1. Risk Assessment Ruth Carrico PhD RN FSHEA CIC Associate Professor University of Louisville Division of Infectious Diseases Ruth.carrico@louisville.edu

2. 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

3. 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

4. Risk Assessment Cycle Identify Risks Identify Who is at Risk Develop Methods to Evaluate Risk Perform Evaluation Establish Priorities Determine Strategies Patients, Healthcare personnel, Community

5. The Joint Commission Standards IC.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.

6. Elements of Performance 1 Location, 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

7. Elements of Performance 2 Programs 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

8. Elements of Performance 3 Surveillance 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)

9. Elements of Performance 4 Time 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

10. Elements of Performance 5 Ranking 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

11. The Joint Commission Standards IC.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.

12. 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

13. 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 Perform Assessment Establish Priorities, Templates and Timelines Establish Priorities Qualitative or Quantitative Determine Goals Strategies Evaluation Process Risk Assessment Cycle Leadership

14. 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

15. 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

16. 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

17. Risk Assessment Process Evaluate scope of service(s) Population served Changes on the horizon Procedures, services performed Workforce Environment Risks

18. 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

19. 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

20. 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

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

22. 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?

23. 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

24. 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

25. 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

26. Getting Started  Risk assessment  Multidisciplinary involvement  Identify champions in areas/functions  Begin a program of development  Build in accountability  Share results frequently  Accept that this responsibility is bigger than you— build your army  Identify tools that can help you with your job  Collaboration with other infection preventionists  Get to know local public health professionals

27. Skills for the IP of Today  Leadership  Management  Knowledge of health behavior, epidemiology, biostatistics, environmental and occupational health  Understanding of the processes of care  Human factors  Application of knowledge  Program evaluation  Technology

28. 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.