Risk Management Strategy Report: Infection Control at Toi Ohomai

This report examines the role of audit as a risk management strategy for infection prevention and control at Toi Ohomai, a tertiary educational setting. It identifies the toilet and cafeteria as high-risk areas for infection spread, discussing the sources of contamination and the need for hand hygiene. The report uses evidence-based auditing standards, specifically observation, to assess the cafeteria's hand hygiene practices. It proposes recommendations like hand hygiene education for food handlers and improved hand hygiene resources, concluding that audits are crucial for managing risk and promoting quality in the organization. The report also addresses the importance of functional facilities and hand hygiene to minimize the rate of infectious disease in crowded settings and highlights the need for auditing practices at critical points to identify steps needed for infection prevention and control.

Running head: RISK MANAGEMENT STRATEGY
Risk management strategy
Name of the student:
Name of the University:
Author’s note

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Table of Contents
2) Introduction:.............................................................................................................................2
3) Role and importance of audit is risk management strategy:....................................................3
4) Two areas that can be audited at Toi Ohomai:.........................................................................4
4.1 First high risk area:................................................................................................................4
4.2 Second high risk area:............................................................................................................6
5.) Evidence based auditing standards for one of the risk identified:..............................................7
6.) Completing the audit:.................................................................................................................9
7.) Recommendations:...................................................................................................................10
8.) Conclusion:...............................................................................................................................11

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1) Executive summary
The report provides an evaluation of the role of audit as a risk management strategy to
prevent and control infectious disease. The report focused on discussing about the role of audit in
preventing infectious disease in Tai Ohomai. The two risk areas that have been identified as high
risk zone for spread of infection at the college includes the toilet and the cafeteria region of the
college. The background information related to cause of infection, source of microbial
contamination and exposure to infectious microorganism in both the two areas justifies the need
for infection in these two regions. The auditing standard for review of risk of infection at the
cafeteria has been done by use of evidence based auditing standard and observation has been
defined as the best step to conduct assessment of the area. The completion of audit at the target
setting suggest the need to implement hand hygiene education session for food handlers and
upgrading resource to maintain hand hygiene at critical points.
2) Introduction:
Audits is a process involving review of actual practice in an organization against set
standards of practice and identifying areas or gaps where improvement is needed to mitigate risk
and promote quality. In many large organizations, audit is an important part of risk management
strategy as it facilitates initiation of process that gives the assurance whether the organization is
appropriate managing risk and following up-to-date standards of practice or not (Knechel &

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Salterio, 2016). The main purpose of this report is to discuss about audit process and evidence
based auditing standards relevant to infection prevention and control practices. This will be done
by explanation of the role of audit in risk management and identifying two areas of risk that can
be audited at Toi Ohomai. The auditing standards related tp one area of risk will be developed
and the recommendations will be proposed based on findings of audit in chosen area.
3) Role and importance of audit is risk management strategy:
Risk is a concept that defines the likelihood of any events or outcomes that can have an
effect on the goals and objective of the organization. The control of risk mainly starts with a risk
assessment process and audit is one of the process that facilitates risk assessment and
identification of possible threats and opportunities in a particular setting (Hopkin, 2018). Audit is
an independent and consulting activity in an organization developed to add values and improve
the key activities and procedures of an organization. The outcome of the audit process gives
management the assurance that risk management processes are working well and all risk are
being effectively managed in an organization. Audit mainly involves the analysis of internal
controls, governance and risk management processes. A successful audit is dependent on proper
access to information, management support, and availability of skilled personnel for audit and
implementation of evidence based auditing standards (George, Theofanis & Konstantinos, 2015).
As the processes and operations in organization is becoming more complex and
challenging, companies are paying more attention to developing effective risk management
approaches. While developing goals for risk management, audit is often included in risk
management strategy as it provides systematic approach to identify, assess, report and respond to
any risk issues. It gives a detailed report about current risk experienced by an organization and

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providing recommendation to implement appropriate control measures for mitigation of risk and
achieve the desired organizational objective (Pérez-Cornej et al., 2019). Hence, it is an
important tool for measuring practice and managing risk. Ma’Ayan and Carmeli (2016) give the
argument that audit process is associated with performance improvement, efficiency and
effectiveness of an organization. This is because it promotes implementation of steps following
audit that makes work process more efficient. Therefore, audit team is crucial for risk
management and quality improvement in an organization.
4) Two areas that can be audited at Toi Ohomai:
This report is mainly concerned with the audit process of infection prevention and control
at Tai Ohomai. Tai Ohomai is a tertiary educational setting in New Zealand consisting of many
college and universities. Infectious outbreak and disease in this setting can occur due to various
factors such as lack of hand hygiene or hand washing, poor cleaning of the environment or lack
of routine practices to prevent transmission of infection and manage an outbreak (Ayoade &
Ardern, 2017). In the context of Toi Ohomai, two areas that are more prone to transmission of
infection and spread of infectious germs to other people include the toilet and the cafeteria
region. These two regions has been selected because these two areas requires hand hygiene at
vital points and hand washing in these two areas can lead to spread of infection. The background
information related to the identified high risk areas, that could lead to infection outbreak at Toi
Ohomai has been discussed in separate paragraph below.
4.1 First high risk area:
The first high risk areas that can increase risk of infection and infectious outbreak at the
setting includes the toilets at Toi Ohomai. Although hand washing and environmental cleaning

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are effective methods to remove infectious microorganisms, however toilet seats and dirty toilet
can be a source of infection. Toilet flushing can aerosolize faecal waste and dirty toilet seats are
contaminated with various microorganisms during defecation (Knowlton et al, 2018). Therefore,
aerosol related transmission as well as skin-to-skin contact transmission of infection increases in
the toilet area. Hence, examination of the toilet area can help to predict the factors contributing
to spread of infection.
The inspection of the washbasin and hand washing facilities near the toilet and access to
aseptic hand washing techniques like presence of soaps, clear water from tap, towels and
sanitizers is also important in the toilet. This is because many times lack of water or lack of
soaps results in people missing the need to wash hand after using the toilet. Towels are the agents
for cross-transmission of infection (Reeves, Priest & Poore, 2012). Hence, monitoring how
frequently this is changes and how frequently hand hygiene is maintained after using toilet can
help to predict the rate of infection. Reeves, Priest and Poore (2012) justifies that functional
toilet and hand washing facilities minimize the rate of incidence of infectious disease in crowded
setting. So, monitoring the way people access and use toilet and hand washing facilities can help
to implement appropriate infection control measures. Crowded locations like college are
important locations for transmission of infection because of sharing toilets and hand basins. Lack
of hand hygiene at vital point increases risk of gastrointestinal tract illness and respiratory illness
(Zivich, Gancz & Aiello, 2018).
Although common practice of hand hygiene can prevent infectious outbreak, however
students and other staffs in college campus hardly follow basic hand washing techniques. A
survey done among college students in a Nigerian University revealed that only 46% of
respondents washed their hand before eating and 40% wash their hand after using the toilet.

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Hence, when such basic hand washing activity is not followed even before eating and using the
toilet, it leads to fecal-oral transmission of infection by hands and spread of pathogenic
microorganisms through food by food handlers and by sharing other things at vital point (Ayoade
& Ardern, 2017). Hence, there is a possibility that such form of non-compliance to hand washing
at critical points might exist at Tai Ohomai too. Therefore, auditing of hand hygiene practices at
critical points like after using toilet can help to identify the steps needed for infection prevention
and control practices.
4.2 Second high risk area:
The second high risk area that can lead to infectious outbreak include the cafeterias of
college where spread of infection occurs during food handling and food preparation. This may
lead to risk of transfer of infection through the hands of a food handler to the foods and then to
the students. This is said because infection is also transmitted through foods and food handlers
are the major source of food contamination because of poor hygienic practices. Intestinal
parasites are transmitted by feco-oral routes and food handlers can be an importance source of
infection to the students and other general population (Mama & Alemu, 2015). The mishandling
of food and lack of importance to hygienic measures by food handlers lead to contact of
pathogens with food and their multiplication in several numbers to cause illness and infectious
disease among consumers. A study done investigating about bacterial hand contamination among
food handlers working in the cafeterias of university main campus revealed that food handler’s
hand are vector of infection transmission and they need to trained regarding personal hygiene
practices and hand washing techniques (Assefa et al., 2015). Hence, in case of auditing at Toi
Ohomai, the audit of hand hygiene practice will be done among students and food handlers in
University campus.

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The main advantage of PPE during to the process of infection prevention and control is
that it can prevent contact with microorganisms and contaminated items (World Health
Organization, 2016). Research evidence indicates that poor personal hygiene and lack of
knowledge regarding effective hand hygiene and infection prevention process is low among food
handlers (Lee et al., 2017). Hence, PPE occupies an important position in the framework of
infection prevention and control because it is a most visible control that can be easily monitored
and audited. Apart from the possibility of auditing hand washing practices among students, it
also necessary to conduct adherence to hand washing for food handlers in university cafeterias.
5.) Evidence based auditing standards for one of the risk identified:
This assignment has focused on conducting auditing for hand hygiene and hand washing
practices at one of the high risk areas of the Toi Ohomia. To plan out appropriate auditing
standards for infection prevention and control, cafeteria has been chosen as one high risk area.
The review of evidence based auditing standards for preventing infection in this region is
necessary. This will to develop appropriate auditing standard to complete audit in the designated
setting.
As per review of research literature, the current gold standard for audit and monitoring of
hand hygiene compliance in crowded regions includes observation of the hand hygiene practice
in desired setting. Observation is a gold standard for measuring and reporting hand hygiene
compliance. The main issue is answered here which involves collecting information by means of
observation provides organization’s the assurance about effective hand hygiene compliance
technique. The investigation about the validity of hand hygiene auditing by direct observation
revealed that lack of staff training and inconsistencies in the data collection process might affect

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the quality of such audits. Inconsistencies were found because of little scrutiny about data
collection process (Jeanes et al, 2015). Hence, such gaps during observation can fail to provide
assurance to organization regarding ways the transmission of infection will be minimized.
Hence, using this evidence, the observation method will be uses a standard for hand hygiene
auditing at the college. However, the audit process will be improved by strengthening the data
collection process.
The research study by Zhang et al. (2017) also supports that the current standard for
monitoring hand hygiene compliances is direct observation of hand sanitation. However, this
process can be time consuming and biased. Hence, the study suggested the use of technology
Hygiene police, a hygiene compliance monitoring app to assess compliance to hand hygiene and
identify improvement needed in existing practice. However, the standards mentioned by Quality
and Patient Safety Division (2015) suggested that direct observation allows assessment of hand
hygiene techniques, compliance rate in different group and hand hygiene behaviour. However,
this form of auditing requires trained observer and it is time consuming. Therefore, other
alternative measures for auditing can include indirect measurements like usage of alcohol gel,
use of paper towel in and self-reporting about hand hygiene. However, self-reporting again can
lead to biases too. Therefore, the advantage of the auditing standards mentioned by Quality and
Patient Safety Division (2015) is that it focused on removing all disadvantages of direct
observation. Based on the review of this evidence, the following auditing standard has been
developed for audit of hand hygiene compliance among students and food handlers at Tai
Ohomai:
 The frequency of hand hygiene observation needs to be determined after observation of
compliance rate in individual departments. In case of Tai Ohomai, the observation can be

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done in cafeterias near the food preparation area and the hand washing zones in college.
All areas where there is chance of transmission of infection such as before eating, during
food handling, during food preparation and after eating food needs to be observed.
 Sample size and duration of audits need to be considered. Although the sample size
cannot be observed, the duration of each audit session can be 1 hour.
 The data that needs to be recorded by the observer includes opportunities for hand
hygiene in the college, the number of missed hand hygiene by students and food handlers
and the rate of use of gloves when a hand hygiene action is missed by any individual at
the campus.
 Optional data collection may focus on collecting self-reported data on compliance with
hand hygiene and cause behind non-adherence to hand hygiene among food handlers and
college students.
The auditing process can focus on analysing the provision of amenities such as sink,
soap, clean towels and clean flowing water in the cafeteria region of college campus, the level of
adherence to hand hygiene before eating and after toilet use and the implementation of any
promotion activity to promote hand hygiene practice among students, teachers, food handlers and
lecturers.
6.) Completing the audit:
Based on the development of appropriate standards to complete an audit in the area, one
of the cafeteria of Tai Ohomai was selected to conduct the audit. The following process was used
to complete the hand hygiene audit:

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 Trained observers with experience in infection control and hand hygiene techniques were
included in the audit process. The process was supported by local auditors
 At least 100 individuals were observed in one audit sessions and the observation was
done near the wash basin were utensils are washed in the cafeteria, near the hand washing
facility of the cafeteria and near the food preparation zone of the cafeteria.
 During the observation stage, observers at the three areas were involved in recording
number of students who washed hand in designated location before eating and after using
food and the number of food handlers who exercise hand hygiene techniques during food
handling and washing of utensils.
 The direct observation stage was followed by a short survey in which all the observed
students and food handlers were questioned regarding the significance of hand hygiene
and any episode of infection in the college campus. The survey mainly consisted of true
or false question on general hygiene knowledge.
The results of the audit for the chosen Tai Ohomai included the following:
 Only 40 participants out of 100 were involved in adhering to hand hygiene at three
critical points
 More than half reported about becoming ill at least once within 3 months.
 The level of knowledge related to hand hygiene was high among students, however they
were not motivated to follow it at all points. In contrast, food handlers had no knowledge
and their basic hygiene was also poor.
 The compliance to hand hygiene differed by means of qualification too.

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7.) Recommendations:
Based on the findings of the audit process, it can be said that students and staffs at the
college campus are unaware about hand as a vector for transmission of infection. As lack of
compliance to hand hygiene was significantly low in participants, the following recommendation
is proposed to eliminate risk of transmission of infection and implement appropriate measure to
prevent infectious outbreak at the campus:
 There is a need to implement a hand hygiene program where all university students can
be made aware regarding the importance of hand hygiene for health and well-being. this
program should focus both on education as well as visual aids at important locations so
that attitude of students towards hand hygiene is changed and they are reminded about the
need to wash hands by means of visual poster
 As food handlers has low education level according to the findings of various researchers,
it is recommended to implement specific hand hygiene session for each food handler
where they can be made aware about basic hand hygiene techniques and the need to
follow hand hygiene guidelines at critical point
 It is also recommended to make arrangements for resources like adequate supply of
sanitizers, soap, towels and PPE like gloves so that no missed cases of hand hygiene can
take place.
 Policy related measures can also be imposed so that fine is imposed when food handlers
misses an opportunity of hand hygiene.