ABSTRACTS
Design and Implementation of a Regional Infection Control Officer (RICO) ProgramAuthor: Joi Shumaker BSN, RN, LP | Regional Infection Control Officer Nurse | Department of Emergency Health Sciences, UT Health San Antonio Associate Authors: Rollman, Jeffrey, E, MPH, NRP | Wampler, David, A, PhD, LP | Chorn, Diana, L, RICO Program Manager - STRAC | Miramontes, David, A, MD, FACEP, FAEMS, NREMT-P
Introduction Following the passage of Texas Senate Bill 1574 in 2015, mandating Designated Infection Control Officers in all emergency medical services (EMS) agencies, the Southwest Texas Regional Advisory Council (STRAC) developed the Regional Infection Control Officer (RICO) program in close collaboration with UT Health San Antonio’s Department of Emergency Health Sciences (UT Health). The aim was to support EMS, fire, and police agencies across the STRAC region by centralizing infection control expertise, standardizing protocols, and improving compliance with SB 1574. Our objective was to describe the development and implementation of the RICO program. Methods This study design is a programmatic description of the RICO program. Program development involved crafting standardized protocols, exposure reporting workflows, training curricula, and agency onboarding materials. Agencies enrolled voluntarily and received consultation, template policies, and access to a 24/7 RICO hotline and exposure support package. Data collection included administrative enrollment, hotline consultation logs, exposure incident reviews, and compliance audit metrics. RICO includes a full time infection control nurse (RICO nurse) responsible for the daily operations and case management, supported by physician medical director oversight. Continuous quality improvement (CQI) efforts, guided by feedback from the RICO nurse and medical director, addressed reported exposures, compliance gaps, and emergent public health threats. Results By 2024, the RICO program included 60 fire, police, and EMS agencies across 22 counties and over 26,688 square miles serving 2.8 million residents. Coordination by the RICO nurse with physician oversight ensures consistent application of protocols, exposure follow-up, and liaison with health departments. The program standardized infection control measures, improved compliance with SB 1574, and centralized reporting workflows. CQI informed protocol modifications and targeted training updates during COVID 19 and mpox surges. Conclusions The STRAC RICO program provides a scalable model for regional infection control in public safety settings. Centralized expertise through a dedicated RICO nurse and physician medical director have been central to its implementation, enabling responsive, clinically grounded, and consistent support across member agencies. Limitations include the voluntary nature of the RICO model and limited generalizability. Formal outcome evaluation is underway to better measure program impact. Other regions may consider similar staffing and governance structures when building prehospital infection control systems.
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