge jump in IPs who are certified by the Certification Board of Infection Control and Epidemiology (CBIC) at 66% in 2021, compared with 35% in 2020.

“The pandemic has shown that well-educated and -trained infection preventionists with departments that have adequate resources can make a big difference in preventing infections which demonstrates the need for job security,” said Conley. “Having a staffed infection prevention department, in many ways, is like having a subspecialty. Not all facilities - especially small facilities or those in rural areas - have the resources to have a robust or dedicated IP team. Fortunately, in a place like New Hampshire, infection preventionists work together to support each other with best practices and knowledge sharing, to the benefit of all patients.”

At Dartmouth-Hitchcock, the IP team created new senior and associate IP positions as a way to offer new IPs a road to advancement, according to Swain.

“My role as one of the two senior IPs has expanded my work to the hospital system and community group practices,” she stated. “In addition, the IP team has expanded its efforts to provide education and resources to all departments within the hospital that come in contact with patients or patient care areas, as opposed to only those providing direct care. We felt that this was an important step since so many non-clinical departments play a big role in how we care for our patients as well.”

Certification paid off for Harper. She began a new job as a Quality Coordinator in February 2020, in her words, “at the beginning of the COVID pandemic before we fully understood the future impact to our nation and the world.” In March 2020, her employer allowed her team to work remotely, but in April it furloughed her and another 600 employees. At the end of May 2020, the facility’s IP Director resigned and because Harper was certified and had recent past experience as an IP, she was hired for the open position.

“I hit the ground running trying to learn a new organization, orient to a new IP department and acclimate in the middle of a pandemic,” she commented. “I am very grateful to have a supportive supervisor, as well as inherited an established infection control team.”

Region and facility type again impact pay

The majority of survey respondents this year are employed by standalone hospitals (60%) and IDN/alliance/multi-group health facilities (32%), with the latter reporting the highest average annual salary ($104,341/year). IPs working in behavioral/psychiatric health facilities had the next highest reported pay ($92,700/year), followed by standalone hospitals ($92,616/year), long-term acute care facilities (LTAC) ($90,000/year), surgery center/ambulatory center ($85,100) and clinics ($63,333). Those working in the largest facilities (over 1,000 beds) earned the most at $129,937 annually, while those in the smallest facilities (0-25 beds) reported the lowest pay at $73,770.

Location matters when it comes to pay. IPs working in healthcare facilities in suburban areas earned the most at $106,296, followed by urban facilities at $104,431 and lastly rural at $79,763 annually. As in previous years, IPs working in the Pacific region of the U.S. reported the highest pay on average at $136,077, which is up from $107,857 in 2020.

Pandemic drives broader roles and responsibilities

According to the IPs surveyed, COVID-19 has affected the profession in many different ways. The top impacts reported are work hours (92%), broadened scope of responsibilities (87%), job satisfaction (58%) and staff shortages (53%).

“The COVID-19 pandemic has impacted and challenged every infection preventionist in ways one would not have dreamed of,” said Muriel. “We have known that an infectious disease X was looming in perhaps the not-too-distant future. However, the daunting logistics and extreme situations of COVID-19 could not have been anticipated.”

“Infection preventionists have been working longer hours creating new policies and procedures to keep healthcare workers and patients safe during the COVID-19 pandemic,” noted Swain. “We have taken on additional responsibilities including 24-hour call, personal protective equipment training and fit testing, and supplementary rounding on COVID units to answer any questions staff may have.”

“Many infection preventionists jumped in to help in many different ways during the pandemic, often working many long hours and having many sleepless nights,” added Conley. “In my infection prevention department, we jumped in to assist with fit testing staff, training staff on COVID-19 precautions and working with Employee Health to test and conduct contact tracing for COVID-19 positive employees. We continue to have a very active role in our Incident Command Center and worked with the PIO to speak with the media.”

When asked what aspects of COVID-19 have most impacted their work, the top response was the need to implement new infection prevention protocols (96%), followed by personal protective equipment (PPE) shortages (76%), patient volumes (52%) and staff shortages (52%). The majority of IPs surveyed (79%) said they have been asked to take on other roles and responsibilities during the pandemic.

Bassett describes how a large portion of each day is dedicated to answering calls and emails about COVID-19, reporting new COVID-19 infections to the health department, ensuring COVID-19 patients are properly isolated or ensuring their isolation is discontinued at the appropriate times, following up on clusters and potential outbreaks, meetings about COVID-19, process deviations, supply chain disruptions, immunizations, and educating staff and IPs themselves on changes to Centers for Disease Control and Prevention (CDC) guidance on the pandemic.

As Bassett points out, IPs have had to manage COVID-19 on top of all of their other responsibilities, including mitigation and tracking of other dangerous and costly infections, as well as all of the other tasks that fall under an IP’s purview.

“Even though a large amount of time is devoted to COVID-related things, we still have all the same other IP duties to tend to like healthcare acquired infection (HAI) surveillance, National Healthcare Safety Network (NHSN) requirements, reporting to the Health Department, construction permits and Infection Control Risk Assessments (ICRA), regulatory activities, audits, Environment of Care (EOC) rounds, etc.” Bassett added. “We don’t have more time available in the day, so we have to be extremely efficient to get everything done, the days fly by so fast because we are constantly pulled in so many directions.”

Among those surveyed, 37% of IPs say they perform duties related to employee/occupational health, 33% NHSN requirements, 25% immunization/vaccination (up from 9% in 2020), 18% quality performance management, and 17% Environment of Care (EOC) Safety management.

“Unfortunately, the pandemic does not stop other infections,” said Swain. “IPs continued to perform the required surveillance and reporting, as well as train and educate healthcare workers on basic infection prevention best practices. We also continued our Joint Commission regulatory readiness efforts throughout the pandemic.”

IPs throughout the care continuum

With clinicians outside of the hospital (e.g., physician offices, clinics, long-term care sites, etc.) bearing much of the burden for testing and treating COVID-19 patients, and administering vaccinations, the vast majority of IPs surveyed (80%) say they have been asked to assist with infection prevention efforts in non-acute settings.

According to Harper, many long-term care facilities did not have a designated IP prior to the pandemic. Rather, the role was often performed by the Director of Nursing, Clinical Educator or other staff member.

“I suppose the COVID pandemic has had some positive outcomes,” she says. “One is the recent CMS implementation of a nursing home training program for frontline nursing home staff and nursing home management. Both frontline caregivers and managers will be able to increase the knowledge they need to stop the spread of COVID-19 in their nursing homes. In the future, I hope CMS provides more definitive guidance regarding the number of IPs required for each organization based on size, patient acuity, and if they also have oversight of long-term care facilities, ambulatory surgery centers, urgent cares and the number of outpatient practices, etc.”

“In my infection prevention department, we have always worked within the hospital and in our ambulatory care practices, but the pandemic certainly increased our education, rounding and partnerships with the ambulatory practices to help them plan and respond to the pandemic,” says Conley.

Muriel explains how patients within her community are cared for by clinicians throughout the continuum – from the hospital and out to physician offices and other sites. Therefore, it is critical for IPs to closely communicate and collaborate with all care locations.

“During this COVID-19 pandemic, communication across hospitals and physicians’ offices has become of the utmost importance,” said Muriel. “The very patients who are seen in private physicians’ practices are the patients our maternity specialty hospital will care for in the delivery of their infants. It has been crucial for these practices to reach out to us to identify infection control and prevention needs for COVID-19. The outpatient clinics have also benefitted from a stronger enterprise with Infection Prevention, where there was a daily discussion with many of our clinics to provide guidance, and various other aspects of infection control issues. In this regard, this pandemic has incepted and strengthened ways of working amongst us all.”

Impact on PPE and other IP product categories

With healthcare organizations struggling with supply shortages over the past year, particularly PPE, it is no surprise that IPs reported strong involvement in product evaluation, education and training. Among those surveyed, 62 percent said they are part of a product evaluation committee, with 75% involved in determining product need (up from 56% in 2020), 78% performing product safety evaluation (up from 50%), 68% engaged in process improvement (up from 45%) and 50% involved in education (up from 30%).

Swain says her team participates on committees that approve new products and equipment coming into the hospital to ensure they meet infection prevention standards.

“Infection preventionists are involved in everything from choosing cleaning products, to assessing risk of construction, to monitoring hand hygiene, to reporting hospital-acquired infections and so much more,” she stated.

Conley notes how her medical center purchased a new temperature portal to assist with temperature screening at hospital entrances.

Bassett believes COVID-19 has “really opened people’s eyes to the potential for more pandemics or outbreaks of diseases in the future” and prompted her medical center to explore new technologies aimed at infection prevention.

“A lot of exploration has been conducted on utilizing non-shared or touchless technology for patients to register for appointments, check in, receive discharge instructions, etc.” said Bassett. “Anything that can be implemented where less touch occurs seems to be on the horizon; touchless checkout in the cafeteria, electronic temperature checking stations, anything like that seems to be on people’s wish lists. Also, a move to, or increase in other things like disposable items, UV light disinfection, machines that can kill airborne bacteria, viruses and fungi, as well as the way rooms and buildings are designed to keep people at a distance from each other and directional airflow technology. I think that healthcare leaders understand the value of having a high-quality IP team who can objectively evaluate the risk versus benefit of new systems and technology for disease reduction.”

The future of the IP profession

While COVID-19 has presented significant challenges to those in IP positions, necessitating long hours, greater responsibilities, struggles with PPE and staff shortages, and myriad other pandemic related factors, this past year has also shined a light on the importance of IP practitioners. There’s hope that increased awareness for the dangers of infection and the need for a preventative approach – for not just COVID-19 but all HAIs – will continue well into the future.

“I feel that the IP role is understood to a very limited degree,” said Bassett. “However, since the COVID-19 pandemic began, more people have become familiar with the words ‘infection prevention.’ People in general seem to have developed a new interest and knowledge of hand hygiene, disinfection of surface and disease transmission, amongst other infection prevention-related items. Since we are essentially the experts on COVID recommendations within the hospital, we receive calls and emails frequently for guidance on this topic.”

“In addition to COVID though, we have seen throughout the country, increases in hospital-acquired infections due to many different factors, like proning of COVID patients, isolation of patients, increases in the number of patients, supply shortages and changes, along with alterations to processes of care,” continued Bassett. “So these increases in other infections have also raised awareness about the IP’s role. I also believe that the cost related to these infections is on people’s radars, so we are seeing more guidance requested from IP on what can be done to mitigate these issues. I feel like more front-line staff are also familiar with terms like CLABSI, CAUTI, MDROs and SSI because of general awareness of infections and more discussions on infection related topics.”

“Infection prevention is one of the keys to quality healthcare, good patient outcomes and cost savings,” said Conley. “Although, infection preventionists are well known in many ways for this, I think the pandemic has shown what infection preventionists can bring to the table and I hope this acknowledgement continues long past this pandemic.” 

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