Action 3.07 states

The health service organisation has:

  1. Collaborative and consultative processes for the assessment and communication of infection risks to patients and the workforce
  2. Infection prevention and control systems, in conjunction with the hierarchy of controls, in place to reduce transmission of infections so far as is reasonably practicable
  3. Processes for the use, training, testing and fitting of personal protective equipment by the workforce
  4. Processes to monitor and respond to changes in scientific and technical knowledge about infections, relevant national or jurisdictional guidance, policy and legislation
  5. Processes to audit compliance with standard and transmission-based precautions
  6. Processes to assess competence of the workforce in appropriate use of standard and transmission-based precautions
  7. Processes to improve compliance with standard and transmission-based precautions

Intent

Infection risks are assessed, managed and monitored, using the hierarchy of controls in conjunction with infection prevention and control systems, and the workforce has the capacity to apply infection prevention and control practices.

Reflective question

  • How does the organisation incorporate the hierarchy of controls into its infection prevention and control systems to reduce transmission of infections?
  • How is the Communicating for Safety Standard used for developing collaborative and consultative processes to assess and communicate infection risks to consumers, carers and the workforce?
  • How does the organisation ensure it keeps updated on emerging evidence, policy and or legislative changes relating to infectious diseases?
  • How does the organisation monitor the workforce's:
    • Compliance relating to the competent use of standard and transmission-based precautions
    • Competent use, testing and fitting of personal protective equipment by the workforce
  • How does the organisation ensure that the workforce (including contractors) is trained in the appropriate use of personal protective equipment?
  • What processes does the organisation use to improve compliance with standard and transmission-based precautions?

Examples of evidence

  • Policies, procedures and/or protocols that document the organisation’s processes for ensuring the workforce is:
    • using the infection prevention and control systems in conjunction with the hierarchy of controls
    • provided with training in the use, testing and fitting of personal protective equipment
    • supported to work collaboratively and in consultation when assessing and communicating infections risks
    • able to monitor and respond to changes in knowledge, policy and legislation relating to infections
    • compliant and competent in the use of standard and transmission-based precautions
    • able to demonstrate how to put on and remove personal protective equipment
  • Observation of collaborative and consultative processes when assessing and communicating infections risks during interactions between clinicians, patients and their families/carers
  • Observation of clear and accurate clinical documentation of patients' infection risks
  • Observation of implementation of electronic alert flags for infection risks
  • Observation of implementation of infection control signage
  • Curriculum, schedule, and attendee logs for workforce PPE training
  • Attendee logs and documented outcomes for workforce respirator fit testing
  • Assessment of workforce competency related to the implementation of standard and transmission-based precautions
  • Audit results of workforce compliance with standard and transmission-based precautions (e.g. audits for compliance with hand hygiene, appropriate PPE use, safe sharp handling and use, aseptic technique)
  • Evidence of how audit results of workforce compliance with standard and transmission-based precautions are used to improve practice and patient safety
  • Evidence of how the outcomes of workforce competency assessment for standard and transmission-based precautions are used to improve practice and patient safety
  • Examples of how the organisation monitors changes in scientific and technical knowledge about infections, relevant national or jurisdictional guidance, policy and legislation are monitored and addressed by the organisation
  • Feedback from consumers and the workforce on processes for standard and transmission-based precautions

See also: