New Questionnaire Puts Infection Control Expertise to the Test in China

Every year, millions of patients around the world acquire infections while receiving healthcare, and the professionals who stand between those patients and harm are often invisible to the public. Healthcare-associated infection prevention and control practitioners, known as HAIPCPs, are the specialists who design hand hygiene programs, monitor outbreaks, audit sterilization practices, and train clinical staff in the daily disciplines that keep hospitals safe. Yet in China, the very people tasked with safeguarding patient safety have never had a validated, context-specific tool to measure whether their competencies meet the demands of the job. A new study from Guizhou Province, published in BMC Health Services Research, sets out to close that gap by developing and rigorously testing a competency assessment questionnaire tailored to this critical workforce.

The research team, led by Maojie Zhang of the First Affiliated Hospital of Guizhou Traditional Chinese Medicine University and including collaborators at Universiti Sains Malaysia, began with a simple but consequential observation. Existing instruments for assessing infection prevention and control competence were largely imported from international frameworks such as those of the World Health Organization and the Association for Professionals in Infection Control and Epidemiology, or drawn from Chinese national guidelines, but none had been systematically adapted and validated for the realities of Chinese provincial hospitals. Without a sound measurement tool, hospital administrators could neither identify skill gaps among their practitioners nor design training programs with any confidence that those programs addressed genuine weaknesses. The consequence is a workforce whose professional development proceeds largely by intuition rather than evidence.

To build the questionnaire, the researchers followed a four-phase instrument development and validation strategy that reflects the gold standard in psychometric science. In the first phase, they generated an initial pool of 55 items by combining a systematic review of the literature, relevant international competency frameworks, Chinese national guidelines on infection prevention and control, and structured discussion among experts. Each item was written to capture a specific competency domain, from foundational microbiological knowledge to the leadership skills required to drive change across entire hospital departments. This triangulation of sources was deliberate: by drawing on global standards and local policy simultaneously, the team aimed to produce an instrument that was both internationally comparable and locally meaningful.

The second phase subjected the draft items to a two-round modified Delphi consultation, a technique in which a panel of experts independently rates the relevance and importance of each item over successive rounds, with anonymous feedback between rounds allowing the group to converge toward consensus. After the first round, the scale-level content validity index, calculated using the averaging method, stood at 0.87, a figure already considered acceptable in survey methodology. Expert qualitative comments were collected alongside the quantitative ratings, and items that scored poorly or attracted persistent criticism were revised or removed. By the end of the second round, the questionnaire had been trimmed from 55 items to 44, and the scale-level content validity index for the retained items had risen to 0.89, indicating strong expert agreement that the questions measured what they were intended to measure.

The third phase tested whether real practitioners could actually understand and complete the instrument. Face validity assessment and pilot testing were carried out among eligible HAIPCPs working in Guizhou Province, who evaluated the comprehensibility of each item and the overall feasibility of the questionnaire in a busy clinical setting. The scale-level face validity index reached 0.98, an exceptionally high figure suggesting that practitioners recognized the questions as sensible, relevant, and clearly worded. This step matters more than it might appear: a questionnaire that is statistically elegant but confusing to respondents produces unreliable data no matter how sophisticated the analysis, so demonstrating that frontline infection control staff found the instrument intuitive was essential to its credibility.

The fourth and decisive phase involved the main survey, in which 209 HAIPCPs completed the 44-item questionnaire. The researchers first confirmed that the data were suitable for factor analysis: the Kaiser–Meyer–Olkin measure of sampling adequacy was 0.957, far above the conventional threshold of 0.60, and Bartlett’s test of sphericity was highly significant at P less than 0.001, indicating that the items shared sufficient common variance to reveal an underlying structure. Principal component analysis then extracted a five-component solution that the investigators labeled basic knowledge, advanced infection prevention and control competency, environmental hygiene, leadership, and professionalism. Together these five dimensions explained 75.34 percent of the total variance, and component loadings ranged from 0.49 to 0.84, indicating that nearly every item aligned cleanly with one of the identified domains.

Internal consistency, the degree to which items within each dimension and across the whole scale measure the same underlying construct, proved equally impressive. The overall Cronbach’s alpha coefficient was 0.986, and the coefficients for the five individual dimensions ranged from 0.885 to 0.983, all comfortably above the 0.70 benchmark generally regarded as acceptable. The resulting instrument has been named the Competency Evaluation Index for Healthcare-Associated Infection Prevention and Control Practitioners, or CEI-HAIPCPs. In practical terms, the questionnaire now offers hospital managers in China a validated 44-item tool that can be administered to infection control staff to produce a structured profile of strengths and weaknesses across five distinct competency domains.

The significance of this work extends well beyond Guizhou Province. Healthcare-associated infections impose an enormous burden on health systems, prolonging hospital stays, driving antimicrobial resistance, and costing lives that rigorous prevention could save. The COVID-19 pandemic made painfully clear that infection prevention and control is not a bureaucratic afterthought but a core clinical discipline, and it exposed wide disparities in the training and readiness of the practitioners who carry that responsibility. A validated competency instrument transforms workforce development from guesswork into measurement: training curricula can be aligned with the five identified domains, certification schemes can reference objective standards, and individual practitioners can receive targeted feedback on where their skills need reinforcement. The authors caution, appropriately, that the instrument was validated in a single provincial sample and that further testing in broader and more diverse populations is needed before generalizing its use across China or beyond.

Nevertheless, the study offers a template for other regions facing the same problem. Its phased design, combining literature synthesis, modified Delphi consensus, face validity testing, and psychometric evaluation, is reproducible in any jurisdiction that needs a locally grounded assessment tool. The high content validity, robust factor structure, and near-ceiling internal consistency reported here suggest that the CEI-HAIPCPs is a sound foundation on which competency-based professional development for infection control practitioners can finally be built. For the largely unseen professionals who guard every catheter, ventilator, and surgical wound against infection, the study provides something they have long lacked: a credible way to demonstrate, and improve, the expertise on which patient safety depends.

Subject of Research: Development and psychometric validation of a competency assessment questionnaire for healthcare-associated infection prevention and control practitioners

Article Title: Development and validation of a competency assessment questionnaire for healthcare-associated infection prevention and control practitioners in Guizhou Province, China

Article References: Development and validation of a competency assessment questionnaire for healthcare-associated infection prevention and control practitioners in Guizhou Province, China. (n.d.). https://doi.org/10.1186/s12913-026-15495-x

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15495-x

Keywords: healthcare-associated infections, infection prevention and control, competency assessment, questionnaire development, modified Delphi technique, psychometric validation, principal component analysis, Cronbach's alpha, content validity, patient safety, China, health services research