Infection Prevention and Control
June 12, 2013
Point of Care Risk Assessment for use of Routine Practices
Prior to every patient interaction, HCW’s have a responsibility to assess the infectious risk posed to
themselves and other patients, visitors and HCW’s by a patient, situation or procedure. The PCRA is an
evaluation of the risk factors related to the interaction between the HCW, the patient and the patient’s
environment to assess and analyze their potential for exposure to infectious agents and indentify risks
for transmission.
A Point of Care Risk Assessment (PCRA) must be conducted at the start of each HCW and patient
interaction to:
1. Evaluate the likelihood of exposure to blood and body fluids,
Blood and body fluids are defined as any blood or bloody body fluid/tissue, including;
vaginal secretions, seminal secretions, cerebral spinal fluid, synovial fluid, pleural fluid,
peritoneal fluid, pericardial fluid, amniotic fluid, non-bloody saliva and tears, nasal
secretions, sputum, sweat, vomitus, urine and feces.
from a specific interaction (e.g. performing/assisting with aerosol-generating medical
procedures, other clinical procedures/interaction, non-clinical interaction, transporting
patients, direct face-to-face interaction with patients, etc.)
with a specific patient (e.g. infants/young children, patients not capable of self
care/hand hygiene, have poor compliance with respiratory hygiene, copious respiratory
secretions, frequent cough/sneeze, early stage of influenza-like illness, etc.)
in a specific environment (e.g. single rooms, shared rooms/washrooms, hallway,
emergency departments, public areas, therapeutic departments, diagnostic imaging
departments, housekeeping, etc.)
under available conditions (e.g. air exchanges in a large waiting area or in an airborne
infection isolation room, patient waiting areas, etc.)
AND
2. Choose the appropriate actions/PPE needed to minimize the risk of patient, HCW/other staff,
visitor, contractor, etc. exposure to infectious agents.
Appropriate actions include consideration of:
Hand Hygiene
Use of additional precautions as required
Accommodation selection
Environmental /Equipment cleaning
Patient ambulation/transportation
PPE includes consideration of the use of:
Gloves
Gowns
Masks/Respirators
Eye/Face protection
PCRA is not a new concept, but one that is already performed regularly by HCW’s many times a day for
their safety and the safety of patients and others in the healthcare environment. For example, when a
HCW assesses a patient and situation to determine the possibility of blood or body fluid exposure or
chooses appropriate PPE to care for a patient with an infectious disease, these actions are both activities
of a PCRA.
Infection Prevention and Control
June 12, 2013
Routine Practices Point of Care Risk Assessment Algorithm
APPROPRIATE USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE)
Adapted from PHAC Routine Practices and Additional Precautions Assessment and Educational Tools 2012
Assess patient,
environment and
interaction
Notes
Contact with patient or
environment expected?
This PCRA applies to all patients at
all times in all health care settings,
when contact with the patient or
environment is expected
No
No action
required
Yes
Use in addition to AP if the patient
has already been placed on AP
Perform Hand
Hygiene
No
Splash or spray of blood, body
fluids/secretions anticipated?
Yes
Put on facial
protection
Contact with mucous membranes,
non-intact skin, blood, body fluids,
secretions, excretions
or soiled or likely soiled items/surfaces
anticipated?
No
Perform hand
hygiene before
leaving the patient
environment
Legend
PCRA= point of care
risk assessment
AP= Additional
precautions
Facial protection= a
mask and eye
protection. Face shield,
or mask with visor
attachment.
PPE=Personal
protective equipment
Yes
Put on gloves
Put on a gown if soiling
of clothing likely
Minimize exposure
Perform hand hygiene
after PPE removal and
before leaving patient
environment
September 2013