PHWR Public Health Weekly Report

The system for managing healthcare-associated infections in the Republic of Korea (ROK) has been continuously improved since the publication of the Guidelines for Healthcare-Associated Infection Control in 1992. Particularly, the Enforcement Regulation of the Medical Service Act was revised to include a provision on establishing Infection Prevention and Control (IPC) units and personnel responsible for infection control in 2003 as the significance of managing healthcare-associated infections was increasingly recognized. Subsequently, several amendments to the Enforcement Regulation resulted in the addition of standards for staffing for IPC units in 2012. Presently, Article 43(3) of the Enforcement Regulation of the Medical Service Act comprehensively stipulates the work scope of IPC units, including surveillance of healthcare-associated infections, analysis and evaluation of performance for managing healthcare-associated infections, staff training on infection control and health management of employees related to infections, and other matters required for infection control [1].

With the recent coronavirus disease 2019 pandemic, the work scope of IPC units has expanded, and medical institutions have become more aware of the importance of infection control [2]. The Study on the Efficacy of Nosocomial Infection Control report from the United States described the essential activities and structures for effective IPC activities, and the World Health Organization (WHO) also presented eight core elements for IPC activities at the national and medical institutional levels [3,4]. In the ROK, the standard for establishing IPC units has been strengthened to reflect such realities, including the expansion to medical institutions with 100 beds or more.

The expansion of the standard for establishing IPC units in medical institutions has led to an increase in the number of medical institutions implementing and operating new IPC units, as well as a continuous expansion of the work scope. Accordingly, an appropriate infection control guideline customized to the Korean medical reality, as well as the work scope and roles of personnel in charge, thereby supporting the efficient infection control, must be established.

Thus, the Korea Disease Control and Prevention Agency (KDCA) has promoted the development of the “Operational Guideline for Infection Prevention and Control Unit” to provide support for infection control in medical institutions by presenting roles, work methods, and procedures for the efficient operation of IPC units.

1. Development Process

1) Organization of the guideline development team

To develop an infection control office protocol applicable to medical institutions, a guideline development team was formed with 18 experts from various fields of IPC, including personnel working in IPC units of various medical institutions, such as the Korean Association of Infection Control Nurses and Korean Society for Healthcare-associated Infection Control.

2) Literature review

We reviewed the related literature to derive the role and work scope of infection control workers in medical institutions. First, the guideline development team selected two topics—“What is the role of infection control workers in medical institutions?” and “What is the eligibility for infection control workers in medical institutions?”—through a working group meeting, followed by searches for previous studies using the PubMed database. By screening articles published since 2010, we selected and reviewed 28 articles to examine the roles and work scope of infection control workers in Korean medical institutions and 11 articles to identify the appropriate standard of essential workers. In the review of 28 articles, we struggled to find studies that clearly delineated the roles and work scope of infection control workers but found abstract descriptions of the elements necessary for successful infection control and the tasks associated with each position. Additionally, the United States Center for Disease Control and Prevention and WHO provided toolkits for national-level infection control programs, listing the core elements that should be implemented in medical institutions or countries. A comprehensive literature review revealed that the main duties of infection control workers should include infection surveillance, standard precautions, transmission-based precautions, infection control education, reprocessing of medical devices, environmental infection control, infection management workers.

3) In-depth interview

To assess the adequacy of the practice of IPC units, the essential workers, and time required, we conducted in-depth interviews with 10 infection control doctors and 10 infection control nurses. They were recommended by relevant academic associations and societies and voluntarily participated in the study by type of medical institution, such as tertiary hospitals, general hospitals, hospitals, oriental medicine clinics, and psychiatric facilities. We collected their opinions about their work practices and the need for infection control work.

4) Survey of the infection control practice state

We conducted a survey to identify the current state of infection control practices. Referring to the literature review and in-depth interviews, a questionnaire was developed and validated by a group of experts consisting of infectious disease specialists and infection control nurses with a master’s degree or higher. We calculated the proportion of expert responses that were rated as “highly inadequate” or “inadequate,” which resulted in a content validity index of 1.0. This allowed the survey to be administered without any revision of questions. The survey comprised 49 questions, including infection surveillance (6), outbreak investigation (3), operation of IPC programs (5), control of infectious diseases (4), response to emerging/high-risk infectious diseases (2), infection management for workers (4), infection control training (4), hand hygiene (3), and reprocessing of medical devices (2), infection control of environment (5), antibiotic management (2), consultation and coordination (2), research (3), response to external evaluation (1), and others (3). The survey was administered to 100 medical institutions by the number of beds (95 medical institutions responded).

2. Development of the Guideline

In addition to the aforementioned literature review, in-depth interviews, and work status survey, we finalized the final guideline’s contents after comprehensively considering various standards, including relevant laws such as the Enforcement Regulation of the Medical Service Act, standards for accreditation of medical institutions, standards for calculating the fees for IPC, and standards for medical quality evaluation subsidies, and after reviewing the acceptability and applicability in the field through consultation with external experts (three infection control doctors and three infection control nurses). The guideline has been distributed through the KDCA website since July 5, 2024 [5].

The guideline mainly comprises the definitions and rationale for major duties, such as the operation of infection control systems, analysis and evaluation of infection control programs and their performance, infection control training, surveillance of healthcare-associated infections, and hand hygiene promotion activities, as well as the duties’ cycle, procedures, and contents. It also describes the eligibility of infection control workers. Additionally, it presents various examples to help workers understand their duties.

Moreover, the protocol answers frequently asked questions about the interpretation and application of relevant laws and regulations, such as the establishment and operation of IPC units, staffing and placement guidelines for IPC units, staff training for IPC units, and operation and organization of IPC units, through e-People (Drum for the people), as an appendix, with the goal of enhancing the understanding of infection control duties in small and medium-sized hospitals and nursing homes that have recently implemented IPC units.

The main contents of the protocol are as follows. As for the operation of the infection control system, medical institutions above a certain size should implement infection control units, such as IPC units and infection control committees, in accordance with relevant laws and regulations, such as the Medical Service Act, along which the protocol has presented the relevant legal standards. In terms of infection control project planning and performance analysis and evaluation, the guideline explains that each medical institution should undertake a series of processes from planning to implementation and evaluation of outcomes to effectively conduct the infection control activities. Regarding training for infection control, the protocol describes that medical institutions should provide training and information to ensure that healthcare workers have adequate competence in infection control and protect patients and caregivers from healthcare-associated infections. As for surveillance of healthcare-associated infections, an essential component of the measurement and effective control of infection outbreaks, the guideline describes data reporting methods, analysis cycles and information sharing within the corresponding medical institution. As for hand hygiene-promotion activities, it covers planning, monitoring, and improvement activities to promote hand hygiene among healthcare workers in medical institutions. Furthermore, it provides guidance and procedures for overall infection control activities performed by IPC units to ensure that infection control promotion activities are conducted in consideration of each medical institution’s work environment.

The Operational Guideline for Infection Prevention and Control Unit (Figure 1) was created to present standardized roles and work scope as a reference for efficient and systematic operation of IPC units in medical institutions. Since each medical institution has different work environments, such as bed size and staffing levels, the guideline’s application scope may also vary by medical institution. The KDCA recommends that IPC units at individual medical institutions should actively refer to this guideline when performing their duties but that the implementation of specific tasks should be adapted to the condition of individual medical institutions through consultation and collaboration with other departments within the institutions.

Figure 1. Operational Guideline for Infection Prevention and
Control Unit

The IPC units of medical institutions play a crucial role in improving the quality of IPC within the medical institutions, and promoting the proper operation of IPC units to enhance the level of IPC is necessary. Beyond simply establishing and operating IPC units, systematic curricula and guidelines for effectively operating IPC units should be prepared to secure workers with the appropriate competencies required for prevention and control of infections. The KDCA will disseminate and promote this Operational Guideline for Infection Prevention and Control Unit to medical institutions and make efforts to ensure that it is actively utilized. Additionally, the KDCA plans to continuously review the standards for installing, operating, and staffing IPC units, including the Enforcement Regulation of the Medical Service Act, based on the opinions of field workers and experts.

Ethics Statement: Not applicable.

Funding Source: None.

Acknowledgments: None.

Conflict of Interest: The authors have no conflicts of interest to declare.

Author Contributions: Conceptualization: HC, SHK, SKP. Data curation: HC, SHK. Supervision: SKP. Writing – original draft: HC. Writing – review & editing: HC, SHK, SKP.