Program Components
Failure of Prevention Activities Expect It 4 Lack of Hand Hygiene Lack of Respiratory Protection Lack of Staff Education Lack of Patient Education Basic Infection Prevention: Lack of Standard Precautions/PPE Lack of High Level Disinfection Practices Lack of Sterilization Practices Failure to Separate Clean from Dirty Failure to Follow Safe Injection Practices Likely
Probability
Risk/Impact Health/Financial/Legal/Regulatory
Never Loss of life/limb/ function 5 Temp Loss of Function 4 Hospital Care Required 3 Moderate Clinical/ Financial 2 Minimal Clinical/ Financial 1 None
Current Systems
Score
Maybe
Rare
Poor
Fair
Good
Solid
3
2
1 X X
0
5
4
3
2
1
X X
X
Program Components
Failure of Prevention Activities Expect It 4 Policy & Procedures: Lack of Current Policies & Procedures Failure to follow established Policy or Procedure Exposure Plans: Lack of BBP Exposure Control Plan Lack of Respiratory Protection Plan Lack of Sterilization Practices Risk of Exposure to TB Lack of Emergency Preparedness Plan Likely
Probability
Risk/Impact Health/Financial/Legal/Regulatory
Never Loss of life/limb/ function 5 Temp Loss of Function 4 Hospital Care Required 3 Moderate Clinical/ Financial 2 Minimal Clinical/ Financial 1 None
Current Systems
Score
Maybe
Rare
Poor
Fair
Good
Solid
3
2
1
0
5
4
3
2
1
X
X
X
X
X
X
Program Components
Failure of Prevention Activities Expect It 4 Healthcare Associated Infections: Lack of Surveillance Process Outbreaks Sentinel Events Employee Health: Lack of Staff Immunization Lack of Compliance with Annual Education Risk of Needlestick/Splash/ Sharps Injury Likely
Probability
Risk/Impact Health/Financial/Legal/Regulatory
Rare Never Loss of life/limb/ function 5 Temp Loss of Function 4 Hospital Care Required 3 Moderate Clinical/ Financial 2 Minimal Clinical/ Financial 1 None
Current Systems
Score
Maybe
Poor
Fair
Good
Solid
3
2
1
0
5
4
3
2
1
X
X X
X X
X
Program Components
Failure of Prevention Activities Expect It 4 Environment: Lack of Acceptable Environmental Cleanliness Lack of Sterilization Monitoring Failure to Identify Construction Risks Likely
Probability
Risk/Impact Health/Financial/Legal/Regulatory
Never Loss of life/limb/ function 5 Temp Loss of Function 4 Hospital Care Required 3 Moderate Clinical/ Financial 2 Minimal Clinical/ Financial 1 None
Current Systems
Score
Maybe
Rare
Poor
Fair
Good
Solid
3
2
1
0
5
4
3
2
1
X
X