Architectural and Engineering Approaches to Infection Control Contents Risk management Architectural and Engineering Approaches to Infection Control 16 July 2018 www.tb-ipcp.co.za / www.iussonline.co.za This program has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control & Prevention (CDC) under the terms of Grant Number - NU2GGH001937-01-02

Importance of risk assessment Introduction Importance of risk assessment HIRA Risk management

Risk management Risk management for healthcare entities can be defined as an organized effort to identify, assess, and reduce, where appropriate, risk to patients, visitors, staff and organizational assets. Risk management in its best form may be to use it in a pro-active manner in identifying and managing the risks

Risk assessment “Risk assessment is a process where the hazards and exposures are identified, the risk potential of these hazards and exposures are analysed and estimated and a decision as to the acceptability of these risks to people, business or the environment is made.” DEA Careful examination of what, in your work, could cause harm to people, so that you can weigh up whether you have taken enough precautions or should do more to prevent harm. Workers and others have a right to be protected from harm caused by a failure to take reasonable control measures.

Hazard Identification and Risk Assessment Also known as HIRA (Hazard Identification and Risk Assessment) Systematic search for hazards Identification of health hazards Assessment of risk to human health Qualitative assessment Quantitative assessment Current or future health hazards Requires sound science as well as professional judgement

Importance of risk assessment The process will identify hazards and minimise the chances of harm. Training staff and providing information minimises the risks of accidents and other hazards. Assessment of risk may indicate that changes would enhance health and safety and minimise risks.

Importance of risk assessment cont. Assessment can make people more aware of risks and ways to avoid or minimise them. Risk assessments can enable staff to bring to the employer’s attention anything that may pose a risk, but has not previously been identified

Legal framework Constitution Section 24 OHS Act Section 8(2)(d) Hazardous Biological Agents regulation At least every 2 years

Which approach to use for RA Use a what-if analysis to identify threats and hazards Use a checklist of known threats and hazards to identify your threats and hazards. Use a combination of checklists and what-if analysis to identify your threats and hazards.

Which method to use for RA HACCP which means Hazard analysis and critical control points. This ensures the processing and production of safe food by analysing health hazards associated with processing, distribution, and consumption of food in which the critical control points of the process are identified. HAZOP also known as Hazard and operability study. It is the analysis is used to identify hazardous working conditions in specific steps of a processing operation.

Which method to use for RA cont. Use a failure mode and effect analysis (FMEA) to identify potential failures and to figure out what effect failures would have. This method begins by selecting a system for analysis and then looks at each element within the system. It then tries to predict what would happen to the system as a whole when each element fails. This method is often used to predict hardware failures and is best suited for this purpose. Use a fault tree analysis (FTA) to identify all the things that could potentially cause a hazardous event. It starts with a particular type of hazardous event and then tries to identify every possible cause.

Risk assessment process Is there a need for action? How bad? What can go wrong?

Hazard vs Risk hazards – which are situations with the potential to cause harm; and risks – which are defined as the probability that a specific adverse event will occur in a specific time period or as a result of a specific situation. Risk is the combination of likelihood and consequence of a hazard being realised. A clinical risk or healthcare risk is the chance of an adverse outcome resulting from clinical investigation, treatment or patient care.

Risk management overview

Ste-by-step process ICU (Intensive care unit) O.R (Operation room) Step 1- Establish the context: Context is very important in risk identification and management. ICU (Intensive care unit) O.R (Operation room) E.R (Emergency room) blood transfusion services CCU (coronary care unit)

Step 2: Identify Risks Risk identification is the process whereby the healthcare professional and the healthcare employees become aware of the risks in the health care services and environment. Use a register if necessary.

Step 2: Identify Risks Sources of risk identification Discussions with department chiefs, managers and staff Patient Tracer Activity (Tracing the journey of a patient from admission till discharge). Incident reporting system Healthcare associated infections (HAI) reports Facility management & safety committee reports Patient complaints and satisfaction survey results Specialized committee reports

Types of hazards and its categories

Step 3: Analyse Risks Level of the risk Underlying causes Risk analysis is about developing an understanding of the risks identified. It includes the following: Level of the risk Underlying causes Existing control measures Existing controls: When examining the existing control measures, consideration should be given to their adequacy, method of implementation and level of effectiveness in minimizing risk to the lowest reasonably practicable level. s These include all measures put in place to eliminate or reduce the risk and may include: d. Policies, procedures, protocols, guidelines e. Alarms and beeps f. Engineering controls g. Insurance coverage program

Step 4: Risk score analysis Consider both consequence (how bad?) and likelihood (how often?). Is there a need for additional action? The law requires everyone providing a service to do everything reasonably practicable to protect patients from harm. Use your organisation’s risk matrix Decide on the precautions (controls) that will most effectively reduce consequence and/or likelihood. Re-evaluate the risks assuming the precautions (controls) have been taken. These include all measures put in place to eliminate or reduce the risk and may include: d. Policies, procedures, protocols, guidelines e. Alarms and beeps f. Engineering controls g. Insurance coverage program

Risk matrix example #1

Example of a risk matrix

Risk matrix example #2

Another example of risk matrx

Another example of risk matrix

Risk matrix example #3

LIKELIHOOD SEVERITY VERY UNLIKELY (freak event – no known history)   LIKELIHOOD VERY UNLIKELY (freak event – no known history) UNLIKELY (foreseeable under unusual circumstances) LIKELY (having a greater- than- even chance of occurring) HIGH LIKELY ( to occur-foreseeable) ALMOST CERTAIN (of occurring) SEVERITY NEGLIGIBLE (no real visible injury / illness) LOw LOW MINOR (no long-term effects, illness) MEDIUM SERIOUS (Possibility of illness ) HIGH SEVERE (Severe illness, disabilibility) VERY SEVERE (long-term injury/illness/ fatality)

What are the meanings of ‘low’, ‘medium’ and ‘high’ risk?   It is unlikely that harm will be caused and the outcome would result in very minor injury/damage. No further controls are needed. However, consideration may be given to a more cost-effective solution or improvement that does not mean more cost. Monitoring is needed to make sure that the current controls are maintained and effective. Medium: There is the possibility that harm may occur. You must consider whether the existing control measures are sufficient or if any further action could be taken to reduce the risk to a low level. The consideration of whether measures need to be implemented should be “as far as is reasonably practicable”. (The risk level may remain as Medium where the risk is inherent in a particular activity/process/operation). High: Certain or near certain that harm will result in serious injury/damage. The planned activity/process/operation must not continue. The risk assessment action plan must be completed to identify what further action will be taken to reduce the risk to an acceptable lower level.

Step 5: Risk Treatment Also known as Risk reduction, Risk mitigation. Risk management is a requirement of Section 21(1) of the Occupational Health and Safety Act 1985 as part of the employer’s duty “… to provide and maintain so far as is practicable for employees a working environment which is safe and without risks to health.” Risk treatment means taking actions to eliminate or reduce the likelihood that exposure to a hazard will result in injury or disease.

Step 5: Risk treatment

Conclusion

Summary Instil a culture of safety throughout the facility Ensure that people know and understand the process Say what you do Do what you say Keep it simple

Katekani Ngobeni (kngobeni@csir.co.za) Thank you www.tb-ipcp.co.za / www.iussonline.co.za Katekani Ngobeni (kngobeni@csir.co.za)