Dr. Lavanya -Infection Control Risk Assessment (ICRA)

7/28/2019 Dr. Lavanya -Infection Control Risk Assessment (ICRA)

1/37

Lavanya Nutankalva M.D.

Consultant- Infectious Diseases April 21, 2011


2/37

CDC: hospital-acquired infections account for an estimated1.7 million infections and 99,000 associated deaths eachyear.

Between - 10 % of the atients who are admitted to U.S.acute-care hospitals acquire one or more infections there.

CDC: 1.7 million hospital-acquired infections each year andapproximately 90,000 deaths.

Hospital-acquired infections are the sixth leading cause ofdeath nationally, costing the health care industry $6 billionannually.


3/37


4/37

NDM-1: Novel, global, complex and a

serious threat Lancet Infectious

Gram-negative bacteria carrying a novel

resistance factor :- New Delhi metallo-beta-lactamase, or NDM-1.


5/37

Govt playing down NDM-1 superbug study?


6/37


7/37

To Err Is Human..

But be sensible what the customer is

thinking and how much they know??


8/37

1. Address Strategic Priorities, Culture, and Infrastructure2. Engage Key Stakeholders

3. Communicate and Build Awareness -. 5. Track/Measure Performance Over Time, Strengthen

Analysis6. Support Staff and Patients/Families Impacted by Medical

errors7. Align System-Wide Activities and Incentives8. Redesign Systems and Improve Reliability


9/37

* Multidisciplinary process focusing on reducing riskfrom infection throughout facility planning, design,and construction (including renovation) activities.

Identif hazards. Analyze the risk associated with that hazard. Determine ways to eliminate or control the hazard.

( process to identify those things, situations,processes, etc that may cause harm to people andthen decide what measures should be taken andadopt them to effectively prevent or control the harmfrom happening)


10/37

A multidisciplinary team considers: the environment

infectious agents the impact of the proposed project.

The team - experts in infectious disease,infection control, patient care, epidemiology,facility design, engineering, construction, andsafety


11/37

Inte ral art of a ood occu ational healthand safety management plan.


12/37

They help to:

Create awareness of hazards and risks.

Identify who might be at risk (employees,c eaners, visitors, contractors, t e pu ic,

etc).

Determine if existing control measures are

adequate or needs improvising

Prevent injuries or illnesses


13/37

Identify hazards. Evaluate the likelihood of occurring, and its severity. Consider normal operational situations as well as non-

s an ar even s Review all available heath and safety information

about the hazard Identify actions necessary to eliminate or control the

risk. Monitor and evaluate to confirm the risk is controlled. Keep any documentation or records that may be

necessary.


14/37

It is important to remember that theassessmen mus a e n o accoun no on ythe current state of the workplace but any

potential situations as well.


15/37

Based on the identified risks, the hospital setsgoals to minimize the possibility of

transmitting infections.


16/37

IC standards have made risk assessment andinfection prevention goal setting more

structured, formal process to enhance a well -

designed and thoughtful approach toinfection prevention activities.


17/37

Important to identify which hazard is the

most serious and which hazard to control

first. Priority is usua y esta is e y ta ing into

account the employee exposure and thepotential for accident, injury or illness.


18/37

percentage of workforce exposed

frequency of exposure egree o arm i e y to resu t rom t e

exposure

probability of occurrence

( It needs objective judgment)


19/37

1. All aspects needs to be assessed

2. Non-routine activities

3. All records about accidents or any significantevents to e recor e an assesse

4. Include all personnel to get the informationboth trained and untrained eye


20/37


21/37

1. Geographic location, community, and

population served.

2. The care, treatment, and services provided.3. T e ana ysis o survei ance activities an

other infection prevention data.


22/37

Likelihood of Event Occurring:

Rare Unlikely Possible

Almost Certain

Infection Risk :

Low Risk Medium Risk High Risk Very High Risk


23/37

Likelihood of harm

Severity of harm


24/37

Very Likely - experienced at least once every

six months by an individual.

Likely - experienced once every five years byan in ivi ua .

Unlikely - experienced once during theworking lifetime of an individual.

Very unlikely - Less than 1% chance of beingexperienced by an individualduring their working lifetime.


25/37

Work activity should be considered, along with:

a) part(s) of the body likely to be affected

b nature of the harm:

1. slightly harmful (e.g., superficial injuries; minorcuts and bruises; eye irritation from dust)

2. harmful (e.g., lacerations, burns, concussion,serious sprains, minor fractures)3. extremely harmful (e.g., amputations, major

fractures, poisonings, multiple injuries, fatalinjuries, occupational cancer)


26/37

Very low - Considered acceptable.

- No further action is necessary .

Low

a) No additional controls are required unlessthey can be implemented at very low cost .

b) Actions to further reduce these risks areassigned low priority.


27/37

Medium a) Consideration for whether the risks can be lowered

to a tolerable or an acceptable level, but the costs of

additional risk reduction measures should be taken.

b) The risk reduction measures should beimplemented within a defined time period.

c) Arrangements should be made to ensure thatcontrols are maintained, particularly if the risk levelsarea associated with harmful consequences.


28/37

High a) Substantial efforts needed to reduce the

risk.b) Risk reduction measures should be

implemented urgently in a defined timeperiod and probably suspend or restrict theactivity, or to apply interim risk control

measures, until this has been completed.c) Considerable resources are needed.d) Arrangements should be made to ensure

that controls are maintained.


29/37

Very high a) They are unacceptable.

b) Substantial improvements in risk control

reduced to a tolerable or acceptable level.c) The work activity should be halted until risk

controls are implemented that reduces therisk so that it is no longer very high.d) If it is not possible to reduce the risk, the

work should remain prohibited.


30/37

Limiting unprotected exposure to pathogens

Limiting transmission of infections associated

with procedures Limiting transmission o in ections associate

with use of medical equipment, devices, andsupplies


31/37

Transmission-Transmission activities

including surveillance to minimize, reduce, or

eliminate risk of infection Stan ar precautions

Transmission based precautions contactprecautions, droplet precautions and

airborne precautions Outbreak investigation


32/37

Employee health health-related issues

Screening Han ing o in ections

Exposures:- Influenza vaccination program,Chicken pox vaccination


33/37

A- Manage by Routine Infection Control ProceduresB- Manage by Specific/Enhanced Infection Control

Procedures

C- This is Serious and Must Be Addressed Immediatelyy n ec on on ro rac ce anagemen ys ems

D- Manage by Routine Infection Control ProceduresE- Manage by Specific/Enhanced Infection Control

ProceduresF- This is Serious and Must Be Addressed Immediately

by Infection Control Practice Management Systems


34/37


35/37


36/37

To see if it was complete and accurate.

To be sure that changes in the workplace

have not introduced new hazards or changedazar s t at were once ran e as ower

priority to a higher priority.

For constant reinforcement and its

continuation.


37/37

Triggers for a review can also include: a change in the work process or flow

a change or addition to tools, equipment,

they are used) new employees

moving to a new building or work area introduction of new chemicals or substances, when new information becomes available

about a current product.

Dr. Lavanya -Infection Control Risk Assessment (ICRA)

Documents

Transcript of Dr. Lavanya -Infection Control Risk Assessment (ICRA)