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{"sheet":"Instructions","index":0,"n_rows":22,"n_cols":2,"rows_kept":22,"cut":false,"hidden":false,"merged":[[0,0,0,11],[8,1,8,4],[2,0,2,11],[4,0,4,11],[6,0,6,6],[1,0,1,11]]}
["How to Use Risk Assessment Tool"]
["Risk assessment is a foundational information source for the Infection Prevention and Control Program. Risk assessment is used to determine where an organization should focus its infection surveillance, prevention and control activities."]
["**Review and identify potential risk at least annually and especially whenever significant changes occur**"]
[]
["Purpose is to assess the risk of acquiring and transmitting infections and prioritizing improvement activities to diminish or eliminate that risk. This is a quantitative risk assessment using a numeric scoring system based upon probability of event occurring."]
[]
["Ratings and priorities based on interdisciplinary team consensus."]
[]
["Steps ","Instructions"]
[1,"Leaderhip team: schedule meetings, draft expectations for participants on the PIP interdisciplinary team, and identify necessary skills and knowledge of PIP team members   "]
[2,"Charter PIP interdisciplinary team"]
[3,"Give copy of PIP Risk Assessment tool to each PIP team member at least 24 hours before scheduled meeting"]
[4,"Select PIP team member to take notes and record responses on the official/master Risk Assessment tool the PIP team will use"]
[5,"Each team member come to meeting with ratings and rational for selected rating"]
[6,"Rate each Infection Events item according to team consensus(Higher probability or likelihood =3. No probability or likelihood =0) "]
[7,"Total selections for each item if totals do not automatically populate in column Q in Infection Events "]
[8,"Prioritize highest rated item totals in column Q in Infection Events "]
[9,"Rate each IPC Practice Failures item according to team consensus"]
[10,"Total selections for each item if totals do not automatically populate in column P in IPC Practice Failures "]
[11,"Prioritize highest rated item totals in column P in IPC Practice Failures "]
[12,"Suggestion: (1)Risk assessment be a function of the QAA committee. (2)Convene two workgroups as subgroups of the PIP team, one workgroup to improve the prioritized Infecton Events and one workgroup to improve IPC Practice Failures. "]
[null,"Both workgroups report to and are coordinated by PIP team that is chartered by the QAA committee."]

{"sheet":"Infection events","index":1,"n_rows":36,"n_cols":13,"rows_kept":36,"cut":false,"hidden":false,"merged":[]}
["INFECTION EVENT","PROBABILITY OF OCCURRENCE","LEVEL OF HARM FROM EVENT ","IMPACT ON CARE","READINESS TO PREVENT","RISK LEVEL ",null,null,null,null,"3 High","3 Poor","3 Serious Harm"]
[null,"(How likely is this to occur?)","(What would be the most likely?)","(Will new treatment/care be needed for resident/staff?)","(Are processes/resources in place to identify/address this event?)","(Scores ≥ 8 are considered highest priority for improvement efforts.)",null,null,null,null,"2 Medium","2 Fair","2 Moderate Harm"]
["Score","3=High, 2=Medium, 1=Low, 0=None","3=Serious Harm, 2=Moderate Harm, 1=Mild Harm, 0=No Harm","3=High, 2=Medium, 1=Low, 0=None","3=Poor, 2=Fair, 1=Good",null,null,null,null,null,"1 Low","1 Good","1 Mild Harm"]
[null,null,null,null,null,null,null,null,null,null,"0 None",null,"0 No Harm"]
["Facility-onset Infections(s)"]
["Device- or care-related"]
["Catheter-associated urinary tract infection (CAUTI)",null,null,null,null,{"$f":"SUM(VALUE(LEFT(B7)),VALUE(LEFT(C7)),VALUE(LEFT(D7)),VALUE(LEFT(E7)))","v":{"$error":"#VALUE!"}}]
["Central line-associated bloodstream infection (CLABSI)",null,null,null,null,{"$f":"SUM(VALUE(LEFT(B8)),VALUE(LEFT(C8)),VALUE(LEFT(D8)),VALUE(LEFT(E8)))","v":{"$error":"#VALUE!"}}]
["Tracheostomy-associated respiratory infection",null,null,null,null,{"$error":"#VALUE!"}]
["Percutaneous-gastrostomy insertion site infection",null,null,null,null,{"$error":"#VALUE!"}]
["Wound infection",null,null,null,null,{"$error":"#VALUE!"}]
["Other (specify):",null,null,null,null,{"$error":"#VALUE!"}]
["Resident-related"]
["Symptomatic urinary tract infection (SUTI)",null,null,null,null,{"$f":"SUM(VALUE(LEFT(B14)),VALUE(LEFT(C14)),VALUE(LEFT(D14)),VALUE(LEFT(E14)))","v":{"$error":"#VALUE!"}}]
["Pneumonia",null,null,null,null,{"$error":"#VALUE!"}]
["Cellulitis/soft tissue",null,null,null,null,{"$error":"#VALUE!"}]
["Clostridioides difficileinfection",null,null,null,null,{"$error":"#VALUE!"}]
["Tuberculosis*",null,null,null,null,{"$error":"#VALUE!"}]
["Other (specify):",null,null,null,null,{"$error":"#VALUE!"}]
["Outbreak-related"]
["Influenza*",null,null,null,null,{"$f":"SUM(VALUE(LEFT(B21)),VALUE(LEFT(C21)),VALUE(LEFT(D21)),VALUE(LEFT(E21)))","v":{"$error":"#VALUE!"}}]
["Other viral respiratory pathogens*",null,null,null,null,{"$error":"#VALUE!"}]
["Norovirus gastroenteritis*",null,null,null,null,{"$error":"#VALUE!"}]
["Bacterial gastroenteritis (e.g.,Salmonella, Shigella)",null,null,null,null,{"$error":"#VALUE!"}]
["Scabies",null,null,null,null,{"$error":"#VALUE!"}]
["Conjunctivitis",null,null,null,null,{"$error":"#VALUE!"}]
["Group A Streptococcus*",null,null,null,null,{"$error":"#VALUE!"}]
["MDRO",null,null,null,null,{"$error":"#VALUE!"}]
["Coronavirus Disease 2019 (COVID-19)",null,null,null,null,{"$error":"#VALUE!"}]
["Other (specify):",null,null,null,null,{"$error":"#VALUE!"}]
[]
["* Risk assessment should take into account the frequncy of this disease in the community as part of determining probability of occurrence. Data from State/local health department may be informative."]
[]
["Date Prepared: "]
[]
["Adapted from https://spice.unc.edu/resources/template-risk-assessment-for-ltc/ "]

{"sheet":"IPC practice failures","index":2,"n_rows":63,"n_cols":12,"rows_kept":63,"cut":false,"hidden":false,"merged":[]}
["IPC PRACTICE FAILURES","PROBABILITY OF OCCURRENCE","IMPACT ON RESIDENT/STAFF SAFETY","CAPACITY TO DETECT","READINESS TO PREVENT","RISK LEVEL ",null,null,null,null,"3 High","3 Poor"]
[null,"(How likely is this to occur?)","(Will this failure directly impact safety?)","(Are processes in place to identify this failure?)","(Are policies, procedures, and resources available to address this failure?)","(Scores ≥ 8 are considered highest priority for improvement efforts.)",null,null,null,null,"2 Medium","2 Fair"]
["Score","3=High, 2=Medium, 1=Low, 0=None","3=High, 2=Medium, 1=Low, 0=None","3=Poor, 2=Fair, 1=Good","3=Poor, 2=Fair, 1=Good",null,null,null,null,null,"1 Low","1 Good"]
[null,null,null,null,null,null,null,null,null,null,"0 None"]
["Surveillance & Monitoring"]
["Lack of access to notices from public health, CDC or WHO",null,null,null,null,{"$f":"SUM(VALUE(LEFT(B6,1)),VALUE(LEFT(C6,1)),VALUE(LEFT(D6,1)),VALUE(LEFT(E6,1)))","v":{"$error":"#VALUE!"}}]
["Lack of process for sharing information from public health CDC or WHO with staff who need to know",null,null,null,null,{"$f":"SUM(VALUE(LEFT(B7,1)),VALUE(LEFT(C7,1)),VALUE(LEFT(D7,1)),VALUE(LEFT(E7,1)))","v":{"$error":"#VALUE!"}}]
["Lack of performing facility wide surveillance to identify opportunities to prevent and/or reduce the rate of infection in residents and employees",null,null,null,null,{"$error":"#VALUE!"}]
["Lack of all staff scheduled time to attend trainings such as Targeted COVID-19 Training for Nursing Homes and Hand in Hand available on Quality, Safety & Education Portal (QSEP) https://qsep.cms.gov and required inservices and trainings for participation in the Medicare and Medicaid programs.",null,null,null,null,{"$error":"#VALUE!"}]
["Lack of facility process for input, feedback and outcome between staff, family and visitors, and the facility's leadership",null,null,null,null,{"$error":"#VALUE!"}]
["Care activity"]
["Lack of accessible alcohol-based hand rub",null,null,null,null,{"$error":"#VALUE!"}]
["Lack of accessible personal protective equipment (PPE)",null,null,null,null,{"$error":"#VALUE!"}]
["Inappropriate selection and use of PPE",null,null,null,null,{"$error":"#VALUE!"}]
["Inadequate staff adherence to hand hygiene",null,null,null,null,{"$error":"#VALUE!"}]
["Inadequate staff adherence to glove and gown use when resident in Contact Precautions",null,null,null,null,{"$error":"#VALUE!"}]
["Inadequate staff adherence to facemask use when resident in Droplet Precautions",null,null,null,null,{"$error":"#VALUE!"}]
["Other (specify):________________",null,null,null,null,{"$error":"#VALUE!"}]
["Other (specify):________________",null,null,null,null,{"$error":"#VALUE!"}]
["Occupational health"]
["Low influenza immunization rates among staff",null,null,null,null,{"$error":"#VALUE!"}]
["Lack of notification of employee illness or working sick",null,null,null,null,{"$error":"#VALUE!"}]
["Low compliance with annual tuberculosis (TB) screening among staff",null,null,null,null,{"$error":"#VALUE!"}]
["Low Coronavirus Disease 2019 immunization rates when vaccine available (COVID-19)",null,null,null,null,{"$error":"#VALUE!"}]
["Other (specify):________________",null,null,null,null,{"$error":"#VALUE!"}]
["Resident/visitor health"]
["Low rates of TB screening among new resident admissions",null,null,null,null,{"$error":"#VALUE!"}]
["Low rate of resident acceptance of influenza immunization",null,null,null,null,{"$error":"#VALUE!"}]
["Low rate of resident acceptance of pneumococcal immunization",null,null,null,null,{"$error":"#VALUE!"}]
["Low rate of resident acceptance of Coronavirus Disease 2019 (COVID-19) immunization when available",null,null,null,null,{"$error":"#VALUE!"}]
["Visitors entering facility when ill",null,null,null,null,{"$error":"#VALUE!"}]
["Lack of notification to visitors during facility outbreaks",null,null,null,null,{"$error":"#VALUE!"}]
["Inadequate resident/visitor education on facility hand hygiene policies",null,null,null,null,{"$error":"#VALUE!"}]
["Inadequate resident/visitor education on facility respiratory etiquette policies",null,null,null,null,{"$error":"#VALUE!"}]
["Other (specify):________________",null,null,null,null,{"$error":"#VALUE!"}]
["Environment"]
["Lack of access to U.S. Environmental Protection Agency (EPA)-registered products for routine cleaning and disinfection",null,null,null,null,{"$error":"#VALUE!"}]
["Lack of access to EPA-registered products with sporicidal activity for cleaning and disinfection (e.g., for C. difficile)",null,null,null,null,{"$error":"#VALUE!"}]
["Inadequate cleaning and disinfection of high touch surfaces in resident room",null,null,null,null,{"$error":"#VALUE!"}]
["Inadequate terminal cleaning and disinfection of resident rooms",null,null,null,null,{"$error":"#VALUE!"}]
["Inadequate cleaning and disinfection of resident common areas",null,null,null,null,{"$error":"#VALUE!"}]
["Other (specify):________________",null,null,null,null,{"$error":"#VALUE!"}]
["Medical Devices and Equipment"]
["Improper handling of medications and injection equipment (e.g., reuse of syringes)",null,null,null,null,{"$error":"#VALUE!"}]
["Lack of access to single-use, auto-disabling fingerstick devices",null,null,null,null,{"$error":"#VALUE!"}]
["Inappropriate sharing of devices labeled for single-patient use",null,null,null,null,{"$error":"#VALUE!"}]
["Improper cleaning and disinfection of point-of-care devices (e.g., blood glucose meter) between residents",null,null,null,null,{"$error":"#VALUE!"}]
["Improper cleaning and disinfection of shared equipment (e.g., blood pressure cuff) between residents",null,null,null,null,{"$error":"#VALUE!"}]
["Lack of separation between clean supplies and dirty/contaminated medical supplies",null,null,null,null,{"$error":"#VALUE!"}]
["Improper storage and/or transport of linen",null,null,null,null,{"$error":"#VALUE!"}]
["Other (specify):________________",null,null,null,null,{"$error":"#VALUE!"}]
["Antibiotic Stewardship"]
["Lack of leadership support for antibiotic stewardship",null,null,null,null,{"$error":"#VALUE!"}]
["Inadequate written policies guiding antibiotic use",null,null,null,null,{"$error":"#VALUE!"}]
["Unable to obtain antibiotic usage report from pharmacy",null,null,null,null,{"$error":"#VALUE!"}]
["Unable to obtain report summarizing antibiotic resistance patterns (e.g., antibiogram)",null,null,null,null,{"$error":"#VALUE!"}]
["Inadequate resident/family education on facility antibiotic stewardship policies",null,null,null,null,{"$error":"#VALUE!"}]
["Other (specify):________________","2 Medium","0 None","3 Poor","2 Fair",7]
[]
["Date Prepared: "]
[]
[]
["Adapted from https://spice.unc.edu/resources/template-risk-assessment-for-ltc/ "]