Case-Based Learning Matters in Infection Prevention
A patient in a step-down unit has a central line placed on hospital day 3. On day 8 they spike a fever and a blood culture grows coagulase-negative staph. A second culture, drawn six hours later, is negative. The patient also has a surgical wound with drainage that was cultured two days earlier. Is it a CLABSI?
Two experienced infection preventionists can work through that case carefully, apply the same NHSN criteria in good faith, and arrive at different determinations. The definitions are clear. The chart may not be.
This is what surveillance actually consists of, and it is not what most infection prevention training prepares people for.
Why definitions alone don't build competency
Policies, definitions, and guidance documents give you the framework. Applying that framework to an incomplete record under time pressure is a separate skill, and it has traditionally been learned the slow way — through years of cases, ideally with someone experienced to check your reasoning.
That works. It just takes a long time, and most programs don't have a long time. New infection preventionists are entering surveillance responsibility within months, often as the only IP in a facility, with no one to compare determinations against.
Meanwhile the consequences of inconsistency are immediate: reported data drives benchmarking, public reporting, and CMS payment.
What case-based learning does differently
Case-based learning puts infection preventionists in realistic scenarios that require applying definitions, interpreting clinical information, and committing to a determination — then examining the reasoning.
The commitment matters. Reading a case and nodding along is passive. Deciding, being wrong, and understanding why you were wrong is what builds the pattern recognition that experience eventually provides.
Our research supports this. In a longitudinal observational study published in the American Journal of Infection Control, infection preventionists who participated in structured surveillance training and repeated competency testing using case-based scenarios achieved significantly higher coding accuracy than first-time participants, with greater than 25% increase in surveillance compliance scores.
The finding worth sitting with is that accuracy improved with repeated testing — not simply with years of experience. Practice that includes feedback outperforms practice alone.
Trying it in your own program
You don't need a formal program to start.
Pick five recent cases from your own facility, including at least two that required real judgment. Have two infection preventionists review each independently, without discussing them first. Record determinations, then compare.
The disagreements are the curriculum. What made the case hard? Which criterion was read differently? Was there documentation one reviewer found and the other missed?
Run it quarterly and keep it non-punitive. The goal is a shared reading of the definitions, not a scorecard.
Where this fits
Whether you're reviewing a potential CLABSI, interpreting isolation requirements, or determining attribution, competency comes from repeated exposure to realistic cases and honest discussion of the hard ones.
Looking to strengthen surveillance accuracy and infection prevention competency within your organization? IP&MA offers NHSN surveillance training and competency validation built on validated case scenarios, plus interrater reliability assessment for teams that want to measure where they currently stand.