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ICRA Form for Infection Control Assessment

The document is an Infection Control Risk Assessment (ICRA) form from Haji Surabaya Public Hospital in Surabaya, Indonesia. The form contains a table to assess potential infection risks and issues based on their probability, impact, and the hospital's current prevention systems. Each risk is given a priority score and the form outlines general and specific goals, strategies, and progress evaluations to address high priority infection control issues.

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159 views3 pages

ICRA Form for Infection Control Assessment

The document is an Infection Control Risk Assessment (ICRA) form from Haji Surabaya Public Hospital in Surabaya, Indonesia. The form contains a table to assess potential infection risks and issues based on their probability, impact, and the hospital's current prevention systems. Each risk is given a priority score and the form outlines general and specific goals, strategies, and progress evaluations to address high priority infection control issues.

Uploaded by

novi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

RUMAH SAKIT UMUM HAJI SURABAYA

KOMITE PENCEGAHAN DAN PENGENDALIAN INFEKSI


Jl. Manyar Kertoadi Telp. (031) 5924000 Extension 5038 Surabaya 60117

FORMULIR ICRA (Infection Control Risk Assessment)

RESCO
Probabilty / Current systems/
Risk/impact(Health, Finacial, Legal, Regulatory
Frequency Preparedness
Catastropic Serious

Expect it
Potensial Risk/Masalah Loss (life/ Loss Prolonged Moderate Minimal

Maybe
Likely

Never

Good
None

Solid
Poor
Rare

Fair
limb/ (Function/ Length of clinical/ Clinical
function/ financial/ stay financial financial
financial) Legal)
5 4 3 2 1 5 4 3 2 1 5 4 3 2 1
                                 
                               

                               

                               

                               

                               

                               

                               
RUMAH SAKIT UMUM HAJI SURABAYA
KOMITE PENCEGAHAN DAN PENGENDALIAN INFEKSI
Jl. Manyar Kertoadi Telp. (031) 5924000 Extension 5038 Surabaya 60117

FORMULIR INFECTION CONTROL RISK ASSESSMENT (ICRA) PROGRAM

JENIS
POTENSIAL RISK / TUJUAN TUJUAN PROGRE
No KELOMPOK SKOR PRIORITAS STRATEGI EVALUASI
MASALAH UMUM KHUSUS SS/ ANALISIS
RISIKO
RUMAH SAKIT UMUM HAJI SURABAYA
KOMITE PENCEGAHAN DAN PENGENDALIAN INFEKSI
Jl. Manyar Kertoadi Telp. (031) 5924000 Extension 5038 Surabaya 60117

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