VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET

STEP – 1 : CONSIDER THE CONSEQUENCES

 What are the consequences of this event occurring?
 Consider what could reasonably happen with existing controls in place?
 If an incident has occurred what could have reasonably happened?
 As well as what actually happened?
Look at the descriptions and choose the most suitable CONSEQUENCE

‘1’ No Fatalities
No Injuries
INSIGNIFICANT Low Financial loss
Little disruption to community
No measurable impact on environment.

‘2’ Small number of injuries, no fatalities, first aid treatment required

Some displacement of people (very short period of time e.g. 24hours)
MINOR Some personal support required, some damage
Some disruption (short period of time), small impact on environment
Some
with financial
no lastingloss.
effects.

‘3’ Medical treatment required, no fatalities, some hospitalization

Displacement of people (very short period of time e.g. 24 hours)
Personal support satisfied through local arrangements
Localized damage which is rectified by routine arrangements
MODERATE
Normal community functioning with some inconvenience
Some impact on environment with no long term effects or
Small impact on environment with long term effects
Significant financial loss.
‘4’ MAJOR Extensive injuries, fatalities, significant hospitalization.
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
Large number displaced (more than 24 hours duration)
External resources required for personal support.
Significant damage that requires external resources.
Community only partially functioning, some services unavailable
Some impact on environment with long term effects
Significant financial loss – Some financial assistance required

‘5’ Large numbers of severe injuries, large numbers requiring

General
hospitalization
and widespread displacement for extended duration
Significant fatalities
Extensive personal support
SEVERE
Extensive damage
Community unable to function without significant support
Significant impact on environment and/or permanent damage
Huge financial loss – unable to function without significant support.

STEP – 2 : CONSIDER THE LIKELIHOOD

 What is the likelihood of the consequence identified in Step - 1 happening?
 Consider what could reasonably happen with existing controls in place?
 If an incident has occurred what could have reasonably happened?
 As well as what actually happened?
Look at the descriptions and choose the most suitable LIKELIHOOD

‘5’ ALMOST CERTAIN Expected to occur in most circumstances

‘4’ LIKELY Will probably occur in most circumstances

‘3’ POSSIBLE Could occur at some time

VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
‘2’ UNLIKELY Is not likely to occur in normal circumstances

‘1’ RARE May occur only in exceptional circumstances

STEP – 3 : CALCULATE THE RISK

 Take the CONSEQUENCES rating (1-5) and select the correct column
 Take the LIKELIHOOD rating (1-5) and select the correct row
 Select the RISK RATING where the two ratings cross each other on the matrix below.
 21-25 = Very High Risk
 15-20 = High Risk
 10-14 = Medium Risk
 0-10 = Low Risk
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
HAZARD IDENTIFICATION AND RISK ASSESSMENT CONTROL PROCESS
LOCATION : DATE : TIME :
H.I.R.A CARRIED OUT BY : FOR EXISTING CONTROLS
WHAT IS
RISK ADDITIONAL
THE HAZARD / RISK WHO IS AT CONTROLS EXISTING CONSEQUENCE LIKELIHOO
LEVE CONTROLS
ACTIVITY / IDENTIFIED RISK CURRENTLY RATING D RATING
L RECOMMENDED
PROCESS
Chemical hazards
Splashing liquids
contained by shields,
deflectors or guards
Toxic chemicals in use in
hospitals include:-
Preparation of Splashing or Spillage of HK Staff 1. Working in well 2 2 4 None
Solutions Industrial cleaners ventilated and well-lit
used by contracted areas.
cleaning staff. 2. Small measuring jars are
available
3. PPE
4. Training
5. MSDS
Sterilization Splashing or Spillage of 1. HK Staff 1. Working in well 2 3 6 Endo-washer
of Chemical sterilizers, in 2. OT Staff ventilated and well-lit
Endoscopes particular 3. Cath Lab areas.
gluteraldehyde used for staff 2. Small measuring jars are
the sterilization of 4. Endoscopy available
endoscopes and other staff 3. PPE
equipment that cannot 4. Training
be steam sterilized. 5. MSDS
Tissue Splashing or Spillage of 1. Staff at 1. Working in well 3 2 6 Eye wash facility
preservation Tissue preservatives Histo-path ventilated and well-lit
in Histo- such as formaldehyde lab areas.
path lab used to store and 2. Storage of chemical in
preserve body tissue small quantities
prior to histopathology. 3. PPE availability
4. MSDS
5. Spill management
training
Tissue Splashing or Spillage of 1. Staff at 1. Working in well 3 2 6 Eye wash facility
preparation Chemical reagents used Histo-path ventilated and well-lit
in Histo- in the hospital lab areas.
path lab Pathology Laboratory. 2. Tissue preparation
equipment
3. Storage of chemical in
small quantities
4. PPE availability
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
WHAT IS
RISK ADDITIONAL
THE HAZARD / RISK WHO IS AT CONTROLS EXISTING CONSEQUENCE LIKELIHOO
LEVE CONTROLS
ACTIVITY / IDENTIFIED RISK CURRENTLY RATING D RATING
L RECOMMENDED
PROCESS
5. MSDS
6. Spill management
training
Cytotoxic drugs requiring NA NA NA NA NA NA
preparation prior to
parenteral
administration to
cancer patients.
X-ray film Splashing or Spillage of X-ray 1. Film processing machine 2 1 2 None
processing Processing chemicals technician 2. PPE availability
for X-ray film 3. MSDS
development.
Surgery Anesthetic gases in the 1. Patient 1. Anesthesia Workstation 4 2 8 None
Operating Theatre. 2. Doctors 2. Code blue team
3. OT Staff
Handling Needle Stick Injury 1. Doctors 1. Needle cutters 2 2 4 None
sharps 2. Nursing 2. PPC bins
Staff 3. No-recapping policy
3. HK Staff 4. Training
Hazardous Mercury spillage 1. Nursing 1. Spillage kit 1 1 1 None
material staff 2. PPE
spillage 2. HK Staff 3. Training
Hazardous Blood & body fluid 1. Nursing 1. Closed Sample containers 2 1 2 None
material Spillage staff for sample transportation
spillage 2. HK Staff 2. Spillage kit
3. PPE
4. Training
Biomedical Staff & other personnel 1. Hospital 1. Segregation of BMW at 2 2 4 None
Waste exposure to hazardous staff source
handling material 2. Patients 2. Adherence to BMW
3. Visitors management protocol
3. Disposal of BMW by
authorized organization
4. Dedicated storage location
for BMW
5. PPE usage by HK staff
Storage of Fire hazard 1. Electrician 1. Pumping diesel into DG set 2 1 2 1. Barricade around diesel
diesel and s using motor storage
fuel filling 2. Storing diesel in small
into diesel quantities.
Generators 3. Adherence to ‘No Smoking’
policy in the hospital
premises.
4. Foam type fire extinguisher
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
WHAT IS
RISK ADDITIONAL
THE HAZARD / RISK WHO IS AT CONTROLS EXISTING CONSEQUENCE LIKELIHOO
LEVE CONTROLS
ACTIVITY / IDENTIFIED RISK CURRENTLY RATING D RATING
L RECOMMENDED
PROCESS
5. Sprinkler system
Diet Fire hazard due to 1. F&B Staff 1. Gas manifold system 4 2 8 Outsourcing of kitchen
preparation cooking gas 2. Other 2. No storage of Cooking in the
hospital hospital premises
staff 3. Fire extinguishers
3. Visitors
Fire fighting Water storage for fire 1. Patients 1. Separate water storage for 4 2 8 Enhance the water
fighting 2. Hospital fire fighting storage capacity for fire
staff 2. ‘Breeching connection’ to fighting
3. Visitors collect water from brigade
source
Fire fighting Failure of power supply 1.Patients 1. Separate diesel generator 4 2 8 Installation of Diesel fire
to Fire pump 2.Hospital availability for fire pump pump
staff
3.Visitors
Building Protection from 1. Patients No control 5 1 5 Installation of lightening
protection lightening 2.Hospital conductor
staff
3.Visitors
X-ray, CT Exposure to radiation 1.Patient 1. The room was constructed 1 1 1 None
Scan or Cath 2.Staff as per AERB guidelines
lab procedures 3.Doctors 2. Lead aprons, gonad and
thyroid shields
3. Staff wearing TLD badges
4. Display of Appropriate
signages to control
personnel entry
5. Surveillance activities by
RSO
6. Staff training
Medication Medication errors Patient 1. Prescription of medicine 2 1 2
Administratio directly in drug chart by the
n consultant
2. Computerized indenting
system
3. Strict adherence to loose
medication policy
4. Strict adherence to high
risk medication policy
5. Effective inventory control
management to reduce
medication delays
6. ID bands for patient
identification
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
WHAT IS
RISK ADDITIONAL
THE HAZARD / RISK WHO IS AT CONTROLS EXISTING CONSEQUENCE LIKELIHOO
LEVE CONTROLS
ACTIVITY / IDENTIFIED RISK CURRENTLY RATING D RATING
L RECOMMENDED
PROCESS
7. Documentation by nurses
on administration
8. Strict adherence to verbal
order policy
9. Adherence to patient safety
goals
10. Barcode system at
OPD for patient registration
Blood Sampling errors Patient 1. Strict adherence to sample 2 2 4 Lab Information System
investigations collection protocol
2. Adherence to patient safety
goals
3. Using vacutainers for blood
collection
4. Computerized patient
registration
5. Sophisticated equipment for
sample preparation
6. Timely transportation of
sample to lab
7. Maintenance of register
8. Training
Blood Blood transfusion Patient 1. Strict adherence to blood 3 2 6 None
transfusion reaction transfusion protocol
2. Maintaining cold chain from
external blood bank to
hospital
3. Blood storage refgirator for
temporary maintenance of
cold chain for blood
products
4. Close monitoring of
transfusion activities
5. Crash cart
6. Code blue team
7. Staff training
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
Use a fume hood or other
extraction device when
working with
hazardous substances
UNSW hazardous
substances and
dangerous goods
procedure
Chemical register kept
for each area
Copies of all material
safety data sheets and
following instructions
for safe use
Working in well
ventilated and well-lit
areas.
Always Wearing correct
PPE
Make sure all spills are
cleaned
No eating, drinking or
smoking
Wash hands/self with
soap and cold water
Disposal of waste
according to MSDS and
UNSW procedure
Biological hazards
1 Level of fume, mist dust
emissions within
regulatory limits.
2 Proper ventilation/
extraction system
provided.
3 Effluent discharge
approved to sewer or
treatment facility
4 Atmospheric discharges
meet statutory
requirements.
5 Compliance with other
relevant Environmental
Acts, Regulations and
Codes
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
6 Management of biological
hazards
comprehensively
covered in the hospital’s
Infection Control
Manual..
7 policies and procedures
developed and
monitored by an
Infection Control
Committee
8 Modes of disease
transmission from
patients to staff
a Airborne and droplet
aerosol exposure -
includes viral upper
respiratory tract
infections, measles and
T
keeping distance (>1m)
from frontal coughing
as much as possible
wash hands after every
patient contact and
especially avoid rubbing
eyes before washing
high filtration face
masks (where
applicable - generally
not practical in the
outpatient setting)
isolate inpatients in a
negative air pressure
room.
b Skin contact exposure -
includes Staphylococcus
aureus and Varicella.
Prevention requires
protective gown and
gloves.
c Exposure to infectious
fluids via broken skin,
eyes, mucous
membranes, and
parenteral exposur
includes hepatitis B,
hepatitis C, and HIV
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
from all body fluids
except sweat, as well as
gastroenteritis
Preventative measures
include universal
precautions (gloves,
gown, goggles and
mask), and appropriate
management of sharps,
spills, and
contaminated waste.
Psychological hazards
Hospitals are stressful
places for sick and
injured patients and
their families. However
they can also be
stressful for staff due to
such factors as:
Shift work, on call duty,
fatigue and “burn out”.
High workload and
demand.
High or unrealistic
patient expectations.
Verbal abuse or threats
from disgruntled or
intoxicated patients.
High or unrealistic
expectations from
supervisors and
management.
Problematic
interpersonal work
relationships.
Frustrations due to
limited resources,
especially staffing
levels.
Poor organizational
climate with low staff
morale.
Internal and External
Emergencies
1 Natural Hazards:
o Cyclones and severe
storms (high winds and
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
rain);
o Earthquake;
o Fire (urban fire;
wildfire)
2 Civil/Political Hazards:
o Terrorism;
o Civil unrest
3 Personal Violence
Risk of injury from
personal violence by
mad, bad , intoxicated
patients or
psychotically disturbed
staff education and set
policy and procedure
needs to be in place for
dealing with aggressive
patients
Personal security
alarms, a system for
rapidly mobilizing
ancillary staff,
and a set approach to
safely restraining,
immobilizing and
sedating violent
patients are all
important components.
Well-documented and
rehearsed evacuation
plans are required to
ensure the safe
evacuation of disabled,
immobilized or
otherwise helpless
patients
In critical care areas this
will include manual
back up for life support
systems.
4 Disaster Management
The procedures for
mobilization of
resources to (i) receive
and triage (ii) assess,
resuscitate and
stabilize (iii) provide
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
definitive care for and
facilitate inter-hospital
transfer of patients
should be clearly
documented in the
hospital’s external
disaster plan.
The Hospital Disaster
Committee is
responsible for the
preparedness and
planning of the hospital
for the management of
multiple casualties, and
should regularly review
and rehearse the plan
with mock exercises
The committee must also
ensure the adequacy of
back up power and
water supplies to the
hospital following the
impact of natural
disasters.
Food Safety
1 Hospital kitchens prepare
meals for inpatients
and in many cases
prepare meals for the
staff canteen
2 food storage, handling
and preparation is done
to the highest
standards and poses no
risk to already sick or
compromised patients.
3 4 national food safety
standards, State and
Territory Food Acts,
Industry guidelines,
food safety auditing,
and food safety
training.
4 Food Act, Food Hygiene
Regulations, and Food
Standards Regulations
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
5 Hospitals to meet
Australian Council of
Healthcare Standards
for hospital
accreditation and these
standards comply with
the 4 national food
safety standards.
6 The Kitchen / Catering
Supervisor is
responsible for
documenting and
administering the
hospital’s food plan,
Employee education
1 Specialised operator
training requirements
have been identified
and planned
2 Safe Operating Procedure
formulated
3 When there are changes
in the work done,
changes in the work
environment,
4 Purchasing new or used
equipment or hiring
equipment,or using new
substances and
processes
5 Responding to incidents
6 Responding to issues
Environmental
Protection
Waste Management
Issues
1 Waste disposal is
governed by BMW Act
1988
2 Policy for biomedical
waste disposal includes
issues relating to
infectious material,
hazardous chemicals
and drugs, and body
parts and is also
documented in the
hospital’s Infection
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
Control Manual.

3 It is based on various
guidelines including (i)
BMW Handling Rules
(ii) CDC Guidelines (iii)
AP Pollution Board
4 The major components of
such a waste
management system
include:-
5 Waste segregation at the
source - sharp
containers, biohazard
bins, general waste
bins, and cytotoxic bins
- all standardized and
color-coded and
appropriately labeled
6 Waste streams - general,
contaminated, cytotoxic
/ pharmaceutical, body
parts.
7 Storage and transport -
cold storage for
contaminated waste
and body parts;
transport in safe, leak
proof containers.
8 Visit Report of Waste
treatment plan to
ensure proper
procedures are followed
for - sterilization of
contaminated waste
(steam autoclave);
incineration of
cytotoxics,
pharmaceuticals and
body parts in an
incinerator meeting all
relevant standards and
statutes.
9 Ensure Waste treatment
plant is Local Council
approved, engineered,
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
sanitary landfill.

Mechanical hazards
1 Hydraulic/pneumatic
systems comply with
standards
3 Ensure all moving parts
are guarded according
to the standard for the
safe guarding of
machinery
4 Safe working procedures
written and displayed
5 No loose clothing or
jewellery to be worn –
6 Machines fitted with
emergency stop buttons
7 Machines tested and
tagged
8 ·nstruction and training
given
Electrical hazards
1 Electrical & electronic
systems comply with
Standards.
2 Use of Electrical
Defibrillators is
restricted to those staff
who have undergone
competency based
training and
certification.
3 Portable Electrical
Appliance Inspection,
Testing and Tagging
Program; RCDs on
power outlets
Thermal hazards
1 Lasers used in Operating
Theatres and
appropriate protective
equipment must be
used, especially eye
protection to prevent
retinal burns.
2 The use of this equipment
is covered by set
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
protocols.

3 Central Sterilizing
Departments utilizing
appropriately trained,
dedicated staff, that are
familiar with policy and
procedure
peripheral steam
sterilizers are still
required in some
departments such as
the Operating Theatres.
This type of set up
minimizes risk of
physical injury from hot
equipment.
Noise hazard
1 Noise levels do not exceed
85 dBA at operator
station, or daily noise
dose as prescribed.
2 As per AP Pollution
Board
Radiation hazards
1 Prescence of radiation
hazards related to
medical imaging (x
rays, nuclear scans
utilizing radioactive
isotopes)emitting short
wave length gamma
waves.
2 and radiation oncology
which utilizes ionizing
radiation from a variety
of sources to treat a
range of malignant
tumors. These sources
include (i) sealed
sources containing
radioactive material
such as isotopes of
radium, cobalt and
strontium, and (ii)
linear accelerators
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
3 appropriate training,
certification and
credentialing of users
4 demonstrated
implementation of
safety precautions
related to storage, use
and shielding of non
target personnel
5 regular inspection,
maintenance and
certification of
equipment by the RSO
6 ongoing monitoring of
radiation exposure of
staff using the
equipment.
Traveling hazards
Vehicle meets relevant
Australian Design
Rules
Population (Community)
Protection
Injury and Illness
Prevention
1 In Australia, injury is the
leading cause of death
for those less than 45
years of age. The
economic cost of
treating survivors as
well as the cost of lost
productivity is
enormous. Injury
prevention is therefore
a very worthwhile
strategy.
2 Emergency Department
Information Systems
that allow collection of
injury data that
complies with the
minimum data set of
the National Injury
Surveillance Unit. This
data gives a good cross
section of the
epidemiology of injury
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
within the community.
Analysis allows direct
comparison with other
communities of injury
incidence, as well as
indicating injury trends
and “hot spots” within
the community.
3 This data allows an
opportunity for
hospitals, various
community
organizations and Local
Government
Authorities to
collaborate in a Safe
Community Project.
Specific injuries can be
targeted with
interventional
strategies to decrease
the incidence.
Outcomes can be
monitored and
strategies modified to
optimize impact.
4 . Referral can then be
made to the appropriate
community agencies for
advice on interventional
strategies.
5 Hospitals also play a role
in disease prophylaxis
through such things as
(i) detection of
incomplete vaccination
schedules in presenting
children (ii) tetanus
prophylaxis for trauma
(iii) antibiotic
prophylaxis in
meningococcal contacts.
6 Hospitals also play a role
in illness prevention
through the early
detection of risk factors
and identification of
risk behaviors related
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
to various lifestyle
factors

7 Health Surveillance
8 The hospital’s role in
health surveillance is
mainly limited to
notifiable disease.This
allows the early
mobilization of
resources for contact
tracing and other public
health measures to
contain outbreaks.
Patient safety
1 Medication Use,
2 Infection Control,
3 Surgery And Anesthesia,
4 Transfusions,
5 Restraint And Seclusion
6 Staffing And Staff
Competence,
7 Fire Safety,
8 Medical Equipment,
9 Emergency Management,
10 And Security.
11 Response To Adverse
Events;
12 System for Prevention Of
Accidental Harm
Through The Analysis
And Redesign Of
Vulnerable Patient
(E.G. The Ordering,
Preparation And
Dispensing Of
Medications)
13 Education of Patient
About The Outcomes Of
The Care Provided To
The Patient—Whether
Good Or Bad.
14 Nosocomial Infection
Control
15 quality indicator for
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
nosocomial infection
rate.
16 The hospital’s Infection
Control Nurse and
Infection Control
Committee are
concerned with the
prevention, surveillance
and control of
nosocomial infections.
17 The Infection Control
Program should be
documented in the
hospital’s Infection
Control Manual, which
outlines the principles,
strategies, policy and
procedures for infection
control in the hospital.
18 All staff need to be
familiar with its
contents.
19 Regular feedback on
surveillance of
nosocomial infection
rates will help motivate
staff to remain vigilant.
20 Injury prevention for
patients may require
some of the following
interventions when
appropriate:-
21 Diligence in keeping bed
rails up particularly for
those patients with an
altered conscious state
from medication or
illness.
22 Bathroom / toilet aids
particularly for the
elderly or disabled.
23 Nurse and physiotherapy
assisted mobilization
during recovery.
24 Walking aids for the
disabled, and during
recovery.
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
25 Occupational therapy
home assessment for
home instructions
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VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET
VISAKHAPATNAM HAZARD IDENTIFICATION AND RISK MANAGEMENT WORKSHEET