Letter to the Editor A new paradigm for infection prevention programs: An integrated approach David J. Weber MD, MPH 1,2 , Emily E. Sickbert-Bennett PhD, MS 1,2 , Lauren M. DiBiase MS 1 , Brooke E. Brewer BSN, MS, RN, CNML 1 , Mark O. Buchanan BS, BSN,RN, RN-BC 1 , Christa A. Clark BSN, RN, RN-BC 1 , Karen Croyle BSN, RN 1 , Cynthia M. Culbreth BSN, RN, RN-BC 1 , Pamela S. Del Monte MS, RN-BC 1 , Sherie Goldbach 1 , Lori Hendrickson MPH, BSN, RN 1 , Pamela B. Miller BSN, RN 1 , Natalie A. Schnell BSN, RN, RN-BC 1 , Katherine M. Schultz MPH, BSN, RN 1 , Amy Selimos MSN, RN, PCNS-BC 1 , Lisa Stancill 1 , Shelly K. Summerlin-Long MPH, MSW, BSN, RN 1 , Lisa J. Teal BSN, RN 1 and Sharon C. Thompson MT, ASCP 1 1 Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, North Carolina and 2 Infectious Disease Division, Medical School, University of North Carolina, Chapel Hill, North Carolina To the Editor—Infection control (now infection prevention) in healthcare settings is a relatively young medical discipline dating back only to the 1970s. Nationwide surveillance for healthcare- associated infections (HAIs) was initiated by the Centers for Disease Control and Prevention (CDC) in 1970 via the National Nosocomial Infections Study (NNIS). The scientific foundation for infection prevention was established by the Study on the Efficacy of Nosocomial Infection Control (SENIC) project that demonstrated essential components of effective programs included (1) conducting organized surveil- lance and control activities and (2) having a trained, effectual infection control physician, (3) having an infection control nurse per 250 beds, and (4) having a system for reporting infection rates to practicing surgeons. 1 The SENIC project also reported the growth in the number of hospitals having an infection prevention nurse (from 6% prior to 1970 to 80% in 1977). 2 However, by 1996 only 47.6% of facilities has a hospital epidemiologist. 3 The initial focus of infection prevention departments was sur- veillance for HAIs, outbreak evaluations and control, and reduc- tion of device-associated HAIs. In the past 50 years, the spectrum of activities of an infection program has dramatically increased to include the following: (1) surveillance and prevention of multidrug-resistant pathogens (eg, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, β-lactamase–producing gram-negative bacilli, carbapenem resist- ant Enterobacterales, Candida auris); 4,5 (2) prevention of Clostridioides difficile; (3) recognition and mitigation of biothreats (eg, anthrax), and emerging infectious diseases (eg, Ebola SARS- CoV-2); (4) public reporting to multiple agencies rating hospitals; and (5) financial penalties for hospitals by the Centers for Medicare & Medicaid Services for “poor” performance including high HAI rates. The most important of these may be the paradigm shift from “control” of HAIs to “prevention” of all HAIs (ie, the goal is now zero HAIs) (Table 1). Infection prevention programs have access to several new tools to aid in the prevention of HAIs: (1) widespread use of electronic medical records that allow more complete and efficient access to medical records documentation; (2) improved information tech- nologies that allow for data mining, manipulation of large data sets, easier use of sophisticated statistics, and machine learning 6 ; (3) improved microbiology laboratory methods that aid in deter- mining microbe transmission pathways and outbreak investiga- tions (eg, MALDI-TOF and whole-genome sequencing) as well as rapid microbe identification methods (eg, PCR) 5,7 ; and (4) qual- ity improvement methodology that allows a more systematic approach to identifying problems and then implementing evi- dence-based infection prevention efforts. As infection prevention has grown both more complex but also more sophisticated, infection prevention programs have 2 options as they adapt to this new reality. First, their staff can continue to be composed of hospital epidemiologists and infection preventionists with the infection prevention department reaching out to other hos- pital departments for expertise in quality improvement, informatics, advanced epidemiologic and statistical methods, advanced microbio- logic methods, and compliance monitoring and coaching. 8 Second, they can accept the new paradigm of evolving into a truly integrated department (Table 1). Based on our experience at the University of North Carolina Medical Center, the advantages of an integrated department are substantial and include the following: (1) ability to approach all infection prevention and control activities (eg, outbreaks, HAI reduction, emerging diseases and pandemics) using a multidis- ciplinary approach; (2) rapid access to required expertise; (3) ability to ensure needed expertise for long-term improvement projects; (4) cross pollination of infection prevention knowledge with other disci- plines, improving ability to reduce HAIs; and (5) taking the lead in planning for future pandemics. 9 Most importantly, staff with training in nonclinical medicine (eg, quality improvement, informatics, and compliance monitoring) have time to also develop a broad and deep Author for correspondence: David J. Weber, MD, MPH, E-mail: David.Weber@ unchealth.unc.edu Cite this article: Weber DJ, et al. (2022). A new paradigm for infection prevention programs: An integrated approach. Infection Control & Hospital Epidemiology, https:// doi.org/10.1017/ice.2022.94 © The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America Infection Control & Hospital Epidemiology (2022), 1–4 doi:10.1017/ice.2022.94 https://doi.org/10.1017/ice.2022.94 Published online by Cambridge University Press