Infection Prevention Director, Nurse

Del Sol Medical Center in El Paso, TX

  • Industry: Healthcare - Nursing - Nursing Manager
  • Type: Full Time
  • Compensation: $111,140.00 - 177,500.00 / Year*


SHIFT: No Weekends

SCHEDULE: Full-time

About Del Sol Medical Center:
Since 1974, Del Sol Medical Center has provided quality healthcare to El Paso and the surrounding region. As a full-service, acute care hospital in East El Paso with a Level II Trauma designation in Emergency Services, we continue to expand our services to meet the growing needs of our tristate community, providing special expertise in Cardiology, Maternity & Child Services, a Level III NICU, a Center of Excellence designation for our Bariatric Clinic, a Level II Trauma Center, and a newly renovated 32-bed Rehabilitation Hospital.

The physicians, nurses and staff at our 350-bed hospital are committed to providing the highest quality care with compassion and integrity.

purpose of the position.)


Director of Infection Prevention is responsible for facility-wide activities of
evaluating and managing infection prevention risks to patients, visitors and
personnel through extensive surveillance and an effective reporting system. The
Director functions as the hospital and enterprise-wide clinical expert in the
prevention and Infection Prevention Plan of infection and is responsible for
the facility and enterprise -wide planning and implementation of the infection
prevention and Infection Prevention Plan program. The objective of the Infection
Prevention Program is to minimize both the risk of and the probability of
transmission of infection, thus providing a better and safer hospital for its
patients and personnel.? This position is
responsible for the coordination of the Infection Prevention Program.

GENERAL RESPONSIBILITIES (The essential responsibilities and accountabilities
of this position including interactions with other departments and outside
vendors, if applicable, in PRIORITY order:
  1. Works directly with the Infectious Disease Medical Director
  2. Develops, coordinates and manages the review and assessment
    functions of the Infection Prevention program
  3. Initiates, develops and delivers education programs on Infection
    Prevention and prevention for staff development and regulatory agency
  4. Represents the Infection Prevention program through membership on
    hospital and medical staff committees;
  5. Serves as liaison and interfaces with all regulatory agencies, and
    the health care community concerning infection prevention issues to assure
    hospital compliance with infection prevention regulations
  6. Performs targeted surveillance and prepares reports and statistics
    on healthcare-associated infection rates
  7. Develops and promotes consistent application of infection
    prevention policies and procedures
  8. Supports emergency management activities and EOC through
    participation on environmental rounds, bioterrorism and patient influx
    planning, emergency response drills
  9. Identifies situations that may present an infectious hazard to
    patients, staff, or visitors. Take appropriate actions to eliminate
  10. Identifies communicable disease cases to be reported to the
    appropriate health department.
  11. Leadership abilities in
    planning and implementing Infection Prevention Programs, and in serving in a
    consultant/teaching role. Organizational ability in planning, coordinating,
    & assessing data, and in making appropriate recommendations. Prioritize
    projects and data collections to meet deadlines.
  12. Excellent verbal and
    written communication skills. Intermediate level skills with Microsoft Office
    (i.e. Word, Excel, PowerPoint, etc.)
  13. Ability to analyze recorded
    hospital acquired infections, and to provide periodic trended statistics and
    focused reviews to the Infection Prevention Team/Committees
  14. Coordinate and lead
    quarterly activities/drills related to the HCA Infectious Disease Response Team
  15. Oversees and conducts
    surveillance activities throughout all areas of the hospital.?
  16. Facilitates the integration
    of principals of infection prevention and Infection Prevention Plan into the
    planning a day-to-day activities of the hospital and evaluates risk for
    infection at all campuses.
  17. Works flexible hours in
    order to adequately meet the needs of employees working all shifts.
  18. Ensures education of
    patient/family members is consistent and compliant with The Joint Commission,
    National Patient Safety Goals, CDC Guidelines for Isolation, State and other
    regulatory standards.
  19. Along with the nursing
    staff, participates in patient and family education, based on learning needs,
    abilities, leaning preferences, and readiness to learn based on age, level of
    understanding, and cultural norms. Educates directors, managers and staff in
    matters related to infection and disease transmission or prevention and in
    isolation procedures and Infection Prevention and Infection Prevention Plan
  20. Conducts patient inspection
    when requested by staff nurses, in regard to risk assessment of skin rashes,
    shingles, or other potentially communicable disease processes present on
  21. Compiles statistical
    database for reportable diseases. Submits data to the National Healthcare
    Safety Network (NHSN) per state regulations, and CMS requirements.
  22. Examines microbiology
    reports of positive isolates to recognize trends, identify hospital acquired
    infections, and for statistical compilation.
  23. Conducts retrospective and
    prospective chart audits to determine hospital onset or community acquired
  24. Instructs nurses, other
    clinicians, and ancillary staff members regarding organisms and associated
    risks to the environment, other patients, or staff members.
  25. Completes rounds of
    clinical areas to identify patients who may have infections of epidemiological
    significance. During rounds of clinical areas, identifies patient care
    practices for compliance with acceptable Infection Prevention and Infection
    Prevention Plan measures.? (i.e.-hand
    hygiene compliance).
  26. Participates in Department
    Director meetings as subject matter expert in the prevention and Infection
    Prevention Plan of infection(s).
  27. Maintains a working
    relationship with contracted Hemodialysis Clinical Staff.
  28. Reviews water samples for
    monthly water cultures of primary, secondary and portable dialysis water
    Reverse Osmosis and/or Deionized systems. Reviews water specimen for annual
    AAMI water quality standards testing. Reports all results of water cultures to
    the Infection Prevention Committees on a quarterly basis.
  29. Works with Facilities
    Management to correct any malfunction or positive culture/assay result.
  30. Works with contracted
    nursing staff to ensure annual dialysate AAMI water sample compliance.
  31. Communicates patient care
    needs with physicians and plans for appropriate interventions.
  32. Attends continuing
    education programs to maintain or enhance skills and knowledge appropriate for
    the position.
  33. Adheres to The Joint
    Commission, CDPH, OSHA, CMS, and other regulatory standards.
  34. Monitors staff compliance
    with Infection Prevention policies regarding the disposal of sharps and
    biomedical waste. Monitors staff compliance with required personal protective
    equipment. Monitors staff compliance with hand hygiene practices and provides
    reports to the Infection Prevention Committees.
  35. Reports isolation activity
    and problems involving Infection Prevention and the Infection Prevention Plan
    to Nursing Leadership and the Infection Prevention Committees.
  36. Implements and revises Infection
    Prevention plan and policies on an ongoing basis as needed.
  37. Conducts annual review and
    revision of the Infection Prevention plan, establishing annual goals.
  38. Maintains Infection
    Prevention patient databases (e.g. TheraDoc) in a HIPAA-safe method.
  39. Compiles infection rates
    for surgical site infections, catheter associated urinary tract infections,
    Adult and neonatal ventilator-associated events, adult and neonatal bloodstream
    infections, C-Difficile infections, and other mandated infections. Reports monthly
    results to Infection Prevention committees on a quarterly basis.
  40. Compiles additional
    statistics or risk factors for infection on an ad-hoc basis.
  41. Participates with Plant
    Operations and outside Contractors in completion of the ICRA (Infection
    Prevention Risk Assessment) for all work within the confines of the hospital
  42. Conducts surveillance of
    all maintenance / renovation or new construction work to identify ongoing risks
    for patients, employees, and visitors to the facility.
  43. Monitors posting of the
    ICRA permit on all construction/maintenance locations within the facility. Provides
    in-service education to construction crew regarding the infection risks to
    patients during construction and renovation.
  44. Collaborates with Employee
    Health to maintain screening of workers (for TB, Flu or other communicable
    diseases) who will work within the hospital environment.
  45. Maintains professional
    contact with government and research agencies regarding infectious disease
    Infection Prevention Plan.? Alerts
    hospital personnel when a new disease has been identified; and measures to
    reduce infection risk.
  46. Notifies physicians when an
    inpatient has a known infection exposure.
  47. Monitors environmental
    cleanliness of working areas and equipment in accordance with safety regulations
    and basic Infection Prevention principles.
  48. Collaborates with Central
    Services to monitor efficacy of sterilization and disinfection methods, rate of
    immediate use sterilization, and documentation of sterilization logs used
    throughout the hospital campuses.
  49. Monitors sterilization records and
    conducts audits of sterilization or disinfection processes throughout the


EXPERIENCE REQUIRED?? (Minimum amount of specifically related experience which is required to perform the role at this level.

3 - 7 years

Other required experience: Minimum of 5-7 years? experience in specialty? ? ? ? with knowledge of epidemiology, microbiology, and principles of asepsis.

Other preferred experience: Five to seven years? acute care experience; experience in education and statistical analysis desirable

EDUCATION REQUIRED?? (Minimum formal academic training which
typically provides the knowledge and skills necessary for successful job
performance. Note in Other if experience may be substituted.)

Bachelor?s Degree-Major: Nursing

If not required, education preferred: MHA



Current license to practice as a Registered Nurse in Texas
or identified compact state

Required Upon Hire
(for certifications only: upon hire is defined as within 2 business days of
start date)

Current CIC Infection Prevention and Infection Prevention
Plan Practitioner certificate


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Associated topics: administrative coordinator, administrative officer, associate, chief operations officer, document, front desk, food, operations director, staff, support

* Estimated salary

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