Infection Prevention Manual

INFECTION CONTROL, RISK ANALYZES LOG Year:__________ Month: ____________ Factor Identify Evaluate Control Addressing prioritized risk Hazards (procedures, processes, area maintenance that may cause harm, particularly spread infections): Risk associated with Hazards: Determine appropriate ways to eliminate or control the hazard (measures should be in place to effectively prevent or control the spread of infections): Monthly Disease Control in our Community Print Report from DOH: Yes No Common Diseases: Staff Protection Use of PPE (such as gloves, mask, etc) Yes No Any Infection: Yes No Staff Education/In-services Supervision check Yes No PPE: Yes No Patient’s home identified risk Total Patients Analyzed: ______ Identified Infection Control teachings, training to patients, families: Yes No Poor Handwashing habits/techniques Yes No Unprotected skin cuts, fissures Yes No N/A Use of Safety disposal containers Yes No Sharing of personal devices such as thermometers, BP/BS equipment, etc. Yes No Contact with persons with respiratory infections: Yes No Poor daily personal cleanliness habits Yes No Not proper store of dirty/soiled sheets, towels and clothing Yes No N/A Not proper wash surfaces or equipment, contaminated with blood or other body fluids Yes No N/A Not proper wound care, dressing changes, PEG and catheter care/changes Yes No N/A Evaluation of infection prevention and control practices, plan for Emergencies, Goals setting : Comments: _____________________________________________________________________________________ Staff Name/Title: ___________________________ Signature: ______________________ Date: ________________ Your Agency Name (PN System)