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INFECTION RISK ASSESSMENT

INFECTION RISK ASSESSMENT

INFECTION RISK ASSESSMENT

Attach this sticker to the transfer documentation in ALL cases.

Attach this sticker to the transfer documentation in ALL cases.

Attach this sticker to the transfer documentation in ALL cases.

If you answer yes to any of the questions, contact the admitting area in advance to allow for appropriate isolation to be arranged.

If you answer yes to any of the questions, contact the admitting area in advance to allow for appropriate isolation to be arranged.

If you answer yes to any of the questions, contact the admitting area in advance to allow for appropriate isolation to be arranged.

Does the patient have a previous history of MRSA or another multi-resistant organism?

NO

Does the patient have a previous history of MRSA or another multi-resistant organism?

NO

Does the patient have a previous history of MRSA or another multi-resistant organism?

YES

NO

NO

Is this patient known or suspected to have pulmonary TB for which they have received less than two weeks treatment/ considered infectious by the TB nurse?

NO

Is this patient known or suspected to have pulmonary TB for which they have received less than two weeks treatment/ considered infectious by the TB nurse?

YES

NO

NO

Following assessment against the viral gastroenteritis algorithm, could the patient have infectious gastroenteritis (viral or other cause)?

NO

Following assessment against the viral gastroenteritis algorithm, could the patient have infectious gastroenteritis (viral or other cause)?

YES

NO

NO

Does the patient have any of the following infections? (circle applicable infections) Chickenpox, slapped cheek, rubella or another infection

NO

Does the patient have any of the following infections? (circle applicable infections) Chickenpox, slapped cheek, rubella or another infection

YES

NO

Is this patient known or suspected to have pulmonary TB for which they have received less than two weeks treatment/ considered infectious by the TB nurse? Following assessment against the viral gastroenteritis algorithm, could the patient have infectious gastroenteritis (viral or other cause)?

YES

YES

YES

Does the patient have any of the following infections? (circle applicable infections) Chickenpox, slapped cheek, rubella or another infection

YES

YES

YES

YES

YES

This form has been completed with information available at the time of the assessment.

This form has been completed with information available at the time of the assessment.

This form has been completed with information available at the time of the assessment.

NAME: ..............................................................................

NAME: ..............................................................................

NAME: ..............................................................................

DATE:.........................................

DATE:.........................................

DATE:.........................................

INFECTION RISK ASSESSMENT

INFECTION RISK ASSESSMENT

INFECTION RISK ASSESSMENT

Attach this sticker to the transfer documentation in ALL cases.

Attach this sticker to the transfer documentation in ALL cases.

Attach this sticker to the transfer documentation in ALL cases.

If you answer yes to any of the questions, contact the admitting area in advance to allow for appropriate isolation to be arranged.

If you answer yes to any of the questions, contact the admitting area in advance to allow for appropriate isolation to be arranged.

If you answer yes to any of the questions, contact the admitting area in advance to allow for appropriate isolation to be arranged.

Does the patient have a previous history of MRSA or another multi-resistant organism?

NO

Does the patient have a previous history of MRSA or another multi-resistant organism?

NO

Does the patient have a previous history of MRSA or another multi-resistant organism?

YES

NO

NO

Is this patient known or suspected to have pulmonary TB for which they have received less than two weeks treatment/ considered infectious by the TB nurse?

NO

Is this patient known or suspected to have pulmonary TB for which they have received less than two weeks treatment/ considered infectious by the TB nurse?

YES

NO

NO

Following assessment against the viral gastroenteritis algorithm, could the patient have infectious gastroenteritis (viral or other cause)?

NO

Following assessment against the viral gastroenteritis algorithm, could the patient have infectious gastroenteritis (viral or other cause)?

YES

NO

NO

Does the patient have any of the following infections? (circle applicable infections) Chickenpox, slapped cheek, rubella or another infection

NO

Does the patient have any of the following infections? (circle applicable infections) Chickenpox, slapped cheek, rubella or another infection

YES

NO

Is this patient known or suspected to have pulmonary TB for which they have received less than two weeks treatment/ considered infectious by the TB nurse? Following assessment against the viral gastroenteritis algorithm, could the patient have infectious gastroenteritis (viral or other cause)?

YES

YES

YES

Does the patient have any of the following infections? (circle applicable infections) Chickenpox, slapped cheek, rubella or another infection

YES

YES

YES

YES

YES

This form has been completed with information available at the time of the assessment.

This form has been completed with information available at the time of the assessment.

This form has been completed with information available at the time of the assessment.

NAME: ..............................................................................

NAME: ..............................................................................

NAME: ..............................................................................

DATE:.........................................

DATE:.........................................

DATE:.........................................

/Care_hom  

http://www.kirklees.nhs.uk/fileadmin/documents/your_health/Infection_prevention_and_control/Care_homes/SR3406_6-upRiskAssessStickers.pdf