6 Steps for an ASC’s Effective Infection Control Risk Assessment

For ASCs to meet the Centers for Medicare and Medicaid Services's requirements for an infection control plan, they must conduct a risk assessment. This process is designed to identify and prioritize plan activities and help ensure the consistent delivery of high-quality care.

"ASCs should embrace the purposes of conducting the risk assessment: preventing infections and ultimately keeping patients and staff safe," says Terri Link MPH, BSN, CNOR, CIC, FAPIC, AORN's product manager for guideline implementation tools. "An effective risk assessment will allow an ASC to determine surveillance activities, identify at-risk populations and decide where to best concentrate improvement efforts."

She continues, "Identification of high-volume, high-risk and problem-prone activities is a critical component of risk assessment. In a nutshell, an infection control program appropriately based on an infection control risk assessment will be effective in detecting, preventing and controlling infections among patients, visitors and healthcare workers."

Link identifies the following as six of the essential steps for performing an effective infection control risk assessment in an ASC.

Step 1: Understand your facility and community. Risk factors can differ for each facility, Link says, so ASCs should develop their infection prevention program plan and assessment based upon what is specifically happening in their community.

Gather details on the following:

• facility information, including services provided, number of operating and procedure rooms, specialties, number of surgeons, breakdown of staff positions and hours of operation;
• referring hospital information, including agreements and distance from the ASC;
• patient population information, including data on the elderly, pediatrics, immigrants and socioeconomic status of patients;
• ASC's and community's risk for natural disasters; and
• ASC's role in emergency preparedness in its community.

Step 2: Develop risk assessment template. Since you will want to perform the risk assessment regularly (more on this later), Link advises developing a template, either on your own or emulating an existing template.

Within this tool, include sections to:

• list potential risks, problems and concerns;
• identify the probability of them occurring (high, medium, low);
• identify their likely impact (high, moderate, minimal) on matters including patient and staff health and the ASC's financial, legal and regulatory standing; and
• identify the ASC's preparedness for these risks (poor, fair, good).

Step 3: Identify risks. Based on your facility's and community's characteristics (as listed in step #2), identify the risks, problems and concerns.

"Consider classifying them in areas such as patient care risks, healthcare personnel risks, environmental risks, site-specific risks and emergency management," Link says. "You can include regulatory requirements as well."

To help ensure there is no confusion about your risks, you may want to include descriptions of them in the tool, Link says.

"For example, under patient care risks, you may note that podiatry cases have experienced an increase in infections over the last six months," she says.

Step 4: Score risks. Once you completed identifying the risks, it's time to score them. You can use any scoring system you choose, but make sure it's one that is easily understood. Consider using a 1-3 points system, Link says. For probability of a risk, assign three to high, two to medium and one to low. Do the same for likely impact. For preparedness, assign three for poor, two for fair and one for good.

"Let's say for those podiatry cases, patients were typically diabetic, had a lower socioeconomic status and a high number of co-morbidities," she says. "You may give these surgical site-infections a score of two for probability, three for impact and a one for facility preparedness, for a final score of six."

Step 5: Put the assessment to work. Upon completion of the assessment, it's time to start taking action. Prioritize the risks by their score, working to tackle those with the highest scores first, Link says.

"Once you have selected a risk, establish baseline data using internal benchmark and/or national benchmarks," she says. "Identify any regulatory requirements that govern the risk's area and include them in your infection prevention plan. Then establish improvement goals and begin to work toward them. Incorporate your efforts into your ASC's quality assurance and performance improvement program."

Sept 6: Repeat. Conduct a risk assessment at least annually, Link says. "You can base each new assessment on the previous year's identified risks, assuming they are ongoing, but at minimum you will probably want to use the previous year as a benchmark for improvement. Though you may decide an identified risk is no longer valid, there should still be ongoing surveillance to ensure prevention measures continue and remain effective."

Prioritize Your Efforts

Upon completion of the assessment, there may be a long list of risks to address. That's why prioritization is key, Link says. "Pick some quick fixes and then move on to the more difficult risks. Make sure there are measurable outcomes with a timeline."

She also advises ASCs to base their assessment in reality, not conjecture. "Your ASC's infection control plan should be developed around the issues at your facility and not based on what individuals believe will be the issues."

References

1. Soule BM. Risk-based approach to infection prevention: Creating an infection prevention and control plan. In: Arias KM, Soule BM, eds. The APIC/JCR Infection Prevention and Control Workbook, 2nd ed. Oakbrook Terrace, IL: Joint Commission Resources, 2010
2. State Operations Manual Appendix L- Guidance for Surveyors: Ambulatory Surgical Centers. CMS Condition for Coverage
3. Ambulatory Surgical Center (ASC) Infection Control Surveyor Worksheet (Rev: 142, Issued:07-17-15, Implementation: 07-17-15)

FREE RESOURCES FOR MEMBERS

AORN Journal CE Articles

A Review of the CDC Recommendations for Prevention of HAIs (1.1 CHs)

Webinars

Recommended Practices for the Prevention of Transmissible Infections (1 CH)

Protecting Surgical Patients and Healthcare Workers Through a Safe Environment of Care (1 CH)

Tool Kits

AORN Comprehensive Surgical Checklist

Guideline Essentials:  Access your implementation tools for high-level disinfection, environmental cleaning, hand hygiene, and many other guidelines.

• Gap Analysis Tools: Tools to assess areas in which your facility may not be compliant with the guidelines.
• Policy & Procedure Templates: Ready-to-use customizable templates for developing your facility’s policies and procedures
• Competency Verification Tools: Ready-to-use customizable templates for verifying competency to meet facility requirements

Plus, members save $70 on the ASC Infection Prevention Online Course.