Infection Prevention Manual

SURVEILLANCE OF INFECTIONS GOALS : to enhance the safety and quality of patient care provided, to reduce morbidity and mortality, and to improve health. Month: ________ Year: ______ Report completed by(Name/Title): ________________________ Signature: _________________ Predominant risk factor : Presence of a Medical Device (i.e., catheters) N/A Total Patients: __________ Devices: ___________________________________________ Total of Infections: _________ _______________________________________________________________________________________________________ Wound management (Skin and soft tissue infections) N/A Total Patients: __________ Total of Infections: _________ Reason: ___________________________________________ _______________________________________________________________________________________________________ Urinary Tract Infection N/A Total Patients: __________ Total of Infections: _________ Reason: ___________________________________________ _______________________________________________________________________________________________________ Central Venous Catheters (Home Infusion, local cannula site, bloodstream infection) N/A Total Patients: __________ Total of Infections: _________ Reason: ___________________________________________ _______________________________________________________________________________________________________ Respiratory, Gastrointestinal infections N/A Total Patients: __________ Total of Infections: _________ Reason: ___________________________________________ _______________________________________________________________________________________________________ Other: _____________________________________ N/A Total Patients: __________ Total of Infections: _________ Reason: ___________________________________________ _______________________________________________________________________________________________________ Other Identified infections: Bloodstream Infections Clinical Sepsis Skin and Soft Tissue Infections (Fungal, Herpes, Surgical site) Eye, ear, nose, and mouth infections Other: ___________________________________________________ Identified contributing factors: Staff was not trained in Infection Control, Handwashing, Nursing Bag, TB Precautions, use of PPE, Bloodnorne Pathogens, Biomedical waste _________________________________________________________________________________________ Was identified that any affected patient was care for other agency, institution, etc. N/A Specimen collection and convenient access to both clinical and laboratory data among those patients was incompleted N/A Not Adherence to published standards, conditions and/or recommendations from accrediting bodies, regulatory agencies. Recommended immunizations not completed, patients/staff not aware of it importance. Identification and reporting healthcare associated infections back to the facility (i.e., hospital, ambulatory surgical centers, long term care facility, etc.) where the patient received the care before admitted to Agency. N/A Infections likely reflect exposure to microbes from other family members, visitors, or home environments. If check, explain: _______________________________________________________________________________________________________ Other: ________________________________________________________________________________________________ Identified Prioritized Risk of Infection: (By Geographic Location, Community, and Population served. Care, Treatment, or Services Provided) extremes of age underlying diseases, stress nutritional status Large metropolitan area immunosuppression trauma/accident Socioeconomic status/profile inappropriate biowaste therapeutic instrumentation (e.g., venous access devices, urinary catheters) lifestyle (e.g., alcoholism, drug abuse) therapeutic modalities (e.g., radiation, cancer chemotherapy) personal hygiene medications occupational history presence or absence of able and willing caregivers Poor sanitation inadequate plumbing contaminated supplies equipment, exposure to the elements (i.e., cold, heat, and water) Diversity population rodent or insect infestation exposure to contagion Medica device (Catheter, feeding devices) Inability to access both clinical and laboratory data Inaccurate numerator data (number of infections) wounds, and burns Intercurrent illness (e.g., viral respiratory or gastrointestinal infections) Inappropriate use of PPE (Gloves, mask, CPR shell, etc) Staff not follow Universal/Standard Prec. (Handwashing tech) Other: ________________________________________________________________________________________________ REPORTING: Collation, and analysis of outcome indicators:____________________________________________________________________ ________________________________________________________________________________________________________ Findings to improve care, prevent HAI and other complications: _____________________________________________________ ________________________________________________________________________________________________________ Risk assessment of the population served: _____________________________________________________________________ ________________________________________________________________________________________________________ Identification of possible trends, outbreaks, or newly emergent infectious diseases in the community: _______________________ ________________________________________________________________________________________________________ Document Non-infectious causes, if applicable: __________________________________________________________________ ________________________________________________________________________________________________________ PAC Informed Infection Control Committee Informed Your Agency Name (PN System)