HospitalInspections.org

Based on a review of facility policy and interview with staff (EMP) it was determined that the facility failed to implement appropriate cleaning protocols, in accordance with facility policy, to ensure care was provided in a safe setting for one nursing unit affected by the Norovirus.

Findings include:

Review on May 1, 2014, of facility policy "Measures to Limit Transmission in Recognized Outbreak of Clostridium difficile or Norovirus," effective date October 7, 2011, revealed "Environmental disinfection should be performed with a hospital approved 1:10 sodium hypochlorite (bleach) wipe. This includes equipment and patient care items removed from the patient's room. ... ."

Interview conducted on May 1, 2014, at 1:50 PM, with EMP2 and EMP3 confirmed that EMP4 had not bleached the room of the first patient identified with Norovirus on 4E/4S on the weekend of April 5 & 6, 2014. Further interview confirmed that the facility had not completely followed their infection control policy for the management of Norovirus with regard to cleaning the patient's room.

Based on a review of the facility's Infection Control Plan, CDC's recommendations, facility documentation and interviews with staff (EMP) it was determined the facility failed to timely implement an appropriate infection control system for identifying, reporting, investigation, and controlling infections during an outbreak of Norovirus on one nursing unit.
Findings include:
1) Review of CDC's "Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings, effective 2011 revealed, "Exclude ill personnel from work for a minimum of 48 hours after the resolution of symptoms. ... ."
Review of the facility line listing documentation revealed that 16 nursing staff on 4E/4S nursing unit developed Norovirus symptoms from March 11 through March 23, 2014. The line listing did not indicate their date of symptom resolution to show that 48 hours had lapsed before they returned to work.
Interview conducted on May 1, 2014, at 1:30 PM, with EMP2 revealed that the facility did not have a policy, which determined the timeframe when hospital staff with Norovirus symptoms were to remain away from the healthcare facility. Further interview with EMP2 revealed that they follow CDC's guidelines for Norovirus management.
Interview conducted on May 1, 2014, at 2:00 PM, with EMP5 revealed that it was not until the Norovirus outbreak was identified as of March 27, 2014, that the staff who called off was directed not to return to work until 48 hours had passed, if they had Norovirus symptoms.
2) Review of the "Infection Control Plan," approved November 8, 2012, revealed, "Post-exposure prophylaxis and monitoring will be conducted by Occupational Health, in consultation with Infection Prevention and Control, based on the organism specific recommendations outlined by the CDC and American Academy of Pediatrics Committee on Infectious Diseases available in the IPC Manual: Occupational Health. ... ."
Review of the facility documentation revealed that 19 nursing staff on 4E/4S nursing unit were identified with Norovirus symptoms from March 11 through April 10, 2014.
Interviews conducted on May 1, 2014, at 1:00 PM, with EMP2 and EMP5 confirmed "Occupational Health Services" was not contacted nor involved in the investigation of providing guidance due to the exposure.
3) Review of the facility's Infection Control Plan approved November 8, 2012, revealed, "an intra-departmental group, consisting of leadership and frontline practitioners, has been developed to review cases of healthcare-associated infections in patients on selected units on a weekly basis. These case reviews consist of a review of the laboratory and clinical findings to identify breakdowns in practice or common modifiable risk factors. Additional multi-disciplinary case reviews may also be conducted in specific units on an as-needed or desired basis. ... "

Interviews conducted on May 1, 2014, at 1:50 PM, with EMP2 and EMP5 revealed that an intra-departmental group had not been developed to review cases of these healthcare-associated infections in patients on a weekly basis during the Norovirus outbreak to identify breakdowns in practice or common modifiable factors. Further interview revealed that there was no documentation to support a case review of the clinical findings, which would have been addressed by the intra-departmental group weekly meetings.
4) Interview on May 1, 2014, at 1:00 PM, with EMP2 revealed that on March 8, 2014, a patient's mother became lethargic and was vomiting. EMP2 indicated that the patient's mother refused to leave and was confined to the patient's room; and nursing and housekeeping staff were required to clean the mother's vomitus.
There was no documented evidence that IC (Infection Control) was notified of this incident.
Interview on May 1, 2014, at 9:40 AM, with EMP5 revealed that on March 11, 2014, three staff called out; March 14, 2014, three staff called out; March 16, 2014, three staff called out; March 17, 2014, two staff called out; March 18, 2014, one staff called out; March 20, 2014; two staff called out; March 22, 2014, one staff called out; and March 23, 2014, one staff called out.
Review of facility documentation, dated March 24, 2014, revealed that EMP6 notified EMP7 "... last week into this week we have a lot of staff calling out with a GI [gastrointestinal] virus (which I think is Norovirus). They are out several days with vomiting, diarrhea and generalized lethargy and achiness. Is there any process in which we can "deep clean" the nursing stations ... "
Review of facility documentation, dated March 27, 2014, revealed a "one time bleach cleaning" of common areas was done. Review of facility documentation, dated March 28, 2014, revealed bleach cleaning as part of a daily clean for all common areas and symptomatic patients.
Review of facility documentation and policies and procedures revealed no documented evidence that the facility developed and implemented infection control measures, in a timely manner, related to hospital personnel, measures for evaluating and screening hospital staff for infections likely to cause significant infectious disease, and policies articulating when infected hospital staff are restricted from providing direct patient care and/or are required to remain away from the facility.