Was the nominee a member of APIC-DFW during the eligibilty period (September 1, 2023 to September 30, 2024)

YES

NO

Name of Nominee *

First Name

Last Name

Person Nominating (Can self-nominate) *

First Name

Last Name

Nominee's Preferred Phone *

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IP Category - Please select the category for the nominee *

**In order for the nominee to be considered, you must select at least 5 domains corresponding to the STAR award criteria listed below as well as include comments supporting the selected domain in the free text box provided for each domain. The nominee must meet at least ONE of the criteria in the chosen domain.** Ensure the category selected matches the domain required. Please refer to the definitions in the APIC Competency Model to determine the appropriate category. The years of experience are a suggestion and not a requirement. For example, an IP practicing for 3 years may have their CIC and other qualifications to be proficient.

NOVICE (Estimated 1-3 years IP experience)

BECOMING PROFICIENT (Estimated 3-5 years IP experience)

PROFICIENT (Estimated 5-10 years IP experience)

EXPERT (Estimated >10 years IP experience)

Domain 1: Leadership

Attends >75% of APIC DFW chapter meetings

Actively works in practice setting on infection prevention and control program elements, practices and processes within healthcare facilities

Actively participates in a local, state, national, or international professional organization committee affiliated with infection control (e.g. APIC, AORN, TSICP, SHEA, etc.)

Participates in training, planning, and mentoring staff to facilitate advancement of IPC practices.

Provides management oversight for healthcare facility infection prevention program

Elected or appointed to a position in a local, state, national, or international professional organization affiliated with infection control (e.g. APIC, AORN, TSICP, SHEA, etc.)

Actively participates in local or national APIC mentorship program

Domain 2: Professional Stewardship

New IP who has independently pursued professional growth through professional organization membership

IP who has independently continued their professional growth through CIC certification

IP who has independently maintained their professional growth through CIC recertification AND Has achieved additional certifications

Volunteers outside of work to support the local community on infection prevention practices

Assist or perform with assistance, a lecture or training on infection prevention and control to internal stakeholders

Independently able to perform a lecture or training on infection prevention and control to internal stakeholders

Independently able to provide an educational presentation (poster or oral abstract) at a local, state, national, or international infection control meeting

Serves on an IP related panel

Provides multiple educational presentations (poster or oral abstract) at a local, state, national, or international infection control meeting

Provides a lecture or training on infection prevention and control to internal and external stakeholders

Provides a lecture or educational class about infection prevention and control topics to a professional group or organization for continuing education contact hours or IPUs

Actively pursuing advanced degree (Master's level or higher)

Achieves advanced degree (Master's level or higher)

Author or Co-author of a published, professional article, chapter, or book related to infection prevention and control

Prepares financial business case to justify or support roles or initiatives within the IPC department

Domain 3: Quality Improvement

Participates on an internal performance improvement project team related to infection prevention and control

Provides assistance with internal risk assessments

Graphs data and generates basic reports and disseminates to internal and external stakeholders

Identifies PI opportunities and assists with facilitating a PI team among internal stakeholders

Identifies PI opportunities, assembles PI team, and champions PI projects using the organization's preferred PI tools, measures success, and disseminates lessons learned

Independently performs internal risk assessments

Independently performs risk assessments, identifies and employs strategies to reduce risk

Assists with analysis and trending of occupational exposure incidents

Proficient in leveraging data to support IP practices

Expert in leveraging data to support IP practices

Leads analysis and trending of occupational exposure incidents and facilitates information exchange between occupational health and IPC department

Develops interprofessional competencies, uses advanced PI tools/methods, and focuses on reliability and sustainability

Achieves certification in PI methodologies (e.g. Lean, Six Sigma)

Domain 4: Infection Prevention and Control Operations

Provides assistance to develop a surveillance plan based on the population(s) served, services provided, and previous surveillance data

Assess the needs of customers and develop educational objectives and strategies to meet those needs

Periodically evaluate the effectiveness of the surveillance plan and modify as necessary

Ensure requirements for communicable disease reporting are met

Collaborate in the development and delivery of educational programs and/or tools that relate to infection prevention, control, and epidemiology

Use epidemiologic principles to conduct surveillance and investigations

Report epidemiologically significant findings to key stakeholders

Use appropriate information technology in educational design and delivery

Use standardized definitions for the identification and classification of events, indicators/measures, and/or outcomes

Evaluate the effectiveness of educational programs and learner outcomes

Incorporate information technology and systems applications into the analysis and dissemination of data

Enhance the visibility of healthcare providers and their knowledge of specific infection prevention and control practices, targets, and organizational goals

Critically evaluate the significance of findings and make recommendations for improvement based on those findings

Conduct outbreak investigations. Use statistical techniques to describe the data, calculate risk-adjusted rates, and establish benchmarks

Domain 5: Infection Prevention and Control Informatics

Knowledge and ability to monitor healthcare worker activities related to patient and provider safety (eg, hand hygiene compliance)

The ability to incorporate infection prevention concepts and practices in scenario simulations

Use data mining and surveillance technology

Use of other technologies including capabilities for hand hygiene compliance monitoring, scenario simulations, environmental disinfection methods, and device design with the intent of reducing the risk of device-associated infections

Access to a variety of tools to aid in prevention efforts

The ability to use a systematic approach to evaluate costs, benefits, and effect

The use of algorithms to identify potential HAIs or syndromes to prompt further evaluation and review

The use of aggregate data to identify changing patterns in microbial isolates in a population

Domain 6: Research

Participate in critically evaluating published research and incorporate appropriate findings into practice

Participate in IPC-related research independently and/or collaboratively with other professions and organizations

Identify sources and apply for funding when applicable. Incorporate cost analysis into IPC research

Share relevant research findings through practice, education, and/or consultation (ie, develop or revise policies, guidelines, protocols, and relevant educational modules/ strategies)

Conduct research in compliance with human subject protection and the Health Insurance and Accountability Act of 1996 regulations

Publish and present research findings to assist in advancing the field