Topic 3.1 Infection Risk Assessment and Clinical Decision-Making

Infection prevention and control (IPC) measures should never be applied using a one-size-fits-all approach. Every client, practice environment, assistance animal partnership and occupational therapy intervention presents a unique combination of risks that require careful assessment and professional judgement. Effective infection prevention therefore begins with a comprehensive infection risk assessment that considers the likelihood of disease transmission, the potential consequences of exposure and the measures required to reduce risk while maintaining safe, person-centred occupational therapy services.

Occupational Therapists (OTs) regularly work in complex environments where competing priorities must be balanced. Clients may have compromised immune systems, chronic health conditions, cognitive impairments or disabilities that influence their ability to participate in infection prevention measures. Therapy may occur in hospitals, schools, aged care facilities, workplaces, community organisations or private homes, each presenting different environmental hazards and organisational requirements. Where assistance animals are involved, additional considerations include the health and welfare of the animal, environmental hygiene, public access and interactions between the animal, client and wider community. Risk assessment provides a structured process for identifying these factors and selecting proportionate, evidence-based control measures.

Clinical decision-making in infection prevention extends beyond identifying hazards. Occupational Therapists must balance infection risks with occupational participation, autonomy, disability rights and animal welfare. Excessively restrictive practices may unnecessarily limit participation, while insufficient precautions may increase the likelihood of disease transmission. Applying a One Health perspective encourages practitioners to consider the interconnected health of people, animals and the environments they share when making clinical decisions.

This topic examines the principles of infection risk assessment, introduces structured approaches to clinical decision-making and explores how Occupational Therapists can integrate evidence, professional judgement and client-centred practice to manage infection risks across diverse practice settings.

What is Infection Risk Assessment?

Risk assessment is the systematic process of identifying hazards, evaluating the likelihood and consequences of harm, and implementing appropriate control measures to minimise risk. Within infection prevention and control, the objective is not to eliminate all risk—an impossible goal in most healthcare and community settings—but to reduce the risk of disease transmission to the lowest reasonably practicable level while maintaining meaningful occupational participation.

Infection risk assessment should occur before, during and after occupational therapy interventions. It is a dynamic process that must be reviewed whenever circumstances change, including changes in a client’s health status, the practice environment, public health advice or the health of an assistance animal.

Effective infection risk assessment supports:

• safe service delivery
• evidence-based decision-making
• appropriate selection of infection prevention measures
• protection of clients, practitioners and assistance animals
• legal and professional accountability
• continuity of care.

The Risk Assessment Process

Although organisations may use different assessment tools, most infection risk assessments follow a similar process.

Step 1 – Identify the Hazard

The first step is identifying any biological hazards that may contribute to disease transmission.

Potential hazards include:

• infectious clients
• infectious practitioners
• infectious visitors
• unwell assistance animals
• contaminated equipment
• contaminated environmental surfaces
• poor ventilation
• inadequate hand hygiene facilities
• overcrowding
• poor waste management
• exposure to blood or body fluids.

Not every hazard will present the same level of risk. Identification simply recognises that a potential source of infection exists.

Step 2 – Assess the Risk

Once hazards have been identified, the Occupational Therapist should consider both the likelihood of transmission and the potential consequences should transmission occur.

Questions to consider include:

• Is there a known or suspected infectious disease?
• How is the disease transmitted?
• Who may be exposed?
• Are vulnerable individuals involved?
• Is an assistance animal participating?
• What environmental factors may increase or reduce risk?
• Can the activity be modified safely?

Both likelihood and consequence should be considered when determining the overall level of risk.

Step 3 – Implement Control Measures

Control measures should be proportionate to the identified level of risk and based on current evidence and organisational policies.

Examples include:

• hand hygiene
• respiratory hygiene
• environmental cleaning
• personal protective equipment
• improved ventilation
• scheduling changes
• telehealth
• physical distancing where appropriate
• postponing non-essential interventions
• modifying activities to reduce exposure.

Control measures should support participation wherever possible while maintaining appropriate infection prevention standards.

Step 4 – Monitor and Review

Risk assessment is not a single event but an ongoing process. Occupational Therapists should continually evaluate whether implemented controls remain effective and modify their approach as new information becomes available.

Examples requiring reassessment include:

• changes in public health advice
• development of new symptoms
• environmental changes
• equipment contamination
• assistance animal illness
• client hospitalisation
• emerging infectious disease outbreaks.

Factors Influencing Infection Risk

Effective risk assessment requires consideration of multiple interacting factors.

Client Factors

Individual client characteristics may significantly influence infection risk.

These include:

• age
• immune status
• chronic illness
• pregnancy
• disability
• cognitive capacity
• personal hygiene
• ability to follow infection prevention advice
• vaccination status where relevant.

Risk assessment should remain individualised and avoid assumptions based solely on diagnosis or disability.

Environmental Factors

The practice environment influences opportunities for disease transmission.

Examples include:

• ventilation
• room size
• crowding
• availability of hand hygiene facilities
• cleaning practices
• shared equipment
• waste disposal
• animal access
• weather conditions for outdoor therapy.

Environmental modifications often reduce infection risk without limiting participation.

Intervention Factors

Some occupational therapy interventions involve closer physical contact or greater exposure to shared equipment than others.

Factors to consider include:

• duration of contact
• physical proximity
• likelihood of body fluid exposure
• use of shared resources
• involvement of food preparation
• water-based activities
• animal-assisted interventions.

Different interventions may require different infection prevention strategies.

Assistance Animal Considerations

When assistance animals are involved, additional considerations include:

• the animal’s health status
• vaccination and parasite prevention
• grooming and cleanliness
• behavioural reliability
• exposure to other animals
• environmental contamination
• client handling skills
• public access environments.

Risk assessment should protect both the client and the assistance animal without creating unnecessary restrictions on legitimate assistance animal access.

Balancing Risk and Occupational Participation

Infection prevention should not unnecessarily prevent individuals from engaging in meaningful occupations. Occupational Therapists are uniquely positioned to balance health protection with participation, independence and quality of life.

Rather than asking, “Can this activity occur?”, practitioners should ask:

• What are the infection risks?
• How can those risks be reduced?
• Can the activity be modified safely?
• What reasonable adjustments support both safety and participation?

This strengths-based approach aligns with person-centred, neuroaffirming and trauma-informed practice.

Applying a One Health Perspective

The One Health framework encourages Occupational Therapists to consider how decisions affect people, animals and the environments they share.

For example, postponing a community visit because an assistance animal has suspected infectious gastroenteritis protects:

• the assistance animal’s welfare
• the handler
• other clients
• other working animals
• the wider community.

Similarly, improving ventilation within therapy spaces benefits human health while reducing environmental transmission of respiratory pathogens.

Applying One Health broadens clinical reasoning beyond the immediate therapeutic interaction and supports sustainable, evidence-informed practice.

The Occupational Therapist’s Role

Occupational Therapists play a central role in assessing and managing infection risks while promoting meaningful occupational participation.

Key responsibilities include:

• identifying infection hazards
• conducting ongoing risk assessments
• selecting proportionate infection prevention measures
• balancing risk with participation
• educating clients and carers
• collaborating with multidisciplinary teams
• documenting clinical decisions
• reviewing risk assessments as circumstances change.

Clinical judgement should always be informed by current evidence, organisational policies, professional standards and the individual needs of each client.

Key Practice Principle

Infection risk assessment is a dynamic and ongoing process that underpins safe occupational therapy practice. By systematically identifying hazards, evaluating risks and implementing proportionate control measures, Occupational Therapists can protect clients, practitioners and assistance animals while supporting meaningful occupational participation through evidence-informed, person-centred and One Health-informed clinical decision-making.