Recently, I've come across various discussions with infection preventionists (IPs) and healthcare administrators who are new to the world of infection prevention and control (IPC). Many displayed a lack of understanding of the difference between 3 different types of infection control assessments: the Infection Control Assessment and Response (ICAR), the Infection Prevention Risk Assessment (often referred to as “the annual risk assessment”), and the Infection Control Risk Assessment (ICRA) for construction projects. An additional facility risk assessment that is causing some confusion is the National Fire Protection Association Healthcare Facilities Code 99 (NFPA 99).
In my experience, when discussing this topic, these professionals tend to use these terms interchangeably. For example, when requesting documentation on the most recent infection prevention annual risk assessment in long-term care facilities, nine times out of ten, the person in charge of the infection control program has presented their NFPA 99 documentation. When asked if they have completed their annual risk assessment, they confirm that they have, when in fact, upon verification, they are actually describing their most recent ICAR conducted during a state visit.
This article will briefly describe these three key terms, explain their importance, as well as their proper usage to dispel the confusion. The NFPA 99 will also be described briefly. It’s important to note that this assessment is beyond the scope of an IP and, therefore, will not be elaborated on.
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The ICAR
The Infection Control Assessment and Response (ICAR) is an assessment tool created by the Centers for Disease Control and Prevention (CDC). It is used to help infection preventionists and public health entities take a comprehensive look at every component of an IPC program. The CDC provides free ICAR tools for various healthcare settings to help its users effectively conduct this evaluation and implement quality improvement interventions.
With an ICAR tool, an investigator, IPC consultant, or facility’s IPC program representative can assess several program components including hand hygiene, PPE, occupational health, cleaning and disinfection, injection safety, and more. The professional assessing the program can easily examine those different components with a series of targeted questions and make inferences on the strengths and weaknesses of the program based on the responses provided. These inferences allow the investigator to provide evidence-based recommendations and help the facility in making improvements to its IPC policies and procedures and follow best practice.
ICAR Tool for General Infection Prevention and Control (IPC) Across Settings. Source: CDC
When was the last time your facility had an ICAR done? Contact us if you need help evaluating your program to start a quality improvement project or prepare for a state visit
The Annual Risk Assessment
The infection prevention annual risk assessment helps the IPC team assess its facility for infection risks to its patient population. It’s an important assessment to conduct and help the IPC program take proactive steps to prevent healthcare-associated infections (HAIs).
Why does HAI prevention matter to IPs?
HAIs cause harm to patients as they present an increased risk for mortality for vulnerable patients, especially for those with comorbidities and weakened immune systems. They also increase costs for healthcare facilities and cause an increased burden on healthcare delivery for healthcare workers. Overall, HAIs severely affect the quality of care provided to patients. Conducting an infection prevention risk assessment helps IPs gauge where their facility stands and plan interventions accordingly to mitigate those risks.
For example, the annual risk assessment can help a nursing home administrator and/or infection preventionist identify risks for the resident population to contract healthcare-associated urinary tract infections (UTIs) and take proactive steps in reviewing current patient care practices to help prevent new cases and reduce current case counts. In an acute care facility, the annual risk assessment may include other metrics such as central line-associated bloodstream infections (CLABSIs) and infection risks for organisms such as C.difficile (C.diff) and other more prevalent organisms based on the setting.
Infection preventionists should conduct this risk assessment every year to ensure that they keep track of HAI trends within their facilities and take the appropriate actions to ensure the program's effectiveness. They should also re-evaluate their progress throughout the year to determine whether the interventions are successful in reaching their target goals and make adjustments accordingly. For this risk assessment to be valuable, historical data must be available at the beginning of the process. The IPC team must establish an infection control work plan in collaboration with department stakeholders to ensure that they can meet their objectives and effectively allocate resources.
If you need help conducting your facility's annual risk assessment, our team can help you streamline your process and assist with implementation. We will then provide you with some tools to help you feel more confident to conduct your assessment independently in the future. Contact us today to speak with one of us.
The ICRA
When new construction and design projects are undertaken in the healthcare setting, there’s always the potential for spreading infections from pathogens that thrive in dust and moist environments within the environment of care. When appropriate infection control measures and barrier precautions are not taken early, fungal diseases such as Aspergillosis can affect high-risk patients (i.e. immunocompromised) through the inhalation of fungal spores aerosolized from mold particles via processes of agitation such as excavation and demolition.
To mitigate these risks, healthcare leaders must ensure that a multidisciplinary committee is established before construction projects are started and that this committee involves a knowledgeable representative from the infection prevention and control team. This infection preventionist will ensure that the health and safety of patients, staff, and visitors near the intended construction site are taken into account and protected. The presence of the infection preventionist on this committee will also ensure that infection prevention measures are at the forefront of the entire construction process and remain in place throughout the entire project.
Before the project is initiated, the infection preventionist should educate the healthcare team working within or near the designated construction area as well as the members of the committee, most specifically the construction team, on barrier methods and other necessary preventative strategies to prevent aerosolization of harmful particles within the construction area and throughout the environment of care.
The infection preventionist must be invited to participate in the ICRA process to ensure that all potential health risks are considered and that a plan is put in place to mitigate those risks. Healthcare institutions can use a free template of the ICRA 2.0 tool provided by the American Society for Healthcare Engineering (ASHE). They should utilize this tool to assess for risks and make it available during their consultation meetings with the infection preventionist throughout the project.
Have you conducted an ICRA before? Does the process seem a bit complex? If you need help, our team can help you get comfortable with this process and take on leadership for the next construction project within your healthcare setting. Contact us today to speak with one of us for free
The NFPA 99 Risk Assessment
The NFPA 99 risk assessment focuses on engineering safety measures in the healthcare setting and is not under the purview of the infection preventionist. However, because this tool has been brought out several times during my consultations, and infection preventionists have expressed some confusion between this tool and the annual infection prevention risk assessment, I’m providing a brief overview of what this assessment focuses on.
This risk assessment tool was created for healthcare facilities by the National Fire Protection Association and is a required safety measure under the Centers for Medicare and Medicaid (CMS) rule. This assessment helps healthcare facility administrator assess all potential fire, explosion, and electrical risks to the life and safety of those within the facility.
Although not directly related to infection prevention, the NFPA 99 risk assessment, among other required healthcare facilities codes, should be incorporated into the healthcare facility’s risk assessment process. Additionally, it should be reviewed and updated annually as necessary. The facility’s administrator should collaborate with clinical engineering experts to ensure that the appropriate equipment is running up to code and all activities are following standard practice and regulatory requirements. Equipment and activities to assess include, but are not limited to, gas equipment such as oxygen tanks, fire protection and safety activities such as proper use of power outlets, electrical system configuration, ventilation, and airflow. ASHE provides a free template of the NFPA 99 2021 risk assessment tool for healthcare administrators.
For healthcare facilities leaders who want to learn more about the NFPA 99 (and other related required codes) and those who want to sign up for training sessions for their facilities, please visit the NFPA website.
By understanding the difference between these three types of infection control assessment processes and their proper usage, healthcare administrators and infection preventionists are on their way to preserving patient and employee health and safety and can ensure that their infection prevention and control programs and processes are effective.
About the reviewer
Nathanael Napolitano brings over a decade of expertise collaborating with hospital facilities engineers in healthcare settings. Proficient in managing flood responses, remodeling, design review, barrier construction, site inspections, and new construction projects, he prioritizes infection control measures to meet standards both internally and for regulatory oversight agencies.
Specializing in infection control risk assessments, Nathanael identifies vulnerabilities in projects and implements strategies aligning with infection control industry standards. His technical proficiency includes barrier construction, managing controlled environments, adherence to policy and procedure, with the sole purpose to curb contagion spread.
Known for meticulous final inspections, Nathanael ensures adherence to high infection prevention standards. His collaborative approach fosters proactive infection control practices within multidisciplinary teams.