SAPTHAGIRI INSTITUTE OF MEDICAL SCIENCES AND RE
Hospital Infection Control Comm
SIMS & RC/ Micro/ no/ /22-21
Probability of Performance -
Program Components Failure
High Med Low Never
Potential Risk/Problems 3 2 1 0
Mandatory (no opting out) Local, State and
Federal Regulation
(add 7 to all Items in this column)
Procedures HAI's
Surgical Site Infections
SSI-Ortho Join Replacement
SSI-plastic surgery
SSI-ophthalmology
SSI-
SSI-
SSI-
Prevention Activities
Hand Hygiene program
Standard Precautions
TB screening of patients
Appropriate prophylactic antibiotic
Appropriate OR attire
Environment
Medication Refrigerator Temp logs
Sterilization monitoring
Infection from inadequate air handling
Positive Pressure room monitoring
Cleaning/high level disinfection process
Construction/Renovation Program (CRA's)
Regulated Waste Management Program
Dr Divya A Dr Anupama Pujar
ICO Professor
SIMS & RC HICC co-convener
SIMS & RC
EDICAL SCIENCES AND RESEARCH CENTER, BANGALORE- 90
al Infection Control Committee/ Team
Date- / /2023
Impact
(Clinical/Financial/Resources) Infection prevention Systems Score Goal
High Moderate Minimal Poor Fair Good Excellent >7
3 2 1 3 2 1 0
Dr Anupama Pujar Dr Hemavathi Dr Jayanthi V
Professor Professor and HOD Principal and Dean
HICC co-convener HICC convener SIMS & RC
IMS & RC SIMS & RC
SAPTHAGIRI INSTITUTE OF MEDICAL SCIENCES AND
Hospital Infection Control Com
SIMS & RC/ Micro/ no/ /22-21
Probability of Performance -
Program Components Failure
High Med Low Never
Potential Risk/Problems 3 2 1 0
Policy Procedures
Current polices or procedures related to-
infection control and prevention
Established policy or procedures-safe
injection practices
Preparedness
Bioterrorism Agents
Norovirus/Influenza/Other Respiratory
infections
Outbreak
Community ID Risk-Lice/scabies/bed bugs
Employee Health
Annual TB screening (TST/QFT)
Annual Fit Testing
Staff influenza immunization program
Bloodborne Pathogens Plan
ATD/Tuberculosis Plan
Multi Drug Resistance Organisms
MRSA(Methicillin Resistant Staph aureus)
C difF (Clostridium difficile)
VRE (Vancomycin Resistant Enterococcus)
ESBL/CRE(Extended Spectrum Beta
lactam/Carbapenemase Resitant
Enterobacteriaceae)
The Infection Control (IC) Risk Assessment grid is a visual tool to develop IC program priorities and stratify infectio
annual IC Plan is developed based on these risks. The Risk Assessment is an ongoing, continual process. If an outbre
Zero- Process has been going well Low or 1- Processes are initiated and being followed Med or 2-The processes in
education sessions may need to be scheduled
Risk Assessment Completed on: Date_________________________Name________________________
Dr Divya A Dr Anupama Pujar
ICO Professor
SIMS & RC HICC co-convener
SIMS & RC
EDICAL SCIENCES AND RESEARCH CENTER, BANGALORE- 90
al Infection Control Committee/ Team
Date- / /2023
Impact
(Clinical/Financial/Resources) Infection prevention Systems Score Goal
High Moderate Minimal Poor Fair Good Excellent >7
3 2 1 3 2 1 0
priorities and stratify infection risks based on our geography, location in the community, and our patient population. The
continual process. If an outbreak should occur it will take precedence over the IC Plan.
d Med or 2-The processes in place are working well and the outcomes are improving and sustaining High or 3- Training or
______________
Dr Anupama Pujar Dr Hemavathi Dr Jayanthi V
Professor Professor and HOD Principal and Dean
HICC co-convener HICC convener SIMS & RC
IMS & RC SIMS & RC
