Infection Control Program Risk Assessment

2008

Program Probabili Risk/ (Health, Financial, Legal, Current

ty Impact Regulatory)
Score
Components System
Expect it Likely Maybe Rare Never Loss of Temp Prolonged Moderat Minimal s None Poor Fair Good Solid
life/limb loss of Length of e Clinical/
/ Function Stay Clinical/ Financial
function Financial
4 3 2 1 0 5 4 3 2 1 5 4 3 2 1
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
 Infection Control Program Risk Assessment
2008

Program Probabili Risk/ (Health, Financial, Legal, Current

Score
Components ty Impact Regulatory) System
Expect it Likely Maybe Rare Never Loss of Temp Prolonged Moderat Minimal s None Poor Fair Good Solid
life/limb loss of Length of e Clinical/
/ Function Stay Clinical/ Financial
function Financial
4 3 2 1 0 5 4 3 2 1 5 4 3 2 1
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
Healthcare-
Associated
Infections
Surgical Site
Infections

Page 2
 Infection Control Program Risk Assessment
2008

Program Probabili Risk/ (Health, Financial, Legal, Current

Score
Components ty Impact Regulatory) System
Expect it Likely Maybe Rare Never Loss of Temp Prolonged Moderat Minimal s None Poor Fair Good Solid
life/limb loss of Length of e Clinical/
/ Function Stay Clinical/ Financial
function Financial
4 3 2 1 0 5 4 3 2 1 5 4 3 2 1
Ventilator-
Associated
Pneumonia in
ICU
Central Line-
Associated
Bloodstream
Infections in
ICU
Catheter-
Associated
Urinary Tract
Infections- All
areas

Healthcare-
Associated
MRSA
Bacteremias- all
areas

Healthcare
Facility-
Associated
Clostridium
difficile-all areas

Outbreaks

Sentinel Event

Employee
Health
Lack of Staff
Immunization

Page 3
 Infection Control Program Risk Assessment
2008

Program Probabili Risk/ (Health, Financial, Legal, Current

Score
Components ty Impact Regulatory) System
Expect it Likely Maybe Rare Never Loss of Temp Prolonged Moderat Minimal s None Poor Fair Good Solid
life/limb loss of Length of e Clinical/
/ Function Stay Clinical/ Financial
function Financial
4 3 2 1 0 5 4 3 2 1 5 4 3 2 1
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
Antimicrobial
Stewardship
Lack of useful
antibiogram
Lack of
antimicrobial
use guidelines
Lack of
monitoring
program

Page 4
 Infection Control Program Risk Assessment
2008

Program Probabili Risk/ (Health, Financial, Legal, Current

Score
Components ty Impact Regulatory) System
Expect it Likely Maybe Rare Never Loss of Temp Prolonged Moderat Minimal s None Poor Fair Good Solid
life/limb loss of Length of e Clinical/
/ Function Stay Clinical/ Financial
function Financial
4 3 2 1 0 5 4 3 2 1 5 4 3 2 1
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
Influenza
Immunization
Non-compliance
in patients
Pneumovax
Immunization
Non-compliance
in 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

Page 5
 Infection Control Program Risk Assessment
2008

Program Probabili Risk/ (Health, Financial, Legal, Current

Score
Components ty Impact Regulatory) System
Expect it Likely Maybe Rare Never Loss of Temp Prolonged Moderat Minimal s None Poor Fair Good Solid
life/limb loss of Length of e Clinical/
/ Function Stay Clinical/ Financial
function Financial
4 3 2 1 0 5 4 3 2 1 5 4 3 2 1

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
 INFECTION CONTROL RISK ASSESMEN
RS. DR. WAHIDIN SUDIROHUSODO MAKA
PERIODE DESEMBER 2016

Risk/Impact (Health, Fin

Probability / Frekuensi Legal, Regulatory)

Potential Risk/ Problem 4 3 2 1 0 5 4

Maybe
Expect

fnancia

(functio
bFuncti

n/fnan
Serious
life/lim
Never
Loss of
Likely

Rare

legal)
cial/
on/j

Loss
it

l
KEWASPADAAN STANDAR

1. Kepatuhan hand hygiene

4
masih <85 %
2. Kepatuhan penggunaan
4
APD belum maksimal
3. Praktek menyuntik yang
aman dan pengelolaan benda
tajam inadekuat : Angka
kejadian tertusuk jarum 3 3
masih tinggi ( 36 kejadian/
tahun 2015)

4. Pengelolaan linen :
kepatuhan pemilahan linen di 3
ruangan masih kurang
5. Pengelolaan sampah
infeksius : pemilahan sampah
di ruangan belum maksimal.
Sampah infeksius dan non 3
infeksius sering tercampur

6. Pengelolaan benda tajam

dan jarum : Pembuangan
benda tajam tidak adekuat.
Tempat sampah benda tajam 4
sering penuh melebihi 3/4.

7. Pengelolaan makanan :
penggunaan APD belum 3
maksimal.

Surveilans HAIs
IDO 3
ISK 1
IADP 1 4
VAP 3 4
Plebitis 4
CONTROL RISK ASSESMENT
N SUDIROHUSODO MAKASSAR
ODE DESEMBER 2016

Risk/Impact (Health, Financial,

Legal, Regulatory) Current Systems/Preparedness
Moderate Clinical/ Finansial

3 2 1 5 4 3 2 1
Score
Minimal
Prolong

Clinical
of stay

Good
length

none

Solid
Poor

Fair
ed

24
3 2

24
3 2

18

2 12
2

2 12

24

3 2

12
2 2

3 2 18
3 2 6
2 8
 2 24
3 2 24
 Infection Control Program Risk Assessment
2017

Program Probabili Risk/ (Health, Financial, Legal, Current

ty Impact Regulatory)
Score
Components System
Expect it Likely Maybe Rare Never Loss of Temp Prolonged Moderat Minimal s None Poor Fair Good Solid
life/limb loss of Length of e Clinical/
/ Function Stay Clinical/ Financial
function Financial
4 3 2 1 0 5 4 3 2 1 5 4 3 2 1
Kegiatan
pencegahan
kurangnya
kepatuhan hand
higyene
kurangnya
pendidikan staf
kurangnya
pendidikan
peserta didik
(residen)

Tindakan
Isolasi
kurangnya
kepatuhan
kewaspadaan
standar (APD)
kurangnya
kepatuhan
terhadap
kewaspadaan
transmisi
airbone

Kurangnya
kepatuhan
terhadap
kewaspadaan
berbasis
transmisi
kontak
Failure to
use/lack of
negative
pressure room

Page 11
 Infection Control Program Risk Assessment
2017

Program Probabili Risk/ (Health, Financial, Legal, Current

Score
Components ty Impact Regulatory) System
Expect it Likely Maybe Rare Never Loss of Temp Prolonged Moderat Minimal s None Poor Fair Good Solid
life/limb loss of Length of e Clinical/
/ Function Stay Clinical/ Financial
function Financial
4 3 2 1 0 5 4 3 2 1 5 4 3 2 1
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
Healthcare-
Associated
Infections
Surgical Site
Infections

Page 12
 Infection Control Program Risk Assessment
2017

Program Probabili Risk/ (Health, Financial, Legal, Current

Score
Components ty Impact Regulatory) System
Expect it Likely Maybe Rare Never Loss of Temp Prolonged Moderat Minimal s None Poor Fair Good Solid
life/limb loss of Length of e Clinical/
/ Function Stay Clinical/ Financial
function Financial
4 3 2 1 0 5 4 3 2 1 5 4 3 2 1
Ventilator-
Associated
Pneumonia in
ICU
Central Line-
Associated
Bloodstream
Infections in
ICU
Catheter-
Associated
Urinary Tract
Infections- All
areas

Healthcare-
Associated
MRSA
Bacteremias- all
areas

Healthcare
Facility-
Associated
Clostridium
difficile-all areas

Outbreaks

Sentinel Event

Employee
Health
Lack of Staff
Immunization

Page 13
 Infection Control Program Risk Assessment
2017

Program Probabili Risk/ (Health, Financial, Legal, Current

Score
Components ty Impact Regulatory) System
Expect it Likely Maybe Rare Never Loss of Temp Prolonged Moderat Minimal s None Poor Fair Good Solid
life/limb loss of Length of e Clinical/
/ Function Stay Clinical/ Financial
function Financial
4 3 2 1 0 5 4 3 2 1 5 4 3 2 1
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
Antimicrobial
Stewardship
Lack of useful
antibiogram
Lack of
antimicrobial
use guidelines
Lack of
monitoring
program

Page 14
 Infection Control Program Risk Assessment
2017

Program Probabili Risk/ (Health, Financial, Legal, Current

Score
Components ty Impact Regulatory) System
Expect it Likely Maybe Rare Never Loss of Temp Prolonged Moderat Minimal s None Poor Fair Good Solid
life/limb loss of Length of e Clinical/
/ Function Stay Clinical/ Financial
function Financial
4 3 2 1 0 5 4 3 2 1 5 4 3 2 1
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
Influenza
Immunization
Non-compliance
in patients
Pneumovax
Immunization
Non-compliance
in 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

Page 15
 Infection Control Program Risk Assessment
2017

Program Probabili Risk/ (Health, Financial, Legal, Current

Score
Components ty Impact Regulatory) System
Expect it Likely Maybe Rare Never Loss of Temp Prolonged Moderat Minimal s None Poor Fair Good Solid
life/limb loss of Length of e Clinical/
/ Function Stay Clinical/ Financial
function Financial
4 3 2 1 0 5 4 3 2 1 5 4 3 2 1

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 16