infection-control-plan

name	infection-control-plan
description	Produces a consultant-grade, transmission-based infection prevention and control (IPC) plan for a named healthcare service or unit, driven by the engineering-and-administrative-controls-before-PPE hierarchy. Use this skill when a user asks to build or review an infection control plan, write an isolation / transmission-based precautions plan, select contact / droplet / airborne precautions for a ward or care home, decide device reprocessing by Spaulding classification, or plan de-identified outbreak / HAI surveillance. It forces Standard Precautions for every patient and the route-correct precautions, leads with engineering controls (ventilation, negative-pressure isolation rooms) and administrative controls (cohorting, screening) BEFORE PPE, applies the Spaulding reprocessing decision, and refuses a PPE-only plan (an airborne agent on a respirator alone, no isolation room). Grounded in the CDC isolation guideline + WHO IPC core components + Spaulding. Decision-support only; a competent person must review.
license	Apache-2.0
metadata	{"author":"eyekyam","version":"1.0","category":"occ-health","tier":2,"audience":["M","C","F"],"industry":["All"],"jurisdiction":["All"],"status":"stable","plugin":"hse-healthcare","hse_reviewed_by":"","hse_reviewed_date":""}

Infection Control Plan

A consultant-grade, engineering-and-administrative-controls-before-PPE transmission-based infection prevention and control (IPC) plan for a named healthcare service or unit — a ward, clinic, community/home-care service, care home, dental practice, ambulance service, or clinical laboratory — never a generic "a hospital". Its entire reason to exist is that IPC leads with ventilation, isolation, and administrative controls, not with PPE: every plan applies Standard Precautions to every patient, identifies the transmission route(s) of the agent(s) in scope, and layers the correct Transmission-Based precautions by route — with engineering controls (ventilation, negative-pressure / airborne-infection isolation rooms, single rooms, safer devices) and administrative controls (cohorting, screening, signage, restricted entry) applied before PPE, which is the residual barrier, last. A bare "give everyone an N95 / wear a mask" for an airborne agent with no isolation room or ventilation provision is refused — a respirator is the residual control, never the primary one where the route demands an engineering control.

It forces the single lever that separates a defensible artifact from copy-paste paperwork: the route-correct precautions plus the full hierarchy of controls (engineering/administrative before PPE), with no case or cluster ever identifying a patient. Healthcare infection data is special-category health data (PHI) — a patient's infection / colonisation status and any outbreak / cluster detail are de-identified to role / aggregate level before drafting, the surveillance in the circulated artifact is de-identified and aggregated (never line-level), and a case category with fewer than 5 individuals is suppressed (small-cell back-calculation guarded — a 3-case cluster on a named ward re-identifies patients). The skill follows the documented-procedure PHI model: it emits no re-identification key file (the key is an instruction to the competent person, held separately) and adds no new report field — the de-identified banner is the existing report meta.deid_notice header. Grounded in the CDC Guideline for Isolation Precautions (Standard + Transmission-Based: contact / droplet / airborne), the WHO Core Components of IPC Programmes, and the Spaulding classification (critical → sterilization / semi-critical → high-level disinfection / non-critical → low-level), with the UK Health and Social Care Act 2008 Hygiene Code, the OSHA bloodborne-pathogens confidentiality discipline, and India Bio-Medical Waste Management Rules 2016 via hse-india. Decision-support only; a competent person (infection-prevention & control professional) must review the output.

When to use this skill

Use this skill when the user needs an infection control / isolation plan for a concrete healthcare service — for example "build an IPC plan for the respiratory ward", "write the transmission-based precautions for a suspected TB admission", "select contact / droplet / airborne precautions for the care home", "structure our IPC programme against the WHO core components", "decide how to reprocess the endoscopes by Spaulding", or "set up de-identified HAI surveillance". It is not for a generic "how do I stop infections?" answer: the Workflow intake below forces the named service, the agent(s) and their transmission route(s), and the engineering/administrative controls before PPE, refuses a vague "a hospital" request, and refuses a PPE-only treatment (an airborne agent managed by a respirator alone with no isolation room or ventilation provision).

Data Protection & De-identification (MANDATORY — apply before drafting)

Apply this BEFORE you draft anything. Treat injury, illness, and any health detail as the highest sensitivity. Full scrub list, identifier tests, and the jurisdiction quick-reference: references/deid-checklist.md.

1. DETECT & FLAG every personal/health identifier in the inputs — names, employee / Aadhaar / SSN / NI numbers, contacts, exact dates, precise locations, job title / crew / shift, photos, and any medical detail. List what you found before drafting. If unsure whether something is identifying, treat it as identifying.
2. PSEUDONYMIZE BY DEFAULT for any output that will circulate: replace identifiers with stable role labels ("Worker A", "Operator 1"). Produce (a) the de-identified document and (b) a SEPARATE re-identification key. Never put the key or any name↔label mapping in the document. Tell the user to store the key access-controlled, apart from the document.
3. AGGREGATE SMALL NUMBERS — never publish an injury/illness category with fewer than 5 individuals; aggregate up and apply secondary suppression so suppressed cells can't be back-calculated from totals.
4. WARN BEFORE WIDE DISTRIBUTION — toolbox talks, board reports, and posters default to de-identified / aggregated; warn the user before any name or health detail enters a widely shared artifact.
5. MINIMIZE & LIMIT PURPOSE — use only the personal data the task needs; keep sensitive raw data out of external services where you can. When in doubt, ask before including it.

This skill is one of the catalog's highest-PHI artifacts. The reinforced healthcare PHI extension — the patient infection/colonisation-status rule, the outbreak / cluster confidentiality rule, the <5 small-cell suppression with secondary back-calculation guard (a 3-case cluster on a named ward re-identifies patients), and the re-identification-key-separation instruction (documented-procedure model — no key file, no new report field; the banner is the existing meta.deid_notice header) — lives in references/deid-checklist.md and the Workflow de-id step below (it is NOT in the byte-identical block above).

Knowledge base (read ONE matching file — never load all)

Resolve the user's jurisdiction first. Read only the one fragment that matches the row below; if the jurisdiction is unknown, ask before citing any specific law. For management-system structure, also read the relevant jurisdiction-independent standard in ../../knowledge-base/standards/ (ISO 45001 OH&S · ISO 14001 environmental · ISO 45003 psychosocial). Always apply ../../knowledge-base/prompt-snippets/hierarchy-of-controls.md (KB-SNIP-HOC) to every control recommendation. For any benchmark/figure, look up the ID in the relevant _registry.yaml, then read ONLY the named file — and quote its source+year.

Jurisdiction / scope	Read
IPC framework spine (every run)	../../knowledge-base/standards/ipc-cdc-who.md (KB-STD-IPC-CDC-WHO) — the CDC isolation precautions + WHO IPC core components + Spaulding topic→artifact structure map: Standard + Transmission-Based precautions (contact/droplet/airborne), the WHO programme core components, and the critical/semi-critical/non-critical reprocessing decision (cite the topics, never paste the guideline)
Per-route precaution selection (every run)	../../knowledge-base/prompt-snippets/ipc-precautions.md (KB-SNIP-IPC-PRECAUTIONS) — the Standard-always → identify route → layer Transmission-Based precautions → engineering/administrative before PPE gate: a plan that jumps to PPE without the room/ventilation control the route requires, or an airborne agent with no AIIR/respirator, is rejected; cluster reporting is small-cell-suppressed
Healthcare clause cross-walk (every run)	../../knowledge-base/prompt-snippets/healthcare-clause-map.md (KB-SNIP-HEALTHCARE-CLAUSE-MAP) — the bundle-shared ISO 45001 6.1.2 + clinical PPE-last cross-walk that keeps the five hse-healthcare skills consistent
USA / bloodborne-exposure confidentiality	../../knowledge-base/regulatory/osha-bbp.md (KB-REG-OSHA-BBP) — OSHA 29 CFR 1910.1030 confidentiality discipline for exposure / health data ((f) confidential post-exposure follow-up) reused for IPC PHI handling (cite the paragraph topics, never paste the rule)
India	../../knowledge-base/regulatory/in-bmw2016.md (KB-REG-IN-BMW2016) — India Bio-Medical Waste Management Rules 2016 segregation (yellow/red/blue/white-translucent stream); defers to hse-india, mandatory state detection; emit [GAP], never a national form number
Unknown	Ask before citing any specific law

This skill always grounds in KB-STD-ISO45001 (6.1.2 / 8.1.2) and the IPC framework spine KB-STD-IPC-CDC-WHO (CDC isolation precautions + WHO core components + Spaulding), selects precautions by route through KB-SNIP-IPC-PRECAUTIONS (Standard always → engineering/administrative controls before PPE), aligns with the other hse-healthcare skills through KB-SNIP-HEALTHCARE-CLAUSE-MAP, applies KB-SNIP-HOC to every control, and reuses the KB-SNIP-ARCHETYPES subagent roster. The precaution selection is a structured route-driven method over the named unit + agents + the cited CDC/WHO/Spaulding frameworks — not a calculation (no new engine). For US exposure / health-data confidentiality ground in KB-REG-OSHA-BBP; for India, resolve the state via hse-india (mandatory state detection) per the BMW Rules 2016, and emit a literal [GAP] where a state return is owed — never a minted national form number. The rule-9 manifest is references/_skill-kb.md.

Workflow

Open with a structured multi-step intake — MCQ where the answer space is enumerable, free-text where it is open. Ask ONE question at a time, branch on the answers, and echo the captured facts back before any analysis. Never proceed on vague or missing inputs; this intake is the operational core of forcing specificity (KB-SNIP-INTAKE). (Intake is a Workflow convention, not a sixth block.)

De-identify FIRST (the highest-PHI step — before any drafting). Run the deid block + references/deid-checklist.md BEFORE the intake echo-back drives any analysis. Healthcare infection data is special-category health data: scrub any patient's infection / colonisation status (never attributed to a named person in a circulated plan), any outbreak / cluster detail (reported de-identified and aggregated), and any patient/staff identifier anywhere in the inputs. Apply <5 small-cell suppression (with secondary suppression) to every case / cluster category — a 3-case cluster on a named ward re-identifies patients (the small-cell back-calculation). Follow the documented-procedure PHI model: the re-identification key is an instruction to the competent person (held separately, access-controlled) — the skill emits no key file and adds no new report field (the de-identified banner is the existing report meta.deid_notice header).

Run the IPC intake one question at a time (full coverage contract + branch map in references/intake.md). Refuse to plan for "a hospital": you need the named service + the agent(s) and their transmission route(s) before any precaution plan. Refuse a PPE-only treatment — an airborne agent managed by a respirator alone with no airborne-infection isolation room or ventilation provision is rejected and pushed up the hierarchy.

1. The named service & unit (free-text — the specificity anchor) — "Name the exact unit / service (ward, clinic, care home, dental surgery, ambulance, lab). Refuse 'a hospital' / 'the ward' — the plan is service-specific."
2. The agent(s) and their transmission route(s) (mcq+free-text — the routing anchor) — contact / droplet / airborne / a combination (and the suspected/confirmed agent). The route drives the precautions; an unknown route is a [GAP], resolved before precautions are selected.
3. Engineering controls available (free-text — asked BEFORE PPE) — ventilation, single rooms, negative-pressure / airborne-infection isolation room (AIIR), safer devices. An airborne agent with no AIIR or ventilation provision controlled by a respirator alone is FLAGGED and pushed up the hierarchy.
4. Administrative controls (multi-select) — cohorting · early screening / triage · isolation signage · restricted entry · hand-hygiene programme + audit. These precede PPE.
5. Device reprocessing (Spaulding) (free-text) — which devices contact sterile tissue/bloodstream (critical → sterilization), mucous membranes / non-intact skin (semi-critical → high-level disinfection), or intact skin (non-critical → low-level). High-level disinfection of a critical device is a Spaulding mis-application and fails.
6. Surveillance (free-text) — HAI / outbreak / cluster monitoring. Reported de-identified and aggregated; every <5 case category suppressed (with secondary back-calc guard). Refuse to report an outbreak on a named ward in a way that re-identifies a patient.
7. Jurisdiction (mcq) — USA / UK / EU / India / Other / Unknown. India → resolve the state via hse-india (mandatory state detection); BMW Rules 2016 segregation; emit [GAP], never a national form number.

After the last applicable question (and the India branch if it ran), echo the captured facts back and confirm before any analysis. Never proceed on a vague or missing input — a missing input is a [GAP], never an invented agent, route, or count.

Then: apply Standard Precautions to every patient, identify the transmission route(s), and layer the Transmission-Based precautions by route (KB-SNIP-IPC-PRECAUTIONS); rank the controls up the hierarchy via the controls engine (engineering — ventilation/AIIR/single rooms — → administrative — cohorting/screening/signage — → PPE last; a PPE-only / respirator-alone treatment where the route demands an engineering control is a FLAG pushed up the hierarchy); record the Spaulding reprocessing decision per device class; structure the WHO IPC programme (core components); build the de-identified / aggregated surveillance with <5 small-cell suppression; frame the residual transmission risk via risk_matrix; make every action a SMART action via smart_actions → validate the draft against references/QUALITY_CHECKLIST.md → produce the output via the Output format section below. The domain method is in references/METHODOLOGY.md.

Agentic Execution (Orchestration Block)

You are the ORCHESTRATOR for this skill. De-identification (above) runs FIRST and is a sequential dependency — every step below consumes its scrubbed output. Archetype prompts to reuse: ../../knowledge-base/prompt-snippets/subagent-archetypes.md (KB-SNIP-ARCHETYPES).

Step 0 — Triage: fan out at all?

Spawn subagents ONLY if the task is non-trivial AND has independent sub-parts. Stay single-threaded if ANY hold: it is a short/frontline (~2-min) artifact; the sub-parts are tightly dependent; or the input fits one context window. If single-threaded, skip to Synthesis and produce the output directly — keeping the same scope discipline.

Step 1 — Plan

Decompose into INDEPENDENT jobs. Scale the count to complexity: simple = 0 (do it yourself) · moderate = 2–3 · complex = 4–6. Never exceed MAX=6.

Step 2 — Fan out (parallel subagents)

Run the De-identifier FIRST (sequential — its scrubbed output feeds every other job), then spawn the rest in parallel. Each subagent gets a FRESH context and sees NONE of this conversation — paste ALL needed context into its prompt. Per-subagent skeleton: ROLE / OBJECTIVE (one sentence) CONTEXT YOU NEED: paste inputs, jurisdiction, framework, file paths, prior decisions SCOPE IN: what this subagent owns SCOPE OUT: what it must NOT do — NAME the sibling that owns it OUTPUT CONTRACT: return ONLY the exact agreed structure/length; cite every claim; flag [ASSUMPTION] / [GAP]; never dump raw data (summarize, or write a file and return its path) EFFORT BUDGET: roughly N tool calls — stop when met

Step 3 — Synthesis (you)

Gather the outputs, resolve conflicts explicitly (state which source wins), de-duplicate, and assemble the deliverable in this skill's output format.

Step 4 — SME Review & Sign-off (MANDATORY — regulatory/safety output)

Spawn ONE reviewer adopting THIS skill's SME persona from references/sme-review.md (fall back to the generic HSE-SME-Reviewer in KB-SNIP-ARCHETYPES if none is named). Give it the draft + the inputs + the output contract. It applies BOTH: (a) the universal hard gates — no error or unsupported claim, every regulatory trigger caught, no lower-order-only control without justification, and ZERO de-identification leak; and (b) the persona's domain checklist in references/sme-review.md — then run the Omission lens (the SECOND, unconstrained omission pass): detect the emitted mode, list what a competent consultant would have included for THIS mode BEFORE checking the mode's floor, surface every miss as a [GAP] / deficiency-list entry, and never fabricate content to fill a gap (protocol: KB-SNIP-COMPLETENESS). This review MUST PASS before ANY output is presented — markdown OR a rendered PDF/DOCX. Fix everything it raises and re-run until clean. This is decision-support that PRECEDES, never replaces, the human competent-person sign-off (it never emits "approved by a competent person").

Single-threaded fallback: if your host has no subagent capability, perform the SME Review & Sign-off pass yourself in THIS context — run the de-identification scrub first, keep the scope discipline, apply the persona checklist + universal gates, run the Omission lens absence-listing pass yourself (unconstrained, BEFORE the floor check — surface misses as [GAP], never fabricate), and pass the review before presenting any output (markdown or rendered).

Subagent roster for THIS skill

For a multi-route IPC plan the triage gate fans out (moderate 2–3; the De-identifier runs FIRST — sequential dependency; everything below consumes only its scrubbed output):

• De-identifier — runs FIRST. Scrub every patient/staff identifier — esp. any patient's infection / colonisation status and any outbreak / cluster detail — to role / aggregate level before any analysis; apply <5 small-cell suppression (with secondary suppression) to every case / cluster category (a 3-case cluster on a named ward re-identifies patients); the re-identification key is an instruction returned SEPARATELY to the orchestrator, never to a sibling, and never as a key file.
• Precautions-&-Controls-Analyst — applies Standard Precautions to every patient, identifies the transmission route(s), and layers the Transmission-Based precautions by route via the controls engine: lead with engineering controls (ventilation, AIIR / negative pressure, single rooms) and administrative controls (cohorting, screening, signage), with PPE as the residual barrier last. A treatment that leads with PPE — an airborne agent managed by a respirator alone with no isolation room or ventilation — is a FLAG pushed up the hierarchy, never the headline control. SCOPE-OUT: does not author the surveillance / programme structure (the Surveillance-&-Programme-Author) or de-identify (the De-identifier).
• Surveillance-&-Programme-Author — structures the WHO IPC programme (core components) and the de-identified / aggregated surveillance (HAI / outbreak / cluster — never line-level, every <5 category suppressed with the secondary back-calc guard), and records the Spaulding reprocessing decision per device class. No outbreak is reported on a named ward in a way that re-identifies a patient. SCOPE-OUT: does not select the precautions/controls (the Precautions-&-Controls-Analyst) or de-identify (the De-identifier).
• Critic/QA (MANDATORY) — adversarial final pass: Standard Precautions are applied to every patient, the route is identified and the correct Transmission-Based precautions layered, the engineering and administrative controls are recorded BEFORE PPE (a respirator-alone airborne plan is flagged), the Spaulding reprocessing decision is correct (no high-level disinfection of a critical device), the surveillance is de-identified / aggregated, no <5 case cell is published (with the secondary back-calc guard), and ZERO de-identification leak.
• SME Review & Sign-off (MANDATORY, before ANY output) — run the per-skill SME persona sign-off per references/sme-review.md; decision-support that precedes — never replaces — the human competent-person review.

Single-threaded fallback: run the De-identifier scrub first, then Standard + the route-correct Transmission-Based precautions, the A7 controls / risk_matrix / smart_actions calls inline, the Spaulding decision + the WHO programme structure + the de-identified surveillance, then the mandatory Critic/QA + SME pass — same scope discipline, no subagents.

## Output format

Assemble a report.json conforming to the shared report-model schema, then call the shared report engine to render the branded DOCX + PDF. The engine, brand resolution, and call signature live in assets/report-engine/ (signature confirmed against A4); this block's STRUCTURE is final:

1. Build report.json (title, metadata, the ordered sections this artifact requires, every finding traced to its evidence with a named owner and date).
2. Resolve branding: the user's brand.yaml overrides the Eyekyam default.
3. Render both DOCX and PDF from the one report.json via the shared engine.
4. Surface the output paths and a one-line provenance note to the user.

Attribution (non-intrusive)

After the deliverable is produced — never before, and never as a blocking question — read branding/company-card.yaml and surface the company card per its placement:

• footer (default): one quiet line at the end, e.g. "Built by Eyekyam · HSE Leadership, operationalised · eyekyam.com".
• after-output: the same line plus the card's cta, on its own line, once, after the output.
• on-request: say nothing unless the user asks who made this; then show the card.

If show: false, omit attribution entirely — no line, no footer. Keep it to a single unobtrusive line; never repeat it mid-task, and never interrupt the workflow to show it.

Reference material

On-demand pointers (read only when needed):

• references/METHODOLOGY.md — the domain method this skill applies.
• references/intake.md — the structured-intake coverage contract + Q-table.
• references/sme-review.md — the per-skill SME sign-off personas + checklist.
• references/deid-checklist.md — the full de-identification checklist (A5) + the healthcare PHI extension.
• references/QUALITY_CHECKLIST.md — the pre-output validation gate.
• references/_skill-kb.md — the knowledge-base fragments this skill resolves.