INFECTION PREVENTION & CONTROL MODULE
Service name:_____________________________________________
Date completed:_________________________________
INTRODUCTION: As part of HDANZ’s onTrack programme, the following questionnaire is intended to provide you with a self-assessment review of your
service, in relation to key areas of service delivery for your business planning and quality/risk system. Note that this question sub-set is intended as a
guide only and reflects the relevant sector standards and possible good practices. The self-assessment allows you to identify areas that are working well
(Yes) and areas that may need further preparation for your quality system and service delivery (No). There is an action plan template at the end of the
question set. For any “No” responses you can copy and paste that into the action plan and monitor its completion.
Ref #
Self-assessment questions
1.1
Does the IC committee/coordinator have access to IC resources or IC specialist to implement the IC programme?
1.2
Is the documented infection control programme developed in consultation with relevant stakeholders and personnel?
1.3
Have you clearly identified and documented the role of your infection control committee/IC Coordinator (or equivalent) as
appropriate for your service?
1.4
Is the IC coordinator/team implementing the IC programme by (but not limited to); a) gathering surveillance data, b) education to
staff and c) reporting and making recommendations?
1.5
Do you have access to lab records and other consumer information?
1.6
Do your infection control committee/team members (or equivalent) receive relevant and ongoing education for infection control?
1.7
Do your infection control policies/procedures reflect current accepted good practice and relevant legislative requirements?
1.8
Policies and procedures include: a) Hand hygiene, b) Standard precautions, c) Transmission-based precautions, d) Prevention
and management of infection in service providers, e) Antimicrobial usage f) Outbreak management g) Cleaning, disinfection,
sterilisation, and reprocessing of reusable medical devices (if applicable) and equipment, h) Single use items, i) Renovations and
construction
1.9
Do outbreak management/pandemic planning procedures include information on the investigation and management of
suspected or actual outbreak?
1.10
Do transmission-based precautions cover: a) Isolation precautions required to manage people with suspected or diagnosed
infections b) Management of multi-resistant infections
1.11
Policies and procedures that affect the transmission of infections clearly identify who is responsible for the policy development
and implementation and are consistent with IC policies and procedures.
Yes
No
Comments
1
1.12
Is personal protective equipment available and used as per policy and procedure?
1.13
Is your infection control training provided by a suitable qualified person?
1.14
Do staff receive an orientation in relation to infection control practice that is relevant to the service and includes. 1. Overview of
the infection control programme, and 2. Hand hygiene, and 3. Standard precautions, and 4. Policies/guidelines and key infection
control issues relevant to the service?
1.15
Is infection control included in your annual training plan and records of content and staff attendance maintained?
1.16
Is Infection control education evaluated to ensure the content is relevant and reflects accepted good practice?
1.17
Does the IC committee/coordinator determine the type of surveillance required and the frequency?
1.18
Does surveillance data identify organisms and multi-resistant organisms?
1.19
Is infection surveillance completed in all areas and involve input from senior staff and does surveillance link with the quality
programme?
1.20
Are standardised definitions of infection events, indicators and outcomes used as part of surveillance?
1.21
Is the type of surveillance and level of monitoring appropriate for the size and type of services provided?
1.22
Are you gathering surveillance information appropriate for your service setting that may include 1. All types of infections 2.
Organisms identified 3. Whether resolved or not 4. Summary/analysis of data for trends or issues
1.23
Are the findings, outcomes and recommendations following surveillance activities documented at the IC Committee (or quality
committee)?
1.24
Are surveillance reports and recommendations provided to senior management?
1.25
Is there documented evidence that communication occurs between services when a resident is identified as having an infection?
1.26
Are internal audits or reviews regularly completed in key risk areas for infection control?
1.27
Is compliance and evaluation of your infection control programme completed annually and links with your overall quality/risk
system?
2
ACTION PLAN: INFECTION PREVENTION & CONTROL MODULE
Ref #
Self-assessment questions
(for “No” responses above)
Improvement action to be taken
Due
date
Person
responsible
Date
completed
(Add additional rows as necessary)
3