2016APIC Heroes of Infection Prevention

This award recognizes APIC members and groups who have work tirelessly to reduce infection, raise awareness, and improve the health and well-being of patients, healthcare workers and the public. APIC aims recognize the great work of sixInfection Preventionists (IPs). The recipients will receive complimentary registration for the 2016 Annual Conference along with a travel stipend to attend the conference in Charlotte, North Carolina. Recipients and their award winning submission will be featured in APIC’s Prevention Strategists magazine.

Award Eligibility:

  1. A qualified candidate must be:
  2. An APIC member in good standing the year of the nomination ofthe award
  3. Currently have responsibility for infection prevention and control activities in a healthcare facility
  1. All applicants are required to have demonstrated a significant impact in any one of the following areas (Please choose one and provide evidence of impact or results):

  • Process and Systems Improvement
/
  • Education

  • Program Development
/
  • Patient Safety

  • Advocacy and Influence
/
  • Cost Savings

  1. Members of the APIC Nominating and Awards Committee and APIC Board of Directors will not be eligible for award nomination during their term of service.

How to Apply:

  1. Complete this application form.
  2. The nominator’s written explanation for choosing the candidate (candidates may nominate themselves)
  3. Describe why candidate is being nominated for this award in conjunction with the impact areas listed above in the area of impact selected above. This statement should be no more than 500 words focusing on onearea of impact.
  1. A written explanation (500 words or fewer) of how you or the individual you have nominated have met the following criteria for selection. This written explanation must be verified and signed by nominee’s manager or department leadership:
  • Sustainability of program, process or activity
  • Quantitative proof of success of program, process or activity
  • Diversity of award candidates or professionals in the infection prevention and control profession, with the goal being to include recipientsfrom a broad spectrum:
  • Geographically, covering all regions of the US as well as international membership
  • By length of time and experience in the profession, including both seasoned and newer professionals
  • By practice setting
  • By specialty area
  • By program reach, to include both setting-wide and targeted, facility-based and community-wide impact
  1. Submit the completed form with supporting documents to APIC at or via fax 202-789-1899.

Applications not meeting the above criteria will not be considered or scored.

Additional Criteria for Selection:

Once your completed application is received, the candidate would be scored based on the following criteria:

  • Innovation found inthe program is key to stand out among your peers.
  • Sustainability of the program or initiative is considered when scoring.
  • Nominating and Awards Committee considers the overall impact the candidate and/or program has made.

APIC Heroes in Infection Prevention Award Application

AREA OF SIGNIFICANT IMPACT (please select most appropriate):

□Process and systems improvement / □Education
□Program Development / □Patient Safety
□Advocacy and Influence / □Cost savings

PRACTICE SETTING (please select most appropriate):

□Acute care / □Long term care
□Other, specify:

NUMBER OF YEARS IN INFECTION PREVENTION:

CANDIDATE’S NAME AND CREDENTIALS

CANDIDATE’S APIC MEMBER ID# (if known)

ADDRESS:

Street addressCityStateZipCountry

BUSINESS PHONE:HOME PHONE:

CELL/OTHER:E-MAIL:

CURRENT PROFESSIONAL POSITION:

NAME OF PERSON OR CHAPTER SUBMITTING NOMINATION:

CONTACT #:E-MAIL:

Submit via mail:APIC-Heroes of Infection Prevention Award

1275 K Street NW, Suite 1000, Washington, DC20005-4006

Submit via fax or email to:202/789-1899 or

ALL NOMINATIONS MUST BE RECEIVED NO LATER THAN Friday, October 30, 2015