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Benefits for using a
standardised risk
management framework to
risk assess Infection
Prevention and Control
Sue Greig
Senior Project Officer
National HAI Prevention Program
1 October 2014
Who might benefit from this presentation?
• Organisation governance – improve their
understanding of their role in infection
prevention and control and risk management
• Quality and safety managers or departments
• Infection prevention and control professionals
Key message –
infection control is everybody’s business
To make this message meaningful it requires a
governance structure and key people to drive and
direct the infection prevention and control
programme and all staff to have a basic
understanding of:
– Effective governance to support implementation,
monitoring, reporting activities
– Effective work practices to minimise risk of transmission
of infectious agents
– Modes of transmission of infectious agents
– Legislation, regulation and standards to be applied
A risk management framework
• Provides a nationally consistent approach that
is robust enough to be applied across the
health continuum
• How do we use risk assessment and
management principles for Infection
Prevention and Control?
• Infection should not be considered an
unpredictable complication but a potentially
preventable adverse event
The risk assessment and management
flowchart
Collaboration
Source: Australian Guidelines for the Prevention and Control of Infections in Health Care (NHMRC 2010) - Adapted
A risk matrix
Source: Australian Guidelines for the Prevention and Control of Infections in Health Care (NHMRC 2010)
Who owns the risk?
Governance of the organisation or service
From where can risks come?
• the system
• the organisation
• the team who are delivering the care
• the individual
Who is at risk?
Patients – some patients more than others,
e.g. elderly, surgical patients, neonates,
patients with indwelling devices
HCWs – they are health consumers as well
and they have extensive exposure to the
risk
The organisation
Firstly, we need to understand the
principles of risk management
Avoid risk – if a risk cannot be eliminated then it
must be managed
Identify risk – what is the risk and who is involved?
Analyse risks – how did it occur , what is the
likelihood and what are the consequences?
Evaluate risk – can the risk be reduced or
eliminated?
Treat risks – who will do this, how and when will it
be monitored?
What do we do to minimise risk
We need to identify:
• Who is at risk?
• What infectious agent is involved?
• How is the agent transmitted?
• Why can it happen?
• How likely is it?
• What are the consequences?
• What can be done?
• How is it applied to the situation?
Successful risk management
includes
• A range of strategies that will be influenced
by
– a base-line review or gap analysis
– review of the current governance
arrangements, systems, processes,
practices and their effectiveness
• Development of an action plan to prioritise
response strategies and resources
A risk assessment tool - example
To find out more, go to:
The Healthcare Associated Infection (HAI) Prevention
Program www.safetyandquality.gov.au/hai
Accreditation and the NSQHS Standards
http://www.safetyandquality.gov.au/ourwork/accreditation-and-the-nsqhs-standards/
Accreditation Advice Line:
Email [email protected]
Phone1800 304 056
Standard 3
Preventing and
Controlling Healthcare
Associated Infections
Risk Management and
NSQHS Standards,
Standard 3 – Preventing
and Controlling
Healthcare Associated
Infections
Sue Greig
Senior Project Officer
National HAI Prevention Program
25September 2014
Risk Management and NSQHS Standard 3
• This presentation outlines how the principles of
risk management will support an organisations
response to NSQHS Standard 3
• For each element of risk management
discussed in this presentation, relevant
examples from NSQHS Standard 3 have been
included
IP&C and Governance
(3.1, 3.3, 3.4, 3.14, 3.16)
• Policies and procedures should utilise a risk
management approach and
• Demonstrate evidence of regular review,
monitoring, audit and assessment of infection
prevention and control activities
• Determine priorities based on risk assessment
• Evaluate effectiveness at least annually
• Minimise risks to patients of HAIs
Prioritising risk
(3.8, 3.9, 3.10)
• Scope of activity and services offered will
influence risk
• Is the origin of the risk internal or external or both?
• What are the risks and opportunities for
transmission?
• What existing controls are in place?
• Identify the opportunities for transmission
• Identify those risks that are high so they can be
prioritised both for likelihood and consequence
Collaboration to reduce risk
(3.7, 3.18, 3.19)
• Recognition of how infection prevention and
control risks impacts upon other areas – WH&S,
HR, education, consumers and clinicians
• Utilising a standardised tool for identification
and analysis of risk
• Evaluation of risk management strategies will
require collaboration
• Minimise duplication
Evaluating the risks
(3.12, 3.13, 3.17)
• To identify how this can happen in your
organisation
• When evaluating the risk how are you going to
prioritise activities?



identify where the risks are high
the simplest intervention
greatest impact in the shortest time period.
What is the balance between
likelihood and consequences?
How will we know how
likely it is to happen?
From the risk assessment - are the risks
– common or rare
– severe or mild
How likely will risk occur?
− monitoring and audit results
− surveillance
− complaints
− observation
Establish a context for the clinical environment
Establishing a context –
what do we need to consider?
• The scope of the services provided
• Availability of policies and procedures
relevant to the intended audience?
• Consultation with HCW during
development and review?
• Literacy issues and comprehension of
risk
• Do HCW understand what the risks
are and what actions will minimise
those risks?
Communication and consultation
• Be proactive when developing protocols and
procedures.
• Identify regular intervals for revision and
updating – this can also be a reactive
response.
• Consider clinicians, managers and nonclinical staff when communicating how
policies, procedures and protocols apply to
them.
• Target the audience when providing
information on the risk of infectious agents
How can communication and consultation
support the risk management process?
• Provide a plan and systems for risk notification,
assessment, management and resolution
• Celebrate achievements
• Encourage and facilitate collaboration
• Utilise appropriate message media including
signage, websites, posters, charts, agenda items
• Provide patient and consumer information in
areas where it is accessible
• Education is provided for
HCW on infectious agents, means
of transmission and interventions
that need to be applied
Monitor and review
• Are the interventions making a difference to
the corporate and/or clinical risk?
• Is risk being reduced?
• How do we know?
• mechanisms are implemented to ensure
identification of risks
• methods of demonstrating how good the
care is including surveillance, quality
improvement activity results, audit
results, education
In Summary
• Infection prevention and control needs:
– effective governance
– resources
– risk management to ensure a safe
environment for both HCW and patients
• Prevent preventable infections
• Success can be measured by addressing
risks with a standardised framework
“Breaking the chain of infection transmission”
To find out more, go to:
The Healthcare Associated Infection (HAI) Prevention
Program www.safetyandquality.gov.au/hai
Accreditation and the NSQHS Standards
http://www.safetyandquality.gov.au/ourwork/accreditation-and-the-nsqhs-standards/
Accreditation Advice Line:
Email [email protected]
Phone1800 304 056
Standard 3
Preventing and
Controlling Healthcare
Associated Infections