Risk management:

‘Risk’ is defined as possibility of acquisition or infection of patients or healthcare workers arising from activities within a healthcare facility. Risk management is the basis for preventing and reducing harms arising from the healthcare-associated infection. A successful approach to the risk management occurs on many levels within a healthcare facility:

  • Facility wide—for example, providing support for effective risk management through Organizational risk-management policy, staff training, follow-up of outcomes and monitoring and reporting.
  • Ward or the department based—for example, embedding risk management into all policies so that risks are considered in every situation.
  • Individual—for an example, considering the risks involved in carrying out a specific procedure and questioning the necessity of the procedure as part of clinical decision making, attending education sessions (e.g. hand hygiene or respirator fit testing).

As healthcare settings differ greatly in their day-to-day function, it is not possible to provide one size fits all approach to risk management. All the healthcare facilities need to be able to determine the risks in their own context and select the appropriate course of action. Therefore it is necessary for facilities to regularly conduct infection prevention risk assessments within their facility and ensure that all staff understands their responsibility in managing these risks.

A stepwise approach to risk management that allows continuous quality improvement and involves:

  • Establishing context—identifying basic parameters in which risk must be managed (E.g. the type of the health facility, the extent of and support for the facility’s infection prevention and control program).
  • Avoiding risk—establishing whether there is the risk and whether potential risk can be averted (e.g. by questioning whether a procedure is necessary)
  • Identifying risks—a systematic and comprehensive process that ensures that no potential risks excluded from further analysis and treatment (e.g. using root cause analysis)
  • Analyzing risks—considering the sources of risk, their consequences, the likelihood that  those consequences may occur, and factors that affect consequences and likelihood  (E.g. existing controls)
  • Evaluating risks—comparing level of risk found during the analysis process with previously established risk criteria and assessing available options for ease of implementation and impact, resulting in a prioritized list of risks for further action
  • Treating risks—implementing the appropriate management options for dealing with identified risk (e.g. modifying procedures, protocols or the work practices; providing education; and monitoring compliance with infection prevention and control procedures).

Risk assessment: Healthcare delivery uses a variety of simple and complex processes each associated with a risk to patients and staff. These processes are measured continuously, reviewed periodically and training imparted in real time to reduce risk .Policies, procedures; education and evidence based activities are designed to reduce the risk of infections hospital wide annually. CT l tracks infection risks, infection rates, and trends in health care–associated infections to reduce the risks of those infections.

Architectural Segregation & Traffic Flow – it is useful to stratify patient care area by risk of patient population for acquisition of infection. Four degrees of risk are considered

Low Risk Area

 

1. Administrative Sections,
2. Stores & Pharmacy,
3. Outpatient Department,
4. Biomedical & Maintenance
5. Medical Records 6. Central Lobby & Dining Hall

 

Moderate Risk Area

 

1. Wards & Patients Units,
2. Emergency Units,
3. Radiology
4. Blood Bank 5. Laundry & Housekeeping
6. Oxygen Plant

 

High Risk Area

 

1. Dialysis Unit,
2. Endoscopy & Bronchoscopy
3. Laboratory & Phlebotomy Area
4. Mortuary
5. CSSD

 

Very High Risk Area

 

1. Isolation Room
2. BMT rooms
3. Intensive Care Units
4. Operation Theatres
5. Cath Lab

Point-of-Care Risk Assessment (PCRA)

HCW before every patient interaction, choose the appropriate actions/PPE

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