Infection Control Risk Assessment Tool 1208

Infection Control Program Risk Assessment
2008
Program
Components
Probability
Expect it
Likely Maybe
Rare
Never
Current
Risk/ (Health, Financial, Legal,
Systems
Impact Regulatory)
Loss of
Temp
Prolonged Moderate Minimal
None
life/limb/ loss of
Length of Clinical/
Clinical/
function Function
Stay
Financial Financial
5
4
3
2
1
5
Poor
Fair
Good
Solid
Failure of
Prevention
Activities
Lack of Hand
Hygiene
Lack of
Respiratory
Hygiene
Lack of Staff
Education
Lack of Patient
Education
Isolation
Activities
Lack of Standard
Precautions/ PPE
Lack of Airborne
Precautions
Lack of Droplet
Precautions
Lack of Contact
Precautions
Failure to use/lack
of negative
pressure room
Page 1

2008
Program
Components
Probability
Expect it
Likely Maybe
Rare
Never
Current
Systems
Impact Regulatory)
Loss of
Temp
None
life/limb/ loss of
Length of Clinical/
Clinical/
function Function
Stay
Financial Financial
5
4
3
2
1
5
Poor
Fair
Good
Solid
Policy and
Procedure
Lack of current
policies or
procedures
Failure to follow
established policy
or procedure
Exposure Plans
Lack of B/BF
Exposure Control
Plan
Lack of respiratory
protection plan
Risk of exposure
to TB
Lack of
Emergency
Preparedness
plan (exposure to
infectious agents
or diseases)
Exposure to
SARS/Other
Respiratory illness
HealthcareAssociated
Infections
Page 2

2008
Program
Components
Probability
Expect it
Likely Maybe
Rare
Never
Current
Systems
Impact Regulatory)
Loss of
Temp
None
life/limb/ loss of
Length of Clinical/
Clinical/
function Function
Stay
Financial Financial
5
4
3
2
1
5
Poor
Fair
Good
Solid
Surgical Site
Infections
VentilatorAssociated
Pneumonia in ICU
Central LineAssociated
Bloodstream
Infections in ICU
CatheterAssociated
Urinary Tract
Infections- All
areas
HealthcareAssociated MRSA
Bacteremias- all
areas
Healthcare FacilityAssociated
Clostridium
difficile -all areas
Outbreaks
Sentinel Event
Page 3

2008
Program
Components
Probability
Expect it
Likely Maybe
Rare
Never
Current
Systems
Impact Regulatory)
Loss of
Temp
None
life/limb/ loss of
Length of Clinical/
Clinical/
function Function
Stay
Financial Financial
5
4
3
2
1
5
Poor
Fair
Good
Solid
Employee Health
Lack of Staff
Immunization
Lack of
Compliance with
Annual Health
Review Policy
Risk of
Needlestick/
Sharps Injury
Environment
Lack of
acceptable
environmental
cleanliness
Lack of
Hemodialysis
Monitoring
Lack of
Sterilization
Monitoring
Failure to Identify
Construction
Risks
Page 4

2008
Program
Components
Probability
Expect it
Likely Maybe
Rare
Never
Current
Systems
Impact Regulatory)
Loss of
Temp
None
life/limb/ loss of
Length of Clinical/
Clinical/
function Function
Stay
Financial Financial
5
4
3
2
1
5
Poor
Fair
Good
Solid
Antimicrobial
Stewardship
Lack of useful
antibiogram
Lack of
antimicrobial use
guidelines
Lack of monitoring
program
Lack of feedback
regarding
monitoring results
Lack of
appropriate
vancomycin use
Lack of culture to
guide
antimicrobial use
Other
Blood Culture
Contamination
Rates >2%
New Program
New Procedure
Page 5

2008
Program
Components
Probability
Expect it
Likely Maybe
Rare
Never
Current
Systems
Impact Regulatory)
Loss of
Temp
None
life/limb/ loss of
Length of Clinical/
Clinical/
function Function
Stay
Financial Financial
5
4
3
2
1
5
Poor
Fair
Good
Solid
Influenza
Immunization Noncompliance in
patients
Pneumovax
patients
The Infection Control (IC) Risk assessment grid is a visual tool to develop IC program priorities and stratify infection risks based on our
location in the community, our patient population and the review of our previous IC data analysis. The annual IC Plan is developed based on
these risks.
The IC Risk assessment is an ongoing, continual process. A more focused review is done on an annual basis after reviewing the quarterly
and annual reports with the Infection Control committee.
Approved by Infection Control Committee: ____________________________

Submitted by:
Form provided courtesy of Terrie Lee RN MS MPH CIC, Director, Epidemiology and Employee Health, Charleston Area Medical Center,
Charleston WV
Page 6

2008
Program
Components
Score
Failure of
Prevention
Activities
Lack of Hand
Hygiene
Lack of
Respiratory
Hygiene
Lack of Staff
Education
Lack of Patient
Education
Isolation
Activities
Lack of Standard
Precautions/ PPE
Lack of Airborne
Precautions
Lack of Droplet
Precautions
Lack of Contact
Precautions
Failure to use/lack
of negative
pressure room
Page 7

2008
Program
Components
Score
Failureand
of
Policy
Prevention
Procedure
Activities
Lack of current
policies or
procedures
Failure to follow
established policy
or procedure
Exposure Plans
Lack of B/BF
Exposure Control
Plan
Lack of respiratory
protection plan
Risk of exposure
to TB
Lack of
Emergency
Preparedness
plan (exposure to
infectious agents
or diseases)
Exposure to
SARS/Other
Respiratory illness
HealthcareAssociated
Infections
Page 8

2008
Program
Components
Score
Failure of
Surgical
Site
Prevention
Infections
Activities
VentilatorAssociated
Pneumonia in ICU
Central LineAssociated
Bloodstream
Infections in ICU
CatheterAssociated
Urinary Tract
Infections- All
areas
HealthcareAssociated MRSA
Bacteremias- all
areas
Healthcare FacilityAssociated
Clostridium
difficile -all areas
Outbreaks
Sentinel Event
Page 9

2008
Program
Components
Score
Failure of
Prevention
Activities
Employee Health
Lack of Staff
Immunization
Lack of
Compliance with
Annual Health
Review Policy
Risk of
Needlestick/
Sharps Injury
Environment
Lack of
acceptable
environmental
cleanliness
Lack of
Hemodialysis
Monitoring
Lack of
Sterilization
Monitoring
Failure to Identify
Construction
Risks
Page 10

2008
Program
Components
Score
Failure of
Antimicrobial
Prevention
Stewardship
Activities
Lack of useful
antibiogram
Lack of
antimicrobial use
guidelines
Lack of monitoring
program
Lack of feedback
regarding
monitoring results
Lack of
appropriate
vancomycin use
Lack of culture to
guide
antimicrobial use
Other
Blood Culture
Contamination
Rates >2%
New Program
New Procedure
Page 11

2008
Program
Components
Score
Failure of
Influenza
Prevention NonImmunization
compliance
Activities in
patients
Pneumovax
patients
The Infection Control (IC) Risk assessment grid is a visual tool to develop IC program priorities and stratify infection risks based on our
location in the community, our patient population and the review of our previous IC data analysis. The annual IC Plan is developed based on
these risks.
The IC Risk assessment is an ongoing, continual process. A more focused review is done on an annual basis after reviewing the quarterly
and annual reports with the Infection Control committee.
Approved by Infection Control Committee: ____________________________

Submitted by:
Form provided courtesy of Terrie Lee RN MS MPH CIC, Director, Epidemiology and Employee Health, Charleston Area Medical Center,
Charleston WV
Page 12

Infection Control Risk Assessment Tool 1208

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Infection Control Risk Assessment Tool 1208

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Infection Control Program Risk Assessment

Infection Control Program Risk Assessment

Infection Control Program Risk Assessment

Infection Control Program Risk Assessment

Infection Control Program Risk Assessment

Infection Control Program Risk Assessment

Approved by Infection Control Committee: ____________________________

Infection Control Program Risk Assessment

Infection Control Program Risk Assessment

Infection Control Program Risk Assessment

Infection Control Program Risk Assessment

Infection Control Program Risk Assessment

Infection Control Program Risk Assessment

Approved by Infection Control Committee: ____________________________

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