As hospital care evolves, the demands on IPC teams have steadily increased, necessitating a revision of existing staffing norms. The previous Dutch guideline from 2007 is outdated. Between 2022 and 2024 we used a Delphi method to reach expert consensus on the minimum time required by IPCP and CM for core infection control tasks. The final proposed norm received broad support from IPC professionals across Dutch acute care hospitals.

While the recommended minimum FTE for CM remained comparable to the 2007 standard, the new norm indicates a 50–60% increase in FTE for IPCP. This rise reflects both the increased needs due to the growing scope and complexity of IPC work and the inclusion of additional team roles, such as epidemiologists, team managers, data managers, and secretarial staff, who were not considered in the previous norm [10, 11]. Robinson et al investigated what an optimal IPC service needs and found that adequate staff resources and a trained competent IPC team are major components for this [11]. A recent U.S. position paper similarly calls for raising standards for IPC programs and proposes staffing calculators (APIC Staffing Calculator) and frameworks to assess institutional needs [12], which unfortunately is only available for members.

Importantly, our new norm covers only basic infection prevention activities. In the second and third Delphi rounds, responses varied considerably. Much of this variation was caused by differences in hospital structure, local task assignment, and the challenge of extrapolating local circumstances to the model hospitals. Some hospitals reported performing tasks beyond the basic IPC scope—such as vaccinations, needlestick injury follow-up, and MRSA screening for staff—or providing IPC services to affiliated long-term care facilities. Others had highly specialized functions, such as managing viral hemorrhagic fever units or had to deal with large newbuilt projects. This is explicitely not included in this norm and would need extra formation. Additionally, IPC workload is subject to seasonal or episodic surges, such as during outbreaks or pandemics which also require more formation. Very small hospitals also noted that some baseline investment—like policy development and education— is always needed, regardless of hospital size, making the relative burden higher, and they will likely need more time than the proposed norm. There was also notable variation in IPC team composition. In some hospitals, tasks are distributed among dedicated support staff (e.g., data managers or infection control epidemiologists), while in others, IPC practitioners are responsible for all duties.

Although these differences were addressed by including all team members in the IPCP norm, this highlights the importance of flexible, competency-based team composition.

The Delphi method provides a structured technique to reach expert consensus on complex topics [13]. While it enables broad expert input, it has limitations. Selection bias and differential willingness to participate may influence outcomes. However, IPC teams from over 80% of Dutch acute care hospitals participated in both the first and final rounds, enhancing the representativeness of our findings. Some risk of conformity bias exists in multi-round surveys, but anonymity and opportunities for free-text feedback mitigated this. Dropout across rounds did occur, though updates via national meetings helped maintain engagement and IPC teams from all Dutch hospitals were again invited to participate in the final round. Finally, this Delphi method offers expert-informed estimates for the Dutch situation. The results might not be easily extrapolated to other type of care facilities or other countries with different organization of care and responsibilities. However, the methodology is transferable and adaptable to other countries and healthcare settings. This enhances the global relevance of our findings beyond the Dutch context.