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ICRA Analysis for Cadasari Health Services

This document contains two Infection Control Risk Assessment (ICRA) forms from a health center in Pandeglang Regency, Indonesia. The first form assesses risks in the emergency room, identifying issues like lack of regular sterilization of equipment, improper separation of infectious and non-infectious patients, inadequate PPE use, and irregular disinfection of beds and tables. The second form assesses risks in the delivery room, noting occasional PPE use and improper disposal of waste materials as potential problems. Both forms rate the potential risks, probability of occurrence, and current systems in place to control infections.

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Maiova N. Annisa
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84 views9 pages

ICRA Analysis for Cadasari Health Services

This document contains two Infection Control Risk Assessment (ICRA) forms from a health center in Pandeglang Regency, Indonesia. The first form assesses risks in the emergency room, identifying issues like lack of regular sterilization of equipment, improper separation of infectious and non-infectious patients, inadequate PPE use, and irregular disinfection of beds and tables. The second form assesses risks in the delivery room, noting occasional PPE use and improper disposal of waste materials as potential problems. Both forms rate the potential risks, probability of occurrence, and current systems in place to control infections.

Uploaded by

Maiova N. Annisa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

PEMERINTAH KABUPATEN PANDEGLANG

DINAS KESEHATAN

UPT PUSKESMAS CADASARI


Jl. Raya Serang Km. 5, Kec. Cadasari Hp 081394383437
P A N D E G L A N G

FORM ANALISIS INFECTION CONTROL RISK ASSESMENT (ICRA)


Hari/Tgl :
Unit Layanan : Ruang IGD
Risk/Impact (Health, Financial,
Potential Probability / Frekuensi Legal, Regulatory) Current Systems/Preparedness
Risks/
5 4 3 2 1 5 4 3 2 1 5 4 3 2 1
Problems
Score

limbFuncti

Prolonged

Moderate
Length of
financial/

Clinical/

Minimal
(function

Clinical/
Very High

Loss of
medium

Very low

on/j
life/

Solid
Poor
High

Good
none
low

Fair
Serious
Loss

/
Sterilisasi alat tidak rutin 4 3 3 10
dilakukan
Penempatan pasien infeksius 3 2 4 9
dan non infeksius tidak dapat
dilakukan
Penggunaan APD belum 2 2 3 7
sesuai standar

Kebersihan lingkungan : 4 1 4 9
PEMERINTAH KABUPATEN PANDEGLANG
DINAS KESEHATAN

UPT PUSKESMAS CADASARI


Jl. Raya Serang Km. 5, Kec. Cadasari Hp 081394383437
P A N D E G L A N G

desinfeksi tempat tidur


dan meja tidak rutin di
lakukan
Pembuangan bahan bekas 2 2 3 7
pakai tidak pada
tempatnya
FORM ANALISIS INFECTION CONTROL RISK ASSESMENT (ICRA)
Hari/Tgl :
Unit Layanan : Ruang Bersalin
Risk/Impact (Health, Financial,
Potential Probability / Frekuensi Legal, Regulatory) Current Systems/Preparedness
Risks/
5 4 3 2 1 5 4 3 2 1 5 4 3 2 1
Problems
Score

Moderate
Prolonge
(function

Clinical/

Minimal
limbFun

Clinical/
Very High

Loss of
medium

Very low

Serious
life/

Solid
Poor
High

Good
none
low

Fair
d
c

Loss
Pemakaian APD 4 2 2
situasional

Pembuangan bahan bekas 4 3 2


pakai tidak pada
tempatnya
FORM ANALISIS INFECTION CONTROL RISK ASSESMENT (ICRA)
Hari/Tgl :2022
Unit Layanan : Ruang Gigi
Risk/Impact (Health, Financial,
Potential Probability / Frekuensi Legal, Regulatory) Current Systems/Preparedness
Risks/
5 4 3 2 1 5 4 3 2 1 5 4 3 2 1
Problems
Score

Moderate
(function

Prolonge

Clinical/

Minimal
limbFun

Clinical/
Very High

Loss of
medium

Very low

life/

Solid
Poor
High

Good
none
low

Fair
d
/
c
Serious
Loss
Air kumur yg di gunaklan 2 2 4
masih air kran

Hari/Tgl :
Unit Layanan : Ruang Laboratorium
Risk/Impact (Health, Financial,
Potential Probability / Frekuensi Legal, Regulatory) Current Systems/Preparedness
Risks/
5 4 3 2 1 5 4 3 2 1 5 4 3 2 1
Problems
Score

limbFuncti

Moderate
financial/

Clinical/

Minimal
(function

d Length

Clinical/
Very High

Prolonge
Loss of
medium

Very low

on/j
life/

Solid
Poor
High

Good
none
low

Fair
Serious
Loss

of
/
Spill kitt unutuk
tumpahan limbah medis
dan kimia belum
memadai
Petugas menggunakan APD
belum sesuai standar
FORM ANALISIS INFECTION CONTROL RISK ASSESMENT (ICRA)
Hari/Tgl :
Unit Layanan : Ruang pemeriksaan Umum
Risk/Impact (Health, Financial,
Potential Probability / Frekuensi Legal, Regulatory) Current Systems/Preparedness
Risks/
5 4 3 2 1 5 4 3 2 1 5 4 3 2 1
Problems
Score

limbFunction/
Loss of life/

Prolonged

Moderate
j financial

Length of
financial/

Minimal
(function

Clinical/
Very High

medium

Very low

Solid
Poor

Good
High

none
low

Fair
Serious

financial
Clinical/
Loss

/
Kepatuhan cuci tangan
masih rendah
Kebersihan lingkungan :
Meja belum didisinfeksi
secara rutin
FORM ANALISIS INFECTION CONTROL RISK ASSESMENT (ICRA)

Hari/Tgl :
Unit Layanan : Ruang Khusus
Risk/Impact (Health, Financial,
Potential Probability / Frekuensi Legal, Regulatory) Current Systems/Preparedness
Risks/
5 4 3 2 1 5 4 3 2 1 5 4 3 2 1
Problems
Score

limbFunction/
Loss of life/

Moderate
j financial

financial/

Minimal
(function

d Length

Clinical/
Very High

Prolonge
medium

Very low

Solid
Poor

Good
High

none
low

Fair
Serious

financial
Clinical/
Loss

of
/
Peralatan kritikal, semi
kritikal belum terpisah
Petugas menggunakan APD
belum sesuai standar
Kebersihan lingkungan :
meja lampu belum rutin

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