Year Infection Control Risk Assessment
Program Components
Potential Risks/Problems
Probability of PerformanceFailure
(Clinical/Financial/Resources)
High
Med
Low
Never
High
Moderate
Minimal
Poor
Fair
Good
Excellent
3
2
1
0
3
2
1
3
2
1
0
Impact
Infection Prevention Systems
Score
Goal
>7
Procedures HAI’s
Surgical Site Infections
SSI-Ortho Join Replacement
SSI-plastic surgery
SSI-vasectomy
2
2
1
2
2
2
3
3
2
1
1
1
6
6
7
3
Failure of Prevention Activities
Lack of Hand Hygiene program
Lack of Standard Precautions
Lack of TB screening of patients
Lack of appropriate prophylactic antibiotic
Lack of appropriate OR attire
2
3
1
2
2
2
2
2
2
2
2
3
3
1
2
7
5
7
7
5
Environment
Refrigerator Temp logs
Infection from inadequate sterilization
monitoring
Improper eating and drinking in the OR
environment
Infection from inadequate air handling
Positive Pressure room monitoring
Problems with cleaning/high level
disinfection
Infection related to
Construction/Renovation
Regulated Waste Management
1
1
0
3
0
3
1
1
1
2
3
5
6
3
2
2
1
1
3
0
1
1
3
3
3
6
4
5
6
1
5
1
4
Policy and Procedures
Lack of current polices or procedures
related to-infection control and prevention
Failure to follow established policy or
procedures-safe injection practices, single
use devices
1
2
2
3
3
8
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Year Infection Control Risk Assessment
Preparedness
Exposure Plan for disaster preparedness
Exposure to: Norovirus/influenza/Other
Respiratory infections-TB /Pertussis
Outbreak
Community ID Risk-Lice/scabies/bed bugs
3
3
3
3
3
3
3
9
9
3
3
3
9
7
2
2
Employee Health
Annual ATD/TB screening Plan
Annual Fit Testing
Lack of Staff influenza immunization
Exposure Plan to Bloodborne
Pathogens(BBP)
Exposure to Tuberculosis/BBP
Exposure to Pertussis
1
1
3
3
3
2
2
2
2
6
5
7
6
3
3
2
2
8
8
2
2
6
5
6
6
2
2
1
3
3
ABX Resistance Organisms
MRSA
C Dif
VRE
ESBL
2
2
2
1
0
0
3
3
3
3
The Infection Control (IC) Risk Assessment grid is a visual tool to develop IC program priorities and stratify infection risks based on our geography, location in the
community, and our patient population. The annual IC Plan is developed based on these risks.
The Risk Assessment is an ongoing, continual process. If an outbreak should occur it will take precedence over the IC Plan.
Zero- Process has been going well
Low or 1- Processes are initiated and being followed
Med or 2-The processes in place are working well and the outcomes are improving and sustaining
High or 3- Training or education sessions may need to be scheduled
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Year Infection Control Risk Assessment
Risk Assessment Completed on:
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