The Manager of Epidemiology and Infection Prevention reports to the Lifespan Director Epidemiology and Infection Control.
Under general supervision and within Lifespan established policies and procedures manages the Lifespan systemwide program designed to identify reduce and prevent healthcare-associated infections.
This position ultimately reports up to Lifespan s VP of Quality & Safety / Operational Excellence (OpX) who in turn reports to Lifespan s Executive Vice President of Quality & Safety and Chief Nurse Executive with strong collaborative relationships through the Operational Excellence organizational structure to affiliate Chief Nursing Officers / Chief Medical Officers and Lifespan Physician Group leadership team.
and collaborates with public health agencies and interdisciplinary team members as needed and in support of our inpatient hospital units / locations departments and ambulatory and outpatient units / locations.
Additionally the Manager of Epidemiology and Infection Prevention monitors quality assessment / performance improvement (QAPI) monitoring requirements of the ambulatory and outpatient infection control program and ensures that The Joint Commission (TJC) Centers for Medicare and Medicaid Services (CMS) RI Department of Health and other regulatory agency requirements (when applicable to inpatient or outpatient settings) are met.
In collaboration with the Medical Director and the Director of Epidemiology and Infection Control assists in the development and evaluates Lifespan s infection prevention and control program across all care settings with focused leadership and support.
In collaboration with the Medical Director and the department Director provides direct supervision for the Infection Preventionists assigned to Lifespan inpatient or outpatient settings and assists in the development implementation and evaluation of a comprehensive and aligned Infection Prevention and Control Plan for assigned affiliate(s) ensuring external regulatory and accreditation expectations are met.
Ensures infection Preventionists competency evaluation against available professional standards (e.g. Association for Professionals in Infection Control and Epidemiology APIC competency domains).
Assists director with the assignment of trained staff to monitor ongoing surveillance processes submit infection information to NHSN / CMS and the RIDOH when necessary and any additional infection control activities.
Provides project management data gathering and analysis and decision-making support for department initiatives focused on infection prevention safety measures reporting and improvement.
Identifies issues through failure analysis; leads or assists improvement teams in understanding issues and improvement opportunities.
Provides tracking and oversight for all performance improvement plans and ensures implemented actions are effective by requesting and evaluating objective data in support of infection prevention outcomes in varied inpatient and ambulatory / outpatient settings.
Notifies the Director when issues arise and supports or facilitates corrective action as needed. Leads and facilitates improvement initiatives addressing inpatient infection control concerns using Lifespan established process and performance improvement tools and approaches.
Develops action plans in response to identified trends in infections / exposures and facilitates the execution and monitoring of action plans to address identified root causes.
Collaborates with staff and physicians across the system to achieve desired outcomes in response to findings identified through the root cause analysis process.
Identifies and addresses gaps and inefficiencies in clinical practice as related to infection prevention efforts. Collaborates with patient care and physician leaders to provide stewardship over antibiotic usage and diagnostic laboratory tests.
Assists the Director in planning activities to ensure dissemination of information for hospital-wide infection prevention improvement efforts.
Collaborates with Risk Management Department Nursing Departments Pharmacy Departments and other departments across the Lifespan system to ensure optimal workflow and accurate reporting / sharing of infection control data and to promote a culture of zero harm.
Reviews appropriate literature to maintain and enhance knowledge of federal state and voluntary regulatory standards that relate to infection prevention practice and program components and Joint Commission accreditation.
Prepares and / or assists Director in preparation of patient safety reports to the Lifespan Board Quality Oversight Committee Lifespan Ambulatory Quality and Safety Council Hospital Acquired Infections (HAI) Council Lifespan Physician Group Board Lifespan Physician Group quality forums affiliate Medical Staff Executive Committees and other affiliate and medical staff infection control quality improvement and patient safety / zero harm committees.
Identifies and presents best practices and other tactics needed to support infection prevention and control. Presents educates frontline staff and other key stake holders on tactics and execution.
Monitors and make suggestions to improve best practices and their integration into existing systems. Provides ongoing support to patient care staff and providers on best practice techniques to eliminate and mitigate potential sources of infection.
Demonstrates technical knowledge of the electronic reporting system for the management and reporting of exposures environmental concerns and identified unsafe conditions and other infection prevention issues and submission of data to required federal and state agencies (as needed.
Addresses environmental concerns as needed across all care settings conducts infection control risk analyses as needed for physical and environmental construction renovation and maintenance.
Responsible for the recruitment and selection of infection prevention staff. Supervises assigns work evaluates performance provides guidance / counsel ensures compliance of policies and procedures and makes recommendations for corrective actions.
Acts as a resource : provides training and oversees staff.
Performs other duties as assigned.
PERFORMANCE STANDARDS :
Effective utilization of resources.
Management of continuous quality improvement.
High quality high value patient-focused services.
Development and implementation of effective quality programs.
Performance improvements year-to-year.
Positive feedback from peers directs reports and staff.
Other information :
QUALIFICATIONS-EDUCATION / CERTIFICATION :
Baccalaureate degree in nursing Public Health or Clinical area with a strong working knowledge of health care processes structures and terminology related to infection prevention and control.
Master s or advanced degree preferred. Certification in Infection Control is required and is a condition of continued employment.
Strong verbal / written and presentation skills required. Six Sigma / Lean Green Belt or Black Belt certification and TapRooT (Root Cause Analysis-RCA) desired or completed within 24 months of accepting position.
Five years of relevant experience in infection prevention and control in health care settings facilitation of small and large groups / project teams performance improvement systems and / or process improvement methods and standards.
Project management experience preferably in a large complex healthcare organization is desired. Knowledge of The Joint Commission (TJC) and specific state agency infection control standards is required.
SUPERVISORY RESPONSIBILITIES :
Supervises up to 10 FTEs.
Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.
Lifespan is a VEVRAA Federal Contractor.