Risk Assessment

Ruth Carrico PhD RN FSHEA CICAssociate ProfessorUniversity of LouisvilleDivision of Infectious DiseasesRuth.carrico@louisville.edu

Objectives

• Review the purpose and processes of risk assessment in the identification of infection risks within individual healthcare settings

• Describe the process for the conducting of risk assessment applicable to all healthcare settings using a template applicable for all healthcare settings

• Identify specific elements that should be included in your infection prevention and control risk assessments

What is a Risk Assessment?

• Part of the IP planning process• Starting point for a well-developed plan and

program• Helps focus activities and effort• Meets regulatory and accreditation

requirements• Validates work• Justifies need and utilization of resources• It is applicable and necessary for all settings

Risk Assessment CycleIdentify Risks

Identify Who

is at Risk

DevelopMethods to

EvaluateRisk

PerformEvaluation

EstablishPriorities

DetermineStrategies

Patients, Healthcare personnel, Community

The Joint Commission StandardsIC.01.03.01 Risk Assessment

The hospital identifies risks for acquiring and transmitting infections

• The risk assessment is the cornerstone upon which the Infection Prevention and Control program is built.

Elements of Performance 1Location, Community and Population

“The hospital identifies risks for acquiring and transmitting infections based on the following: Its geographic location, community, and population served.”

• Geography involves diseases specific to some area(s)

• Community involves resources available in urban, suburban and rural areas

• Population involves determinants of health

Elements of Performance 2Programs and Services Provided

“The hospital identifies risks for acquiring and transmitting infections based on the following: The care, treatment, and services it provides.

• General surgery• Interventional procedures• Infusion services• Dialysis• Rehabilitation• Pharmacy compounding

• Transplant• Specialty surgery• Critical care• Oncology• Pediatrics• Rehab• Long-term care

Elements of Performance 3Surveillance and Other Data

“The hospital identifies risks for acquiring and transmitting infections based on the following: The analysis of surveillance activities and other infection control data.”• Surveillance data• Laboratory/microbiology data• External communications (other facilities, health

department)• Internal communications (medical staff, nursing

staff, ancillary departments, patients)

Elements of Performance 4Time Frame and Input from Staff

“The hospital reviews and identifies its risks at least annually and whenever significant changes occur with input from, at a minimum, infection control personnel, medical staff, nursing, and leadership.”• Maintain dates on risk assessments• Note multidisciplinary involvement• Risk management reports

Elements of Performance 5Ranking Risks

“The hospital prioritizes the identified risks for acquiring and transmitting infections. These prioritized risks are documented. There must be a method for ranking risk”• Probability and severity are the most common

factors utilized• Consider using a similar ranking scheme to the

one used for hazard vulnerability analysis

The Joint Commission StandardsIC.01.04.01 Goals

Based on the identified risks, the hospital sets goals to minimize the possibility of transmitting infections.

• Must address the prioritized risks and include in your written plan and goals.

• Must also address success or failure of goals.

Regulatory and Accreditation Requirements

• Identifies risks for acquisition and transmission of infection

• Performed annually and when changes occur or are anticipated

• Multi- and Interdisciplinary input• Prioritization• Documentation• Evaluation• Accountability

Performing a IC Risk Assessment

Identify Risk Targets For Analysis

•Local Community•Organizational•Societal

Involve Others

•ICC•Leadership•Key Staff•Health Dept

Develop Methods

•Quantitative•Qualitative•SWOT•Gap Analysis

PerformAssessment

Establish Priorities, Templates and Timelines

Establish Priorities

Qualitative or Quantitative

Determine GoalsStrategiesEvaluation Process

Risk Assessment Cycle

Leadership

Risk Assessment Process

• Gather information• Evaluate scope of service(s)• Form team• Determine risk assessment steps• Determine risk assessment uses• Consider how you will share the information

Starting The Assessment

• List activities that place patients at risk for HAI• BSI, VAP, SSI, UTI, hand hygiene, environmental

cleaning, sterilization/disinfection of instruments, BBP, legionella, aspergillosis, vaccine preventable diseases (flu, measles, mumps, varicella, pertussis), MDRO

• List activities that place healthcare personnel at risk for HAI• BBP exposure, TB exposure

• List activities that place community at risk due to the facility’s ability to address infection issues• Surge capacity

Risk Assessment Process

• Gather information• Regulations (e.g., CMS, OSHA, State)• Recommendations and Standards (e.g., CDC, TJC)• Professional Standards (e.g., APIC, SHEA)• Community issues (health department, KDPH)• Patients, advocates, community leaders

Risk Assessment Process

• Evaluate scope of service(s)• Population served• Changes on the horizon• Procedures, services performed• Workforce• Environment• Risks

Risk Assessment Process

• Form team• Multi- and interdisciplinary• Uses historic data regarding identified

problems (e.g., environmental issues needs environmental services participation)

• Includes administration• Not a meeting of “friends”• Everyone has a responsibility and needs to

expect homework

Risk Assessment Process

• Determine the steps in the risk assessment process• Use of background/historic data (e.g.,

surveillance data to determine problems)• Builds evaluation methods at the beginning of

the journey (how will I know if improvement occurs?)

• Looks at probability of an event occurring• Impact/severity• Current systems that impact or address the risk

Risk Assessment Process• Determine the uses of the risk assessment

• What data/information will be shared• To whom• How will it be shared• How can duplicative work be prevented• How can report errors be prevented• Plan the communication methods (e.g., Paste Special

function in Excel)• Do not routinely perform work that is not in alignment

with the risk assessment• Policies and procedures should be consistent with risk

assessment

Based upon information provided by Terrie Lee RN MS MPH CIC, Director, Epidemiology and Employee Health, Charleston Area Medical Center, Charleston WV

Risk Assessment Elements

• What are your biggest concerns?• How can you prioritize?• How can you align resources?• How can you make sure leadership is involved

and has knowledge of the priorities (and what isn’t)?

• What are areas where you feel more information or expertise is needed?

Addressing Identified Risks• Infection Prevention Program

• Skilled leadership• Program plan

• Surveillance (processes, practices, outcomes)• Quality monitoring • The infection prevention “army”

• Interventions (identifying breaches)• Education (orientation, targeted, ongoing)

• Useful policies and procedures• Competent practice

• Feedback• Monthly reporting from you• Regular reporting to you

Surveillance

• Should be tied directly to your risk assessment• If it is not identified as a risk, you should consider

whether or not the time invested in surveillance will benefit your patients or your program

• Involve the healthcare personnel who have the power to change the processes and outcomes

• The magic in surveillance is the inclusion of others in the data collection phase, analysis of results, and reporting of findings

• Monitoring processes, practices, outcomes

Involving Others

• Infection prevention is everyone’s responsibility• Engage assistance in all processes• Push out information and education• Avoid the temptation to be an information

hoarder• Continuously ask others about their ideas for

improvement• Be aware of unintended consequences• You must be visible

Getting StartedRisk assessmentMultidisciplinary involvement Identify champions in areas/functionsBegin a program of developmentBuild in accountability Share results frequentlyAccept that this responsibility is bigger than you—

build your army Identify tools that can help you with your jobCollaboration with other infection preventionistsGet to know local public health professionals

Skills for the IP of Today

LeadershipManagementKnowledge of health behavior, epidemiology,

biostatistics, environmental and occupational health

Understanding of the processes of careHuman factorsApplication of knowledgeProgram evaluationTechnology

Working Session Instructions• Use blank risk assessment papers to develop your

facility risk assessment and the team you need• Share risk assessment elements with others in your

group. Share your team members, too.• Select a reporter for your group• Will do a 2 minute summary of your risk

assessment elements when we return to large group.