Our results demonstrate that complementing the IP knowledge network with public health professionals may increase the ability of IPs to share knowledge with each other. Since many IPs in Iowa communicate with the public health department regarding HAIs those public health professions play a unique role within the structure of the Iowa network. Our findings that public health professionals in Iowa have higher network statistics suggest that these members have important structural roles within the infection prevention knowledge network. The higher in-degree statistics for public health professionals suggest that they are contacted by many IPs, while higher out-degree statistics suggest they provide information to many members of the network. The larger betweenness statistics suggest public health professionals can connect otherwise disconnected members of the network, and higher eigenvector statistics suggest that these members contact IPs who themselves contact a large number of other IPs. These findings provide evidence that information can quickly diffuse through this network when provided to public health professionals.
One important finding was that public health members are able to connect otherwise isolated IPs. Although the density of the network did not increase a great deal (0.2%) with the addition of public health professionals, they added 62 communication ties to the network, a very large number for only 4 additional members. These additional ties will allow network members to maintain communication if some IPs leave their positions. Key player metrics further demonstrated the importance of these members within the knowledge-sharing network. With the addition of the public health members, communication between nearly every member of the network was possible after initiating communication through a smaller set of key members. In the event of a pandemic or outbreak, it is critical to quickly convey new information to nearly every member of the network, and focusing communication efforts on these reach key players may provide an ideal mechanism for improving the flow of information. Finally, we found that the public health members reduced the network fragmentation upon removal of fragmentation key players. Because of the presence of these public health professionals and their unique placement within the structure of the network, the network will be less affected when other members leave the network (e.g. retirement or changing jobs).
Another important concept in communication networks is “bridging”. Members who represent bridges are capable of connecting members of a network that do not readily connect with each other. These members are considered to be personnel with critical influence for improving team performance in a network [19, 22, 23]. Here, we identified that the network member with the lowest constraint score (indicative of a good bridge) was a public health professional. This bridge allows for dissemination of information from diverse areas of the network. As various areas of the network may hold members with different areas of expertise, bridges allow for this expertise to flow to and from these areas. For example, if some IPs in a network are strong in prevention of ventilator-associated pneumonia, and another is proficient with use of the National Healthcare Safety Network (NHSN), the network bridge is capable of connecting these IPs. Bridges are particularly important in a rural state where most of the hospitals are critical access hospitals. In these facilities, IPs have multiple demands and limited resources, making it difficult to gain expertise in multiple areas. Because of these factors, it is especially important to identify bridging network members capable of gathering and disseminating a wide variety of HAI-related information.
Another possible method of increasing knowledge sharing is periodic statewide meetings of infection preventionists . However, despite the presence of a long-standing annual statewide IP meeting in Iowa, there were many similarities between the Iowa and the Kentucky IP knowledge-sharing networks. Both of these knowledge-sharing networks had similar numbers of components, similar densities and similar skewed node centrality scores. Also, these networks shared similar numbers of reach key players that could reach approximately the same proportion of other IPs in the network . These findings were surprising, as we originally thought that the longstanding statewide meeting in Iowa would have led to a much different more connected network in Iowa compared to Kentucky. Iowa does have regular APIC chapter meetings, which are similar to the structure within Kentucky. These local chapter meetings may also be a mechanism for communication in this group of professionals outside of the statewide meeting. This suggests that local APIC chapter meetings function similarly in both Iowa and Kentucky with regard to knowledge sharing. However, it appears that the only major differences in the networks are the addition of the public health professionals.
Our study has several limitations, including the possibility of missing data. As not every member of the knowledge-sharing network attended the statewide meeting, it is possible that important members of the network were not included in this analysis, thereby biasing the results. A basic assumption in knowledge sharing is that the information that is shared is correct, which may not be the case. The knowledge network may be responsible for the sharing of misinformation that may, in fact, be detrimental to HAI elimination efforts. Although generalizability to other states may be limitation, it is important to emphasize that public health professionals may play important functional roles for bolstering communication in metropolitan states as well as rural states. The ability of these professionals to focus infection prevention activities, as well as their key placement in public health departments suggests that their roles in supporting communication may apply to all types of facilities in all states.
Despite these limitations, our results demonstrate that public health officials play an important role in the communication network among IPs in Iowa. Iowa and Kentucky are similar in terms of the percentage of population living in rural regions, but in Iowa the state health department is more involved with coordinating HAI prevention. Future research efforts should be devoted to discovering what kinds of information travel across these communication networks, and understanding how the metrics we present affect real-world knowledge sharing.