COVIDIEN 2010 Infection Control Scholarship Application Form

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Have you initiated a successful infection control strategy in any of these areas:
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Needle stick injury minimization and sharps disposal management?
Wound care management and infection prevention?
Best practice urinary catheterization and infection control?
Best practice airway management/patient suctioning and reduction of
associated infections?
Oximetry, patient monitoring and reduction of intra patient infection?
If so, COVIDIEN wants to recognize your excellence!
Purpose:
The Covidien 2011 Infection Control Scholarship has been designed to encourage Australian
and New Zealand infection control practitioners to share their successes and innovations and
to gain support for further work in these areas. The Scholarship is to support critical Infection
Control projects to ultimately enhance patient safety and assist best practice procedures and
work place outcomes
Eligibility:
To be eligible:
1. You must be a current healthcare employee within an Australian or New Zealand
healthcare institution.
2. You must submit a scholarship application outlining your respective area of infection
control interest within the clinical areas of sharps safety, urology, continence, wound
care, airway management, patient suctioning or oximetry monitoring (see scholarship
application form).
3. You must highlight the specific procedural, patient and/or work place benefits of such
current or future projects.
4. You must summarize what support you require to continue/complete your project
(please refer to examples below).
5. You must submit a typed application on the Covidien 2011 Infection Control
Scholarship Application Form provided. No hand written applications will be
accepted. Soft copies of the Covidien 2011 Infection Control Scholarship Application
Form are available by visiting the AICA website (www.AICA.org.au) or by emailing
Aust.Infection.Control@Covidien.com
You are ineligible if:
1. You are an employee of a State or Territory Health Department [State or Territory
Health Department means an employee of the health department directly (i.e. in a
government post) not a public hospital employee.]
2. You apply for funding to cover resource issues with respect to backfill of your
position. Funding is not for direct salaries.
Scholarship Program:
A maximum of AUD $40,000 is available over the period 1st January to 31st December 2011
to be provided for successful scholarship applications.
. This funding will be awarded across four categories:
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Major Research Project: Awarded to one project requiring funding up to $15,000.
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Minor Research Projects: Three grants for research projects requiring funding up to
$5,000 will be awarded (Total Award = $15,000).
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Educational Grant: A total of $6,000 in grants to further educational requests related
to Infection Control
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Articles for Publication: A total of $4,000 in grants to assist in writing articles for
publication in ‘Healthcare Infection’, [the official journal of the Australian Infection
Control Association] or any other peer reviewed journal. This will be awarded as
eight (8) grants of $500 each.
For successful applicants, the agreed scholarship funding will paid to the institution where the
applicant is employed, to be used specifically for required project activities such as:
1. Direct education for post graduate training, bridging courses and certificate training
2. Attendance (i.e. registration fees, travel and accommodation costs) for conferences,
seminars and study days
3. The provision of required books, teaching resources and poster presentations
4. Other agreed specific activities
Selection Process:
Scholarship applications are to be submitted to Covidien. As the applications are received,
Covidien will review all applications and pass the applications of candidates to an
independent panel of Infection Control Practitioners, appointed by Covidien. The panel will
review project applications on their merit against agreed criteria including:
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Best infection control clinical practice
Innovative infection control research
Enhanced patient and co worker safety
Enhanced work place outcomes and occupational health and safety
The Panel will give their recommendations as to which candidates should receive
scholarships. Covidien, in its absolute discretion, reserves the right to make the final
selections.
Successful candidates and their employers will be notified in writing within 30 days of the
Panel review, specifying:
1.
2.
3.
4.
5.
6.
The scholarship value for the agreed project
Verification of the project objective and expected outcomes
The specific activities for which the scholarship monies will be used
Guidelines for receiving and spending scholarship monies, recording of
expenditures and the submission of regular status reports concerning the project
Request for a tax invoice for the nominated scholarship value, from the
healthcare institution that the applicant is employed by, made out to Covidien
Timeline for project completion
Each scholarship recipient will be required to present a summary of their project outcomes to
the Panel within 3 months of project completion.
Please note, the closing date for all applications is 1st June 2011.
Please email or mail completed application forms to:
Tony Poulton
Director of Medical
Covidien Australia
166 Epping Road
Lane Cove NSW 2066
Ph: 02 9429 4358
Fax: 02 9418 9622
Email: tony.poulton@covidien.com
COVIDIEN 2010 Infection Control Scholarship Application Form
Application Deadline: 30th June 2011
Date of Application:
Applicant’s Name:
Applicant Contact Details:
Address:
Phone:
Fax:
E-mail:
Institution Name & Address:
Institution ABN:
(required for tax invoice purposes)
Type of Institution:
 Hospital
 Aged Care
 Long Term Care
 Other ________________
 Public  Private
Bed Size ________
Project Name:
Project Category:
 Major Research Project
 Minor Research Project
 Educational Grant
 Article for Publication Grant
Infection Control Project Area : i.e.
sharp safety, wound care, urology,
continence, airway, suction,
oximetry
Brief description of the project:
Summarize project strategy,
methods, expected outcomes and
estimated duration of project:
State total project funding
requested:
Summarize funding requested by
category (i.e. travel, research,
education, materials etc)
Summarize specific activities that
scholarship monies will be used for:
Summarize procedural, research,
patient or work place benefits of the
proposed project:
Describe how the applicant intends
to apply findings from the project to
their healthcare institution:
I, _________________________, of ________________________________
hereby agree that, if I am successful in my application for a Covidien
2011 Infection Control Scholarship, I will prepare and submit, within 3
months of completion of my project, a summary of my project outcomes
to the Covidien Australia Infection Control Scholarship panel and I will
submit any requested update of my project to the panel during the
project phase.
Signed: ___________________________________
Date: _________________________
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