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Based on observation, interview and record review, the hospital failed to provide an environment free from dust and debris in the emergency department. The hospital failed to keep chairs in the emergency room in good repair.

The findings include:

Observation of the emergency room waiting area on 04/14/11 at 8:40am revealed four chairs with cracked vinyl seat cushions.

Observations of the emergency room on 04/14/11 from 8:40am to 9:35am revealed the following:
Room #32 -Code Cart (cart used in patients in cardiac arrest) had a layer of dust on top of the cart.
Room #9- Dust was observed on top of the cardiac monitor and on the holder for the otoscope and ophthalmoscope.
Room #12-Dust was observed along the railing which has the oxygen and suction adapters.
Room #17-Dust was observed on top of the cardiac monitor.
Room #20- (also known as the Code Room)- had dust and debris on top of the code cart, dust was also noted on the mechanical ventilator (machine used to assist patients with breathing).
Room #28-A layer of dust was noted inside the bedside table.
Room #26-Dust was observed on top of the cardiac monitor.
Room #25-Dust was observed on top of the ophthalmoscope and otoscope.
The blood pressure machine in the triage area, had a layer of dust on top of the machine.
Room #1-Dust was observed on top of the needle box, on top of the glove box, on the top of the cardiac monitor. This room also had an exposed part of the wall showing metal mesh.

A checklist for the cleaning of equipment in the emergency room does include the code cart. The department surveillance survey completed monthly, includes observation of the crash cart. Is the cart orderly and free from dust?

An e-mail sent 02/23/11 by the nurse manager of the emergency room states all "high touch" areas must be cleaned between patient use. This list includes monitors.

Environmental services has a training module for cleaning the emergency room. The stated purpose is to maintain a clean, hygenic environment after each procedure and before the next procedure. Equipment needed includes a high dust tool and lint free cloths or reusable dust control head and tool. The process includes sanitizing all horizontal surfaces.

The policy regarding discharge room cleaning, with a review date of 06/02/2008, states cleaning of the room includes dusting all surfaces above the the shoulders following high dusting procedures.

Interview with an Environmental Service Worker from the emergency room on 04/14/11 at 9:35am revealed she/he was trained through a video module and by hands on training. When a patient is discharged, the trash and linens are pulled, high dusting is done, flat surfaces are wiped, horizontal dusting is done, the stretcher rails and underneath the stretchers are cleaned. The bathroom is cleaned by doing high dusting, the sink is wiped and then the toilet is cleaned. The floor is cleaned last.

Interview with a Registered Nurse on 04/14/11 at 11:10am revealed the nurse is responsible for cleaning high touch areas in the room after a patient is discharged. This includes all equipment , the TV screen, the phone, monitor cords, blood pressure cuff, the top of the cardiac monitor, otoscope/ophthalmoscope if it is used, and all the counter tops.

Interview with the Chief Nursing Officer on 04/14/11 at 8:30am revealed the hospital was aware of the issues regarding cleanliness in the emergency room and were in the process of a focused initiative. She stated a change had been made in the Emergency Department Director on April 11, 2011.

Interview with the Director of Environmental Services on 04/14/11 at 9:45am revealed patient satisfaction scores for cleanliness in the emergency room were down and they were working to improve this area. He stated, there is one environmental service person for each shift in the emergency room. Every room should be terminally cleaned every twenty four hours. Terminal cleaning does include dusting. After touring the emergency room with the surveyor, he admitted they do an okay job of cleaning but not dusting.

Interview with the Nurse Manager of the Emergency Room on 04/14/11 at 9:40am revealed nursing is responsible for cleaning the stretchers and any item that is considered high touch like monitor cords, etc. She stated the code carts are checked at 2am and the code cart in room #20 was unacceptable due to the dust and debris found on top of the cart. She stated the dust on the equipment could cause respiratory problems and could be an infection control issue.

Interview with the Infection Control Nurse on 04/14/11 at 10:00am revealed she did not see the dust on the equipment in the emergency room as an issue. However, she agreed the equipment should be dust free .She also stated the cracked vinyl in the seat cushions of the chairs could be a potential hazard for infection.