Infection Prevention and Control Risk Assessment Tool to Prevent the Spread of Infection
To be completed on admission and as needed.
Name		
Date of Birth		
Assessed by		
Designation		
Date of Assessment		

Risks	Yes	No	Actions/Interventions	
Respiratory Tract Risks:

Suspected/confirmed Tuberculosis (TB) AAFB in sputum?
Compliant or non-compliant with drug treatment?
Productive cough with weight loss in last 6 months, with or without fever and night sweats?
Family or other TB contacts?
Previous history of TB and/or incomplete treatment with risk of drug resistance?			Liaise with TB specialist nurses
Hand Hygiene
PPE e.g. Gloves, Aprons, Face Masks
Provide clean tissues
Dispose of tissues in infectious waste stream
Provide advice to client
Increase environmental cleaning
Isolation
Correct waste disposal
	
Skin Risks:

Evidence of weeping vesicles e.g. Chicken Pox or Shingles?
Skin Shedding e.g. eczema/psoriasis?
Suspected/confirmed scabies/lice?
Itchy rash or skin lesions?
MRSA Colonisation
			Hand Hygiene
Regular observation of skin and document any changes
Inform D/N’s, Podiatrist, GP etc of any changes
PPE when changing bedding/applying creams etc
Increase environmental cleaning
Seek advice if scabies identified & commence treatment and scabies pathway
If confirmed MRSA colonisation commence suppression treatment
Correct waste disposal	
Elimination Risks:

Diarrhoea and/or vomiting currently or in the past 12-72 hours?
History of antibiotics in the past 8 weeks?
Recent admission to hospital?
Suspected or confirmed Clostridium difficile?
			Hand Hygiene
PPE e.g. gloves, aprons
Increase environmental cleaning and use hypochlorite solutions
Clean all equipment regularly with hypochlorite solutions.
Inform D/N’s, Podiatrist, GP etc of any risks
Place laundry into a red soluble bag 
Dispose of waste correctly
Wash all commode pans and urinals in the sluice	
Urinary Tract Risks:

Suspected or confirmed urinary tract infection (UTI)?
Recurrent UTI with risks for multi-resistant organisms egESBL’s?
History of antibiotics in the past 8 weeks?
Urinary catheter currently in situ or inserted in the past 6 weeks?			Hand Hygiene
PPE e.g. gloves, aprons
Increase environmental cleaning 
Inform D/N’s, Podiatrist, GP etc of any risks
Ensure a catheter care plan is in place
Receptacles used for emptying catheters should be single use or washed appropriately
Dispose of waste correctly	

Wound Infection Risks:

Suspected/confirmed wound infections including MRSA from exudate from;
Lacerations
Boils
Carbuncles
Venous ulcers
Pressure Sores
Other wounds that are slow to heal			Hand Hygiene
Regular observation of skin and document any changes in care plan
Inform D/N’s, Podiatrist, GP, Tissue Viability etc of any changes
PPE when changing bedding/applying creams, changing dressings etc
Increase environmental cleaning
Collect wound swabs if infection is suspected.
Dispose of waste correctly	
Blood-Borne Virus (BBV) Risks:

Suspected/confirmed BBV e.g. Hep B, Hep C, or HIV?
History of IV Drug use?
			Hand Hygiene
PPE e.g. gloves, aprons, eye protection
Increase environmental cleaning 
Inform D/N’s, Podiatrist, GP etc of any risks
Dispose of all sharps appropriately
Dispose of waste correctly
Ensure appropriate policies are in place	
Behaviour which increases infection risks:

E.g.;
Not washing hands
Resistance to assistance with personal hygiene
Physical Disability
Confusion e.g. Alzheimer’s, Dementia etc			Promote hand washing (hand wipes)
Assist with hygiene where necessary
Cohort for outbreaks if unable to isolate individuals	
Other Infection Risks:

Fever of unknown origin, increased confusion/disorientation?
Symptoms with or without any of the above risk factors
Transfer from another hospital or care home within the last 6 weeks
Previous infections			Liaise with GP, DN’s etc.
Ensure accurate documentation
Look for signs and symptoms of infection e.g. Raised temperature, increased heart rate, increased confusion.	

On completion of the assessment:	
What immediate precautions and action will need to be taken?

	
Does the client need to be isolated from other residents?
	YES	NO	N/A	
If unable to isolate client state why and how they would be managed?
E.g. if confused, or refuses to follow advice

	
Are appropriate referrals made and is treatment commenced promptly?
	YES	NO	N/A	
Infection Control Nurse Contacted By:		Date:		
Referral made to other professionals:
(State which)

		
Date: