<<Name of Hospital>>

2007 Infection Control Plan

Risk Assessment
EVENT

PROBABILITY OF
OCCURRENCE

SCORE

High (3) Med (2) Low

(1)

PATIENT EFFECT

None
(0)

Life Threat Perm

Temp
(3)
Harm (2) Harm
(1)

None
(0)

INTENSITY OF
ORGANIZATIONS
RESPONSE NEEDED TO
ADDRESS THE RISK

ORGANIZATION
RISK
PREPAREDNESS TO LEVEL
ADDRESS SUCH A
RISK AT THIS TIME

High (3) Med (2) Low

(1)

Poor
(3)

None
(0)

Fair
(2)

Good
(1)

Total

Geography and
Community
Transportation Mass
Causality
Community
Acquired MRSA
Hospital Acquired
Infection Rates
Surgical Site
Infection-Vascular
VAP
Resistant
Organisms
Extended Spectrum
Beta Lactam (ESBL)
MRSA (HA)
VRE (HA)
Services Provided
NICU
ICUs
Total Joints
Interventional
Radiology
Transfusion and
Oncology Suite
Bariatric Surgery
Hemodialysis
Communication
Lack of notification
of presence of HAI
(internal transfer)
ED/Occ Med
Coordination of n
Exposure Follow- up
Staff
Hand Hygiene Noncompliance
Sharps Injuries
Non-compliance IHI
Central Line
Insertion Guidelines
Lack of Early
Recognition of
Potential Infections
Compliance with
isolation
Flu Vaccine NonCompliance

EVENT

PROBABILITY OF
OCCURRENCE

SCORE

High (3) Med (2) Low

(1)

PATIENT EFFECT

None
(0)

Life Threat Perm

Temp
(3)
Harm (2) Harm
(1)

None
(0)

INTENSITY OF
ORGANIZATIONS
RESPONSE NEEDED TO
ADDRESS THE RISK

ORGANIZATION
RISK
PREPAREDNESS TO LEVEL
ADDRESS SUCH A
RISK AT THIS TIME

High (3) Med (2) Low

(1)

Poor
(3)

Environment
Page 1 of 2

None
(0)

Fair
(2)

Good
(1)

Total

<<Name of Hospital>>
Water Intrusion
Ineffective
preconstruction IC
planning
Improper cleaning
of environment
Supplies and
Equipment
Improper cleaning or
disinfection of
equipment between
patients
Emergency
Management
Plan for influx of
infectious patients
Bio-terrorismproximity to NYC

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