Risk Management
1. Identify the four stages of risk
management for infection prevention
and control.
2. Develop a system for setting priorities
for action based on risk management.
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Objectives
2
• 40 minutes
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Time involved
3
• Risk is defined as
‘possibility of incurring
misfortune and loss’
• Primary aim of risk
management is
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Risk Management
• Proactive
• Reduction of risks to the
lowest level that is
“reasonably practicable”
• Ongoing process
4
• By applying concepts of risk management, the
Infection Control Team can help healthcare
facilities set priorities
• Aim is to
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Risk Management
• Identify unsafe and hazardous practices
• Recommend cost effective preventive measures
5
This approach can also be used for
hazards or risks that arise from the
environment or equipment,
as well as patient-related risks
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Risk Management
6
1.
2.
3.
4.
Risk identification
Risk analysis
Risk control
Risk monitoring
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Four Stages of Risk Management
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•
•
•
Identify tasks and activities that put
patients, healthcare workers & visitors at
risk
Identify the infectious agent(s) involved
Identify the mode of transmission
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Risk Identification
8
• Why are infections happening?
• How frequently they are happening?
• What are the likely consequences if the
appropriate action is not taken?
• How much they are likely to cost to
prevent it?
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Risk Analysis
9
• Compare level of risk found during the
analysis process with previously established
risk criteria
• Using statistical analysis
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Evaluating risks
• Type I
• Type II
• Type III
10
• Sources of performance deficit
• These occur due to an act of omission
Example: failure to comply with current professionally
accepted practice
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Why Are They
Happening? - Type I Error
• Could be due to:
• Lack of knowledge
• Inadequate provision of education, training and
supervision
• Lack of communication
• Lack of availability/regular supply of goods
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• Sources of performance deficit
• These occur due to an act of commission
• an act should not have been committed
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Why Are They Happening? Type II Error
• Could be due to:
• Lack of commitment
• Lack of consideration for others
This is more complex and may also require management reinforcement
12
• Occurs when we fail to understand the true
nature of the problem
• Real solutions are adopted to deal with the
wrong problems, rather than incorrect
solutions to real problems
• Often due to lack of communication or
misinterpretation of information
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Why Are They Happening? –
Type III Error
13
• This is quantitative information
• Can be achieved by on-going surveillance or by
prevalence study
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How frequently are they
happening?
• Frequency can be measured as the
percentage or rate of persons who developed
infection
• If there are no infection data, probability can
be used instead
14
Rating
Probability
Comments
4
1: 10
Almost certain or very likely to occur
3
1: 100
Highly probable that they will occur.
2
1: 1000
It is possible that they may occasionally
occur
1
≥ 1: 10000
They are rare and do not believe/expect
to occur
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Risk Probability - Frequency
15
• Consequences are expressed by severity
• Severity is measured by
morbidity/mortality of infection involved
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What are the likely
consequences?
16
Rating
Description
Consequence/Impact
Comments
20-30
High or
major
Major impact on patient which
may lead to death or long term
consequences
Urgent action is
required
10-19
Moderate
Moderate impact which may
lead to short term
consequences
Action required
1-9
Low risk or
minor
Minimum impact with no or
minor consequences
Keep under review
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Risk Probability - Severity
17
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Prioritising Risks
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Risk Factor = Frequency (Probability) X
Consequence (Impact)
Surveillance data provides probability or
frequency of infection from a task or a
procedure
Risk assessment provides impact or
consequence to patient as a result of a task or
a procedure
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Calculating Risk
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• Estimated cost is important as it helps to
target IP&C resources to specific
procedure
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How much does it cost to
prevent ?
• where risk was identified
• where they will deliver the greatest advantage
in terms of preventing harm for patients
• Often it is not possible to have exact cost
estimated cost is acceptable
20
• Once all information on the severity, frequency
of occurrence and cost of prevention are
available
• Priorities for action can be calculating as follows:
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Priorities for action
RISK RATING = SEVERITY x FREQUENCY
21
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Priority for Action
22
• Put an agreed risk reduction plan in place in
the problem area
• Eliminate risk, if possible
• Reduce risk to acceptable level, if needed
• Transfer risk to a third party
• May need to accept risk in short term
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Risk Control - 1
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Risk Control - 2
Identify Risks
↓
Analyse
(Evaluate & Rank)
↓
Control
Avoid
Prevent
Transfer
Accept
Risk Control : Think possible solutions !




How they can be avoided eg minimize/avoid use of sharps
How they can be prevented eg use aseptic techniques
Can it be transferred eg outsource waste management
Can you accept it eg low risk/high cost intervention
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• Feedback and reporting
• To ensure that risk reduction plans
are followed
• Performed by
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Risk Monitoring
• regular audit
• process surveillance
• outcome surveillance
• Feedback provided to relevant staff
and senior management
25
• Audit process can identify infection risks
• When risk reduction plan in process, audit can
• identify new risks
• analyse risk against evidence-based practice
• identify any gaps in practice
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The audit process
• Key elements of the audit process
• communication
• consultation
• timely feedback
26
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Summary: Risk Management
27
1.
2.
3.
Roberts G. Risk Management in Healthcare. 2nd
ed. London: Witherby & Co. 2002
Australian Standard: Risk management.AS/N2S
4360: 2004.
http://www.mwds.com/AS4me_files/ASNZS%2043602004%20Risk%20Management.pdf
Australian Guidelines for the Prevention and
Control of Infection in Healthcare (2010)
http://www.nhmrc.gov.au/book/australianguidelines-prevention-and-control-infectionhealthcare-2010/a2-1-risk-management-bas
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References
28
1. Risk management is a retroactive approach and its aim
is to minimise harm. T/F
2. In setting priorities for action, which of these is
needed?
a.
b.
c.
d.
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Quiz
Severity or consequences
Frequency
Cost of implementing plans
All of the above
29
• IFIC’s mission is to facilitate international networking in
order to improve the prevention and control of
healthcare associated infections worldwide. It is an
umbrella organisation of societies and associations of
healthcare professionals in infection control and related
fields across the globe .
• The goal of IFIC is to minimise the risk of infection within
healthcare settings through development of a network of
infection control organisations for communication,
consensus building, education and sharing expertise.
• For more information go to http://theific.org/
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International Federation of
Infection Control
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