2013 APIC Heroes of Infection Prevention

This award recognizes APIC members and groups who have worked tirelessly to reduce infection, raise awareness, and improve the health and well-being of patients, healthcare workers and the public. In partnership with Becton, Dickinson and Company (BD), APIC aims to recognize the great work of 12 Infection Preventionists (IPs) every year.

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
  1. All applicants are required to have demonstrated a significant impact in any one of the following areas (Please provide evidence of impact or results):

  • Process and Systems Improvement
/
  • Education

  • Program Development
/
  • Patient Safety

  • Advocacy and Influence
/
  • Cost Savings

  1. Members of the 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. Include the nominator’s written explanation for choosing the candidate (candidates may self-nominate). This explanation must:
  3. Describe why the candidate is being nominated for this award related to the impact areas listed above. This statement should be no more than 500 words and focus on onearea of impact.
  1. In addition to the impact statement, it is also necessary to provide a written explanation (500 words or less) demonstrating the work of the nominee(s) with regards to the following: of how you or the individual you have nominated have met the following criteria for selection:
  • Sustainability of program, process or activity
  • Quantitative proof of success of program, process or activity
  • Professional and practice related diversitywithin the infection prevention and control profession, with the goal being to include winners from a broad spectrum:
  1. Submit the completed form with supporting documents to APIC at or via fax 202-789-1899.

Applications that do not meet the above criteria will not be considered or scored.

Criteria for Selection:

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

  • Innovation found in the 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.
  • 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

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 November 12, 2012