RISK ASSESSMENT PRACTICE SESSIONS –LONG TERM CARE

Cindy Winfrey, MSN, RN, VA-BC, CIC, IP-BC, CDONA, CDP, CADDCT, FACDONA

Master Trainer NADONA

OBJECTIVES Discuss the format of an Infection Control Risk Assessment Demonstrate how to create an

Infection Control Risk Assessment based on practice setting.

WHAT’S ASSESSED?

Risks: (Infections, contamination,

exposures)

Harm: (Loss of life/function,

reputation, financial, legal/regulatory)

Preparedness: (Ability to eliminate or mitigate the harm

or risk of harm)

WHY DO IT? The risk assessment:

Is the basis of the infection prevention program

Provides focus for departmental and organizational activities

Outlines where resources needed (may be used to justify additional resources)

Outcomes (positive or negative) effect everyone so the assessment should be multidisciplinary

INFECTION CONTROL DOMAINS FOR GAP ANALYSIS

Infection Control Program and Infrastructure

Healthcare Personnel and Resident Safety

Surveillance and Disease Reporting

Hand Hygiene

Personal Protective Equipment (PPE)

Respiratory/ Cough Etiquette

Antibiotic Stewardship

Injection safety and Point of Care Testing

Disaster Preparedness

STRUCTURE Descriptive analysis:•Geographic location & size

•Populations served

•Staffing mix

•Services performed (volumes)

•Surveillance data

•Epidemiologically important organisms

•System issues

•Other risks / support agencies

NHSN

Currently, LTCF can enroll in two NHSN Components

Long-term Care Facility Component (UTI; MDRO & CDI surveillance)/(HH, PPE Use)

Healthcare Personnel Safety Component (HCW Flu immunization rate)

For more information see http://www.cdc.gov/nhsn/hps.html

EXAMPLES

Program Components Probability of Performance-

Failure Impact

(Clinical/Financial/Resources) Infection Prevention Systems Score Go

Potential Risks/Problems High Med Low Never High Moderate Minimal Poor Fair Good Excellent >7

3 2 1 0 3 2 1 3 2 1 0

Procedures HAI’s

Surgical Site Infections 2 2 2 6

SSI-Ortho Join Replacement 1 3 2 6

SSI-plastic surgery 2 3 2 7

SSI-vasectomy 1 1 1 3

Failure of Prevention Activities

Lack of Hand Hygiene program 2 3 2 7

Lack of Standard Precautions 1 2 2 5

Lack of TB screening of patients 2 3 2 7

Lack of appropriate prophylactic antibiotic 2 3 2 7

Lack of appropriate OR attire 1 2 2 5

Environment

Refrigerator Temp logs 1 1 1 3

Infection from inadequate sterilization monitoring

0 3 2

5

Improper eating and drinking in the OR environment

0 3

6

REFERENCES

Chilton, L. Infections and Antimicrobial Resistance in the Elderly Living in Long-Term Cares Settings. Available at http://www.medscape/com/viewarticle/493678

Centers for Disease Control and Prevention. (2007). Guidelines for isolation precautions: Preventing transmission of infectious agents in healthcare settings 2007. Retrieved January 5, 2010 from http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf Centers for Disease Control and Prevention (2017). Vaccination Information for Adults.

Available at: https://www.cdc.gov/vaccines/adults/index.html

SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term Care Facility. (2008). Available at http://www.journals.uchicago.edu/doi/pdf/10.1086/592416

ADDITIONAL RESOURCES

APIC available at: http://www.apic.org

https://apic.org/Search/Index?Keywords=risk+assessment&x=0&y=0

Centers for Disease Control and Prevention (CDC) available at https://www.cdc.gov/longtermcare/index.html

https://www.cdc.gov/infectioncontrol/pdf/ICAR/LTCF.pdf

Centers for Medicare and Medicaid available at: https://www.cms.gov

Office of Disease Prevention and Health Promotion (ODPHP). Healthcare Associated Infections available at: https://health.gov/hcq/prevent-hai.asp