Tania Bubb, PhD, RN, CIC, AL-CIP, FAPIC, senior director of infection prevention at Memorial Sloan Kettering Cancer Center, similarly describes enterprise risk leadership as “looking beyond individual infections and recognizing how infection risks can affect patients, staff, operations, finances, and organizational reputation.”

To fulfill that role, infection prevention needs a dependable connection to the people making organizational decisions.

“Infection prevention teams need the authority to raise concerns early, contribute to major decisions, and recommend action across the organization,” Bubb said. “This requires a direct and trusted relationship with executive leadership, not involvement only after a problem occurs.”

Making the business case

Securing that relationship requires explaining how a proposed intervention addresses a problem the organization needs to solve. Smathers points to visitor screening as an example of infection prevention translating clinical concerns into a request for financial and operational support.

“Visitor screening is a challenging process for so many healthcare systems,” she said. “You have multiple points of entry into a facility and many visitors and caregivers coming to see patients who are vulnerable to infectious diseases. Having senior leadership buy-in to support visitor screening was crucial to the success of this process.”

The case for investment required evidence connecting the proposed process to patient exposure.

“In order to influence a financial and resource commitment to support visitor screening, infection prevention needed to create a business case by showing both the rate of healthcare associated viral infections in our patients and the percent known to be exposed to symptomatic visitors,” Smathers said.

The example illustrates why a recommendation needs to explain both the risk and the work required to address it. Screening involves decisions about staffing, entry points, communication, and how visitors move through a facility. Presenting those requirements alongside the patient safety concern gives executives a fuller picture of what they are being asked to support.

Bubb recommends starting with “a clear explanation of the risk, who may be affected, and what could happen if the risk is not addressed.” Measures become more useful to organizational leaders when they connect infection outcomes with patient harm, treatment delays, additional hospital days, workforce impact, regulatory risk, and operational disruption, she said.

“A specific patient, patient population, or operational example can make the consequences more understandable.”

For purchasing and value analysis teams, the same approach can sharpen discussions about products and equipment. A recommendation should explain what problem a purchase addresses, what resources implementation requires, and how the organization will evaluate whether it works as intended. Where an alternative carries additional training or reprocessing needs, those requirements belong in the discussion before a purchasing decision is final.

Smathers also emphasized the relationship between infection prevention outcomes and organizational performance. She said the costs of healthcare-associated infections extend to patient harm and financial consequences, while infection metrics can also affect reimbursement, rankings, and ratings. Connecting improvement initiatives to those priorities helps leaders assess competing requests for funding.

The business case should remain specific to the intervention. A general statement about the burden of infections does not establish how much a particular project will save. Where local results or financial estimates are unavailable, teams can identify the assumptions they need to test and the outcomes they intend to track.

“Infection prevention priorities should be presented as part of the organization’s broader goals for patient safety, quality, workforce protection, and reliable operations,” Bubb said. “Recommendations should clearly describe the risk, the expected benefit, the resources required, and the consequences of delay.”

Bringing infection prevention into planning

Timing determines how much room an organization has to respond to a concern. An issue identified while teams are comparing options can inform the selection. The same issue discovered just before implementation may require changing a purchase, redesigning a space, or postponing a project.

Without early involvement, Bubb said, “organizations can find themselves ready to implement a major change only to uncover critical safety concerns at the last minute. That often leads to delays, redesign, or cancellation of the project, all of which can be costly and disruptive.”

She highlighted the importance of including infection prevention in decisions about clinical spaces, equipment, and care processes.

“Our role is to identify risks that may not be obvious during initial planning, such as cleaning limitations, water or ventilation concerns, or challenges with safely reprocessing equipment,” Bubb said.

For an equipment review, that means giving infection prevention and sterile processing an opportunity to examine how the device will be used, cleaned, stored, and returned to service. Questions about instructions for use, staff competencies, and compatibility with existing processes are easier to resolve while the organization still has options.

A useful planning discussion also considers responsibility after implementation. Who will train staff? Which department will confirm that the proposed workflow is feasible? How will problems be reported? Establishing those responsibilities helps connect the purchasing decision to the daily work that follows it.

Smathers emphasized the need for sustained relationships with facilities, project management, sterile processing, and supply chain. Those departments have their own committees and structures for decisions about construction, renovation, product evaluation, and reprocessing. Infection prevention needs a consistent opportunity to participate in that work.

She also called for access to the resources needed to develop subject matter expertise, including guidelines from the Facility Guidelines Institute and the Association for the Advancement of Medical Instrumentation.

“Involving an IP expert early helps to avoid patient safety concerns and costly re-work,” Smathers said.

Participation becomes more useful when teams share enough information to understand one another’s constraints. Purchasing may be working against an availability deadline. Facilities may be managing a project schedule. Sterile processing may need to assess whether existing staff and equipment can support a proposed change. Infection prevention’s recommendations need to account for those conditions while clearly explaining the risks.

“Effective collaboration starts with shared goals, clear roles, and early communication,” Bubb said. “Infection prevention should explain the clinical risk in practical terms while also understanding operational, financial, and supply constraints. The strongest decisions are made when each group’s expertise is respected, and the team works toward a solution that is safe, workable, and sustainable.”

Preparing for 2027

Looking ahead to 2027, both experts described a broad set of pressures that require coordination beyond the infection prevention department.

“One major risk that organizations should be preparing for is the ongoing impact of vaccine hesitancy and rise of vaccine-preventable diseases,” Smathers said.

She also identified severe weather and its effects on hospital environments as preparedness concerns, pointing to water damage from large-scale flooding and the potential for invasive mold infections. These issues connect infection prevention with facilities operations and recovery planning, including decisions about affected spaces and the resources needed to restore them safely.

Supply availability adds another complication. Smathers said shortages can require infection preventionists to evaluate replacement products quickly, sometimes with limited opportunity to educate staff before those products enter patient care.

A substitution therefore deserves a defined review process even when time is short. Purchasing teams can help by notifying clinical partners as soon as an interruption appears likely, identifying available alternatives, and gathering the information needed to compare them. Infection prevention can then assess relevant risks with the departments that will use or process the replacement.

The review should consider how the substitute changes the task. Different preparation, application, cleaning, or storage requirements may affect staff practice. A product that appears similar in a catalog may require a different workflow. Any necessary education should accompany implementation, with a clear way for staff to raise questions.

Bubb identified “emerging infections, antimicrobial resistance, supply interruptions, aging infrastructure, and increasing demands on a limited healthcare workforce” as areas requiring preparation. She also urged organizations to consider how construction, new technology, expanded outpatient care, and more medically complex patients may introduce risks.

“Preparedness must be flexible because the next major threat may not look like the last one,” she said.

That flexibility depends on knowing how decisions will be made when circumstances change. Hospitals can use planning discussions to identify who evaluates a substitution, who approves a revised workflow, and how affected departments receive the decision. The goal is to reduce uncertainty about responsibilities while preserving the ability to assess the specific situation.

Testing plans under operating conditions

A written plan provides direction, but an exercise can reveal whether staff have the information and resources needed to carry it out. Bubb identified shortages of trained staff, readily available supplies, clear decision-making, and reliable communication systems as common barriers to execution.

Exercises should “test how the plan works under real operating conditions,” she said.

For supply chain and infection prevention, that could mean walking through a disruption involving a routinely used product. Participants could examine how the shortage is communicated, how alternatives are reviewed, and how revised instructions reach the clinical setting. Such an exercise would test the connections between departments as well as the availability of supplies.

The follow-up matters as much as the scenario. If participants discover that nobody owns a decision or that necessary information is difficult to locate, the organization needs to assign the corrective work and confirm that it has been completed. Otherwise, the exercise documents a gap without improving readiness.

Smathers emphasized the need to keep plans current as organizations expand. New service lines, locations, and workflows can change how an existing response plan operates. Staff also need dedicated time to rehearse their responsibilities so they can carry them out when a real event occurs.

Growth planning creates an opportunity to address these needs before a service opens. Alongside equipment and staffing decisions, leaders can consider whether preparedness procedures cover the new setting and whether the departments supporting it understand their roles.

“Infection prevention should also be involved in growth planning so that new services, technologies, and facilities are designed with safety built in from the start,” Bubb said.

Protecting time for strategic work

The expectation that infection prevention will contribute to enterprise planning raises a staffing question. Leaders need enough capacity within their departments to maintain daily responsibilities while participating in purchasing reviews, construction planning, preparedness, and executive discussions.

Bubb identified data and analytics, education, project management, emergency preparedness, and leadership development as areas where additional investment may support that work. She also recommended reviewing how tasks are assigned.

“Organizations should review which tasks require infection prevention expertise and which can be automated, standardized, or shared with other teams,” she said. “Reliable data systems, clear workflows, and appropriate administrative and analytical support can reduce manual work.”

That review should examine the actual steps involved in a task. Moving a process into an electronic system does not necessarily remove the need for review, interpretation, or validation. Before assuming that technology creates additional capacity, leaders need to understand which activities it changes and which still require professional judgment.

Bubb described her department’s work with a data analytics team to optimize reports and streamline data collection. The work required planning and validation to ensure that the reports were reliable. She reported that improving those processes saved time and allowed infection preventionists to spend more time on critical work in clinical settings.

The example offers a useful way to evaluate technology investments: identify the work consuming staff time, determine whether a proposed change addresses it, and assess the result after implementation. A purchasing decision can include the support needed to configure and validate a system, rather than assuming those responsibilities will fit within existing workloads.

Staffing approaches also need to reflect the size and scope of the organization. Smathers said smaller facilities may need generalists who cover multiple responsibilities, while larger facilities or systems may benefit from specialized roles.

Specialization, she said, can support professional growth, develop deeper expertise for partnerships, and help departments use resources strategically. Support staff may also be able to take on work that does not require an infection preventionist’s expertise.

For a smaller department, the practical question may be how to participate consistently in essential decisions without attending every meeting. Teams can establish when an IP review is needed and what information should accompany a request. Larger systems may need clearer arrangements for how specialized expertise reaches local purchasing and operational teams.

Smathers emphasized that IP leaders need to trust their teams with departmental work and protect time for executive engagement. That requires an organizational commitment to coverage and delegation, so participation in strategic decisions does not depend on leaders continually absorbing more work.

Leaders can make that commitment concrete by reviewing the department’s upcoming responsibilities alongside its operating workload. A planned expansion, equipment conversion, or preparedness exercise should come with an assessment of the IP time required. When priorities conflict, executives need enough visibility to decide which work takes precedence and what additional support is necessary.

This approach also gives supply chain a clearer partner. A defined review process, an identified IP contact, and realistic expectations for turnaround can help teams plan purchases and substitutions. Urgent requests will still occur, but routine work can be organized so that clinical review happens while decisions remain open.

Hospitals need to give infection preventionists enough capacity to prepare for planning discussions, evaluate options, and follow through on decisions. Those responsibilities should inform how leaders staff the department and assign its work.

“Strategic responsibilities also need protected time,” Bubb said. “They cannot simply be added to an already full workload.”