Address
Form of work- Job Objective: A brief overview of the position.
- Manages the planning, development, implementation, evaluation/continuous improvement of the Infection Prevention and Control program for the hospital and associated ambulatory care clinics. Also manages the physician peer review RN Outcomes Analysts and the Covid-19 Infection Prevention Incident Command Center (IPICC) staff
- Reports to
- Administrative Director – Quality and Performance Improvement
- Supervises
- RN Infection Preventionists
- RN Outcomes Analyst (physician peer review)
- Infection Prevention Incident Command Center (IPICC) staff
- Ages of Patients
- Neonate/ Infant
- Pediatric
- Adolescent
- Adult
- Geriatric
- Blood Borne Pathogens
- High Potential
- Qualifications
- Education
- Required: BSN
- Preferred: Master's degree in nursing, public health, epidemiology, environmental health, microbiology or other public health related field
- Licensure/Certification
- Required: California RN License
- Preferred: Certification in Infection Control; CIC® credential awarded by the Certification Board of Infection Control and Epidemiology, (CBIC)
- Experience
- Required: Minimum five (5) years of experience as an Infection Control Professional
- Required: Minimum three (3) years of experience in an established Infection Prevention/control program in an acute care hospital including minimum (2) years of program management
- Preferred: Demonstrated knowledge/experience in leading performance improvement initiatives
- Education
- Essential Responsibilities
- Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations
- Program Management:
- Manages the planning, development, implementation, evaluation/improvement of Infection Prevention and Control services/programs that meet or exceed established standards/performance measures for quality, patient satisfaction, cost, employee quality of work life, physician and department satisfaction, clinical outcomes and regulatory compliance
- Develop, evaluate and modify the annual surveillance plan based on the population(s) served, services provided and analysis of the surveillance data
- Manages Infection Prevention and Control services/programs in the hospital and ambulatory clinics. Ensures that services/programs are of uniform and consistent value, quality, performance and cost throughout all departments in the hospital and outpatient clinic buildings
- Manages the development and implementation of evidence-based interventions designed to reduce/eliminate the risk for Healthcare Associated Infections (HAIs) and/or disease transmission
- Acts as the Infection Prevention and Control liaison/consultant for the entire Medical Center and/or delegates appropriate duties
- Manages surveillance activities and the monitoring, reporting and development of applicable intervention(s) for infection trends (e.g. National/Regional/ Divisional Indicators, Board Report, facility specific indicators, etc.) in the acute and ambulatory settings
- Develops and reviews Infection Prevention and Control policies and protocols
- Manages the planning, development, implementation, evaluation/improvement of physician peer review processes that meet or exceed established standards/performance and medical staff regulatory compliance.
- Manages the planning, development, implementation, evaluation/improvement of the Covid-19 Infection Prevention Incident Command Center (IPICC) processes, including but not limited to, the management and notification of Covid-19 positive & Covid-19 exposed staff & patients.
- Design and Deliver Education:
- Manages the preparation and response to emerging infectious disease threats and/or exposures
- Serves as subject matter expert who assists medical center leadership team in internal or external disaster response/mitigation
- Manages the compliance with applicable regulatory requirements through interpretation of Regulatory Standards, investigation of disease outbreaks and exposures, surveillance and reporting communicable diseases to the CDPH as required
- Manages the development and review of Infection Prevention and Control Standards of Care Policy and Procedure manuals
- Serves as subject matter expert who assists medical center leadership team in internal or external disaster response/mitigation
- Provides expert review and consultation for all facility construction/remodels as described in the Organization's Pre-Construction Risk Assessment (PCRA)
- Develops, implements and improves systems, methods, processes to evaluate/improve performance and quality outcomes/measures for Infection Prevention and Control services/programs throughout the entire healthcare system
- Utilize Performance Improvement (PI) methodology as a means of enacting change
- Define the scope of the project and select appropriate PI tools to aid in efficiency, reliability, effectiveness and ensure sustainability of the initiative
- Participate in PI committees, teams and initiatives as indicated
- Assess the risk of occupational exposures to infectious diseases
- Develop (or assist with) rates and trends of occupational exposures
- Develop (or assist with) immunization and screening programs
- Pursue professional growth and development of required knowledge and skills
- Maintain certification and licensure requirements
- Establish at least one professional goal per year
- Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and reports suspected violations
- Develops and maintains effective communication with administrative/management staff and physicians
- Participate in an Infection Prevention and Control professional organization/association (i.e. APIC)
- Consult and collaborate with local, state, and federal public health officials, and community health organizations.
- Involve multidisciplinary teams to ensure changes are vetted and approved by all stakeholder groups
- Develops and maintains excellent, collaborative relations with key stakeholders/departments including but not limited to: Employee Health, Nursing, Perioperative, Perinatal, Emergency Services, Urgent Care, and various physician specialties
- In partnership with Infection Prevention staff and departmental managers develops, monitors and modifies Infection Prevention and Control Program department specific goals/objectives as appropriate
- In partnership with the Sterile Processing Director/Manager provides expert leadership and knowledge to assure all sterilization and disinfection processes throughout the Hospital and Ambulatory Clinics are in compliance with all national and state standards
- Work collaboratively with others providing direction when necessary
- Contribute to the development of healthcare providers through education and mentorship
- Manage human resource processes; provides supervision and leadership to Infection Prevention staff; hires, fires, promotes, demotes, manages and evaluates staff performance and development
- Prepare and deliver Infection Prevention presentations to external groups and organizations
- Together with the Infection Control Committee Chair, initiates and directs research projects and epidemiological investigations of significant clusters of infection or serious communicable disease concern
- Critically evaluate research and evidence based practices and incorporate appropriate findings into routine practice
- Integrate evidence-based practices into policies, guidelines, protocols and educational strategies
- Identify barriers for implementation and develop strategies to minimize or remove barriers
- Demonstrate expertise in Infection Prevention software and technology
- Collaborate with Information Technology to create meaningful electronic reports to enhance Infection Prevention initiatives
- Consider the financial/safety implications and clinical outcomes when making recommendations, evaluating technology and products and developing policies and procedures
- Use a systematic approach to evaluate costs, benefits and efficacy
- Manages and/or reduces costs
- Assist with development and maintenance of departmental budgets
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