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Risk assessment and risk management are an integral part of healthcare. They ensure the provision of a high quality, safe service to patients and a more cost effective service by eliminating unnecessary costs.

Risk management provides a solid foundation for clinical governance, a framework within which organisations work to improve and assure the quality of clinical services for patients.

As with any other clinical risks, we need to assess infection risks, evaluate the likelihood of them occurring and implement appropriate control measures. Risk assessing clinical situations and producing a rationale for undertaking the correct procedure can help justify the time and cost of implementing a specific measure and minimise any errors that might lead to hospital acquired infections.

At an organisational level, infection control risks are identified by the Core Controls Assurance Standards in England and the new Standards for Better Health. At an operational level, in the ward or department, these risks are managed as part of a cyclical process of identification, analysis, possible solutions, implementation and evaluation. This should be an ongoing process with clearly defined dates for review that may range from daily (e.g. assessing ongoing risks of a patient with a transmissible infection) to annually (e.g. updating policies and procedures).

The primary aim of risk management is to be proactive in reducing risks to the lowest level that is “reasonably practicable”. The Management of Health and Safety at Work Regulations (1992) require managers to undertake formal risk assessments of the workplace. In addition, the Control of Substances Hazardous to Health (COSHH) Regulations (2002) require that managers undertake risk assessments of substances such as micro-organisms, chemicals, radioactivity, etc.

A practical approach to infection control risk management can be achieved by devising a structured care plan for each individual patient who is at risk from acquiring an infection and/or a source of infection to others. This ensures that infection hazards have been identified and risks of transmission assessed. This can be achieved by using a problem solving approach:

• assess risks
• plan management
• implement care
• evaluate outcomes.

This approach can also be used for hazards or risks arising from the environment or equipment, as well as patient related risks. However, it must be recognised that this approach requires a basic understanding of the various stages of the transmission of infection, as well as knowledge of the key principles of infection control.