By Phenelle Segal, RN, CIC, FAPIC, Founder, Infection Control Consulting Services
Key Takeaways
A fractional infection preventionist provides expert infection prevention support on a defined scope and schedule, without the cost and commitment of a full-time hire.
Hospitals and critical access hospitals can appoint a qualified outside consultant as their infection preventionist, and ambulatory surgery centers can designate one when onsite time meets surveyor expectations.
Fractional support also strengthens an existing program through mentoring, specialized expertise, and coverage during turnover or leave.
Ongoing work typically includes surveillance and reporting, policy updates, practice audits, staff education, and survey readiness.
Smaller facilities with limited local recruiting options, including critical access hospitals, federally qualified health centers, surgery centers, and physician practices, tend to benefit most.
Every healthcare facility needs a qualified professional leading its infection prevention program, but many lack the workload to justify a full-time infection preventionist, the budget to fund one, or a local talent pool to recruit from. A small rural hospital may go months without a viable applicant. A surgery center may hand the role to a nurse who already manages the operating room schedule. For these facilities, a fractional infection preventionist is a practical alternative to a full-time hire.
1. What Fractional Means in Infection Prevention
A fractional infection preventionist is an experienced infection prevention professional who works for your facility part-time under an ongoing agreement. The scope, schedule, and deliverables are set in advance, and the work continues month after month. You may also see the arrangement described as fractional infection control support or fractional infection control consultants.
Most of the work happens remotely: reviewing surveillance data, updating policies, joining committee meetings by video, and answering staff questions as they come up. Onsite visits cover the tasks that require direct observation, such as environmental rounds, sterile processing reviews, and hands-on staff education. The balance between the two depends on the facility's needs and any onsite expectations set by regulators.
2. Serving as Your Designated Infection Preventionist
The Centers for Medicare & Medicaid Services (CMS) requires hospitals and critical access hospitals (CAHs) to have their governing body appoint an infection preventionist qualified through education, training, experience, or certification in infection prevention and control. The CMS Conditions of Participation define the qualifications for the role. They do not require the infection preventionist to be an employee or to work a minimum number of hours. A fractional infection preventionist can hold the appointment, provided the facility documents it and the responsibilities assigned to the role get done: surveillance, policy development, staff education, auditing of practices, and collaboration with the quality assessment and performance improvement (QAPI) program.
At some critical access hospitals (CAHs) we support, an ICCS consultant serves as the hospital's primary infection preventionist, taking on the full scope of tasks an onsite or in-house infection preventionist would perform. That includes but is not limited to identifying healthcare-associated infections (HAIs), reporting to state and federal agencies through the National Healthcare Safety Network (NHSN), developing, reviewing and revising policies, attending meetings virtually, coordinating quality and performance improvement projects, and liaising with the clinical staff member assigned to manage acute issues or emergencies.
Ambulatory surgery centers (ASCs) follow a similar rule. The Conditions for Coverage require a designated professional with training in infection control to direct the program, and CMS surveyor guidance expects that person to be a licensed healthcare professional who spends enough time onsite for the center's size and surgical volume. Many ASCs designate a nurse on staff and use fractional support to oversee and strengthen the program. An outside consultant can hold the designation when the onsite schedule meets that expectation.
Whichever model you choose, put the designation in writing, have your governing body approve it, and keep documentation of the designee's qualifications on file. Some states add requirements such as certification, so confirm your state's rules before finalizing the arrangement.
3. Supporting an Infection Preventionist Already on Staff
Many facilities already have someone in the infection preventionist role, often a nurse who took on infection prevention alongside other duties with little formal training. A fractional infection preventionist can mentor that person, review their work, and help them build the knowledge to run the program with confidence. At ICCS, we provide this through structured infection preventionist onboarding and mentoring.
Fractional support also adds depth in areas where even experienced staff may have limited exposure. Sterile processing, high-level disinfection, outbreak investigation, and accreditation readiness all call for specialized knowledge that a generalist role seldom develops. A consultant with that background can review these areas before surveyors do.
4. Covering Turnover, Leave, and Vacancies
When an infection preventionist resigns, retires, or goes on extended leave, the program's requirements stay in place. Surveillance still has to be completed, NHSN reports are still due, and surveyors can arrive at any time. Recruiting a qualified replacement can take months, especially in rural communities.
A fractional infection preventionist can step in quickly and keep the program on track during the search. Once a new hire starts, the same consultant can shift into a mentoring role, which shortens the learning curve and preserves continuity. Some facilities find the interim arrangement works well enough to keep permanently.
5. What the Work Looks Like Month to Month
The exact scope depends on the facility, but a typical engagement includes:
Surveillance for HAIs and required reporting to NHSN and state agencies
Review and revision of infection prevention policies and procedures as guidelines change
Participation in infection prevention, QAPI, and other committee meetings
Audits of hand hygiene, environmental cleaning, and other practices, with results reported to leadership
Staff education and competency training
The annual infection prevention risk assessment and program evaluation
Ongoing survey readiness, so the facility is prepared whenever surveyors arrive
Between scheduled tasks, the consultant serves as a resource for day-to-day questions. When a staff member is unsure about a new disinfectant, an exposure, or an unusual cluster of infections, they have someone to call.
6. Facilities That Benefit Most
Fractional support fits any facility where the infection prevention workload is steady but does not fill a full-time position. That description covers many of the settings we work with:
Critical access hospitals, where recruiting a certified infection preventionist to a rural community is often the hardest part
Federally qualified health centers (FQHCs), which need a compliant infection prevention program across every clinic site
Ambulatory surgery centers that want specialized depth behind the staff nurse designated to direct the program
Micro-hospitals, which must cover the full program with a small clinical staff
Imaging centers and physician practices with reprocessing, high-level disinfection, or procedural risks to manage
Final Thoughts
Some facilities have enough infection prevention work to support a full-time hire. Many smaller facilities do not, and a fractional arrangement gives them infection prevention leadership scaled to their workload. Whether you need someone to hold the role, support the person who already does, or cover a vacancy, ICCS can build an arrangement around your facility.
Our fractional infection control consultants work with CAHs, ASCs, FQHCs, and other healthcare facilities nationwide. If you are still deciding whether outside help makes sense, review the signs it may be time to turn to infection control consultants, or schedule a complimentary consultation to talk through your facility's needs.
Frequently Asked Questions About Fractional Infection Preventionists
Can a fractional infection preventionist serve as our designated infection preventionist?
In many settings, an outside consultant can hold the role. CMS requires hospitals and critical access hospitals to appoint a qualified infection preventionist but does not require that person to be an employee or to work a set number of hours. ASCs can also designate an outside consultant. In every case, the governing body should approve the designation in writing, and the facility should confirm any additional state requirements.
How much of the work is done remotely?
Most ongoing work, including surveillance review, NHSN reporting, policy updates, and committee participation, can be handled remotely. Occasional or established onsite visits, such as twice-yearly or quarterly visits, are typically scheduled for a comprehensive review of hands-on processes, staff education, and assistance with upcoming survey preparation.
How is fractional support different from a one-time consulting engagement?
A one-time engagement addresses a defined project, such as a risk assessment, mock survey, or plan of correction, and ends when the deliverable is complete. Ongoing support continues over time, with the same consultant maintaining the program between surveys and getting to know the facility's staff and operations. Many facilities start with a single project and move into an ongoing arrangement afterward.
Can support increase before a survey or after a deficiency?
The arrangement can scale up when a facility's needs change, such as in the weeks before an accreditation or state survey, during an outbreak investigation, or after a survey results in deficiencies that require a plan of correction. Support can return to its usual level once the program is stable.
Does a fractional infection preventionist need to be certified?
Federal rules do not require certification. CMS requires hospital and CAH infection preventionists to be qualified through education, training, experience, or certification, and requires ASCs to designate a professional with training in infection control. Some states set stricter standards, and Certification in Infection Control (CIC) from the Certification Board of Infection Control and Epidemiology (CBIC) is the most widely recognized credential in the field. While not mandated, the CIC is considered the national gold standard and signifies a level of training, experience, and expertise.