Infection Prevention & Control Risk and Hazard Vulnerability Assessment

SEVERITY = (MAGNITUDE - MITIGATION)

HUMAN PROPERTY BUSINESS PREPARED- INTERNAL EXTERNAL
PROBABILITY RISK
EVENT IMPACT IMPACT IMPACT NESS RESPONSE RESPONSE
Time, Community/
Likelihood this will Possibility of Physical losses Interruption of Preplanning &
effectiveness, Mutual Aid staff Relative threat*
occur death or injury and damages services Prevention
resources and supplies
0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A
1 = Low 1 = Low 1 = Low 1 = Low 1 = Low 1 = Low 1 = Low
Issue 2 2 2 2= 2= 0 - 100%
2 = Moderate = Moderate = Moderate = Moderate 2 = Moderate Moderate Moderate
3 = High 3 = High 3 = High 3 = High 3 = High 3 = High 3 = High

Device-related infection
- Blood Stream Infection
- Ventilator Associated Infection
- Urinary Tract Infection
- Implant from Surgical Procedure
- Drain or Tube - Temporary
- Ostomy or Related Opening
- Peritoneal Dialysis
- Shunt
- Other
Resistant Microbes
- MRSA
- VRE
- ESBL
- Clostridium difficile 0%
- other 0%
Surgical Site Infection
- Superficial 0%
- Deep 0%
- Organ space 0%
Extrinsic Infection
- Patient-to-Patient Transmission 0%
- Worker-to-Patient Transmission 0%
- Visitor-to-Patient Transmission 0%
- Foodborne / Waterborne 0%
- Vectorborne / Vermin 0%
- Airborne Environmental Source 0%
- Waterborne / Aerosol Source 0%
- Surface / Immediate Environment 0%
- Contaminated Instrument/Equip 0%
- Contaminated Med / Product 0%
- Other 0%
Special Populations
- Neonates 0%
- Elderly 0%
- Pediatrics 0%
- Transplant 0%
 HUMAN PROPERTY BUSINESS PREPARED- INTERNAL EXTERNAL
PROBABILITY RISK
EVENT IMPACT IMPACT IMPACT NESS RESPONSE RESPONSE
Time, Community/
Likelihood this will Possibility of Physical losses Interruption of Preplanning &
effectiveness, Mutual Aid staff Relative threat*
occur death or injury and damages services Prevention
resources and supplies
0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A
1 = Low 1 = Low 1 = Low 1 = Low 1 = Low 1 = Low 1 = Low
Issue 2 2 2 2= 2= 0 - 100%
2 = Moderate = Moderate = Moderate = Moderate 2 = Moderate Moderate Moderate
3 = High 3 = High 3 = High 3 = High 3 = High 3 = High 3 = High

- Chronic Conditions 0%
- HIV 0%
- Other immunocompromised 0%
- Behavioral / IVDA 0%
- Other not specified above 0%
Occupational Health
- Bloodborne Pathogen Exposure 0%
- Tuberculosis Exposure 0%
- Vaccine Preventable Comm Dis 0%
- Non VP Comm Dis 0%
- Other not specified above 0%
Building / Facility
- Water intrusion 0%
- Construction & Renovation 0%
- Utilities loss (refer to facility HVA) 0%
- Surge capacity 0%
- Other not specified above 0%
Community
- Bioterrorism 0%
- Internal cluster/outbreak 0%
- External outbreak 0%
- Epidemic/Pandemic 0%
AVERAGE SCORE 0%
RISK = PROBABILITY * SEVERITY *Threat increases with percentage