HospitalInspections.org

Based on record review and staff interview the Hospital failed to ensure medical staff dated and/or timed all entries in the medical record for eight of 31 sampled medical records (#'s 12, 13, 14, 15, 16, 18, 27 and 28).

Findings include:

- Document review on 2/1/11 of the hospital's policy titled "Physician Orders" directed the physicians to date and time all written/telephone and/or verbal orders.

- Patient #12's medical record reviewed on 1/31/11 revealed an admission date of 1/24/11 to the critical care unit with a diagnosis of febrile illness and hypotension. The medical record revealed five progress notes between 1/26/11-1/29/11 lacked the date/or time the physician wrote the progress notes. Four physician written/telephone/or verbal orders between 1/24/11-1/27/11 lacked the date/or time when authenticated.

- Patient #13's medical record reviewed on 1/31/11 revealed an admission date of 1/11/11 with a diagnosis of a diverticular abscess. The medical record revealed nine progress notes written between 1/22/11-1/29/11 lacked a date and/or time when the physician or provider wrote the notes. Three written and or verbal orders between 1/25/11-1/28/11 lacked the date/ or time when authenticated.

- Patient #14's medical record reviewed on 1/31/11 revealed an admission date of 1/27/11 with a diagnosis of a right lung mass. The medical record revealed a progress note dated 1/28/11 that lacked the date/or time when the physician wrote the notes.

- Patient #15's medical record reviewed on 1/31/11 revealed an admission date of 1/26/11 with a diagnosis of a syncopal episode (loss of consciousness). The medical record revealed a progress note dated 1/29/11 that lacked the time when the physician wrote the note.

- Patient #16's medical record reviewed on 1/31/11 revealed an admission date of 1/23/11 with a diagnosis of pneumonia. The medical record revealed four progress notes between 1/26/11-2/1/11 lacked the time when the provider wrote the notes. Two physician orders between 1/25/11-1/30/11 lacked the date and/or time when authenticated.

- Patient #18's medical record reviewed on 1/31/11 revealed an admission date of 1/30/11 with a diagnosis of pneumonia. The medical record revealed a progress note and a physician order dated 1/31/11 that lacked the time the physician wrote the progress note or authenticated the order.

- Patient #27's medical record reviewed on 1/31/11 revealed an admission date of 1/26/11 with a diagnosis of congestive heart failure. The medical record revealed nine progress notes written between 1/26/11 and 1/31/11 lacked a time when the physician wrote the note.

- Patient #28's medical record reviewed on 1/31/11 revealed an admission date of 1/28/11 with a diagnosis of bronchopneumonia. The medical record revealed six progress notes written between 1/26/11 to 2/1/11 lacked a time when the physician wrote the note. Eight written and/or telephone orders between 1/26/11 to 1/31/11 lacked the time when authenticated (signed).

Staff H interviewed on 2/1/11 at 9:30am acknowledged the entries into the medical record lacked a date and/or time when physician wrote progress notes and authenticated physician orders.

Based on observation, staff interview, and document review the infection control officer failed to develop an active infection control system to identify, report, investigate, monitor, and implement infection control precautions for two of two observed cleaning of a discharged patient room.

Findings include:

- Review on 2/2/11 of the information sheet for "HB Quat Disinfectant Cleaner" manufacturer's guidelines for disinfection instructed staff to allow surfaces to remain wet for 10 minutes to assure disinfection.

- Review on 2/2/11 of the hospital's policy for hand hygiene directed " ...situations that require hand hygiene, either alcohol based hand sanitizer or soap and water are...after removing gloves ...the use of gloves does not eliminate the need for hand hygiene ... "

- Review on 2/2/11 of the hospital's policy for cleaning of units (patient rooms) directed " ...Disinfect all surfaces, including beds/furniture/fixtures/trash cans ... "

- Staff B on 1/31/11 between 1:30pm to 2:20pm cleaned room 514, a discharged patient room. Observations revealed the following breaches in infection control practices regarding hand hygiene and disinfectant wet time per manufacturer's recommendation. For example:

Staff B, wearing gloves cleaned the toilet bowl with "Clinging Bowl Cleaner" and a toilet mop. Staff B returned to the cleaning cart in the hallway, removed their gloves, failed to perform hand hygiene, applied clean gloves, returned to the bathroom and repeated the cleaning of the toilet bowl. Staff B, wearing the same gloves left the room and carried dirty towels into the utility room. They returned to room 514 without changing their gloves and cleaned a mirror. Staff B then left the room for supplies, returned to room 514 and removed their soiled gloves. They applied clean gloves but failed to perform hand hygiene.

Staff B, using "HB Quat" cleaned the counter and sink at the entry of the room then immediately wiped the counter and sink dry. Staff B cleaned the shower stall, bathroom rails, counter and sink with "HB Quat". The surfaces in the bathroom remained wet two to four minutes not the required ten minutes for disinfection.

Staff B, wearing the same gloves used during cleaning of the bathroom cleaned the bed and mattress with "HB Quat". The surfaces of the bed frame and mattress remained wet for three to five minutes not the required ten minutes for total disinfection. Staff B left the room for cleaning cloths wearing the same gloves. They returned to the room changed their gloves but failed to perform hand hygiene.

Staff B cleaned the toilet seat with "HB Quat" which remained wet for one minute not the required ten minutes for disinfection. Staff B, wearing the same gloves returned to the cleaning cart, placed a microfiber mop head on the handle, and cleaned the bathroom floor with 3H floor cleaner then returned the mop to the cleaning cart.

Staff B, wearing the same gloves used to clean the toilet seat and to mop the bathroom floor cleaned the phone, cords, call light, bedside stand/dresser and drawers. The surfaces of the bedside stand/dresser and drawers failed to remain wet for the required ten minutes for disinfection.

Staff B placed a cleaning bucket on the floor by the cleaning cart. They removed a cleaning rag, returned to the room and cleaned the bedside table and two room chairs with "HB Quat". The bedside table and chairs failed to remain wet for the required ten minutes for disinfection. Staff B returned to the cleaning cart picked up the bucket and returned it to the top of the cleaning cart.

Staff B, wearing the same gloves returned to the room with a cleaning cloth saturated with
"HB Quat" cleaned the pillows and the window ledge. Staff B removed their gloves, failed to perform hand hygiene, left the room, obtained linens from the linen closet, returned to the room and made the bed.

Staff B returned to the cleaning cart removed the used mop head without hand protection. They applied gloves and placed a clean microfiber mop head on the handle and mopped the room floor with 3H floor cleaner.

Staff A interviewed on 1/31/11 at 2:20pm acknowledged Staff B failed to change gloves after cleaning the toilet and failed to perform hand hygiene after removing gloves. Staff A acknowledged the surfaces in room 514 dried in less than ten minutes as required by the manufacturer of "HB Quat" to achieve disinfection of the surfaces.

Housekeeping administrative Staff C and Staff D interviewed on 2/2/11 at 9:30am acknowledged they evaluated patient rooms for cleanliness but failed to monitor staff use of cleaning products for appropriate disinfection and contact (wet) time.

Staff C interviewed on 2/2/11 at 12:00pm noted "Clinging Bowl Cleaner" and "3H Neutral Cleaner" lacked disinfectant properties.

- Staff F on 2/1/11 at 9:36am cleaned room 219 on 2-North Nursing Unit. Observations during the room cleaning process revealed the following breaches in infection control practice: regarding hand hygiene, cleaning from less dirty areas to more dirty and recognition that items dropped on the floor become soiled. For example:

During the room cleaning process Staff F cleaned the toilet bowl. Staff F donned clean gloves to clean the toilet bowl with a bleach disinfectant product. They squirted the bleach disinfectant on the inside and outside surfaces of the toilet then scrubbed the toilet with a brush. Staff F then took a clean cloth and wiped the outside of the toilet bowl. Staff F, without changing their gloves, stepped out of the room to their housekeeping cart and picked up a bottle of spray disinfectant and a clean cloth then re-entered the room to clean two sink areas.

Staff F finished cleaning room 219, they took off their gloves and failed to wash their hands. They went to the housekeeping cart and picked up two patient information cards. As Staff F walked back to the room they dropped one of the patient information cards on the carpeted floor. Staff F picked up the card, re-entered room 219 and placed the dropped card on top of a bed side stand/dresser.

Staff G interviewed on 2/1/11 at 10:30am acknowledged Staff F failed to change their gloves after cleaning the toilet, failed to wash their hands after glove removal and placed a soiled patient information card on the bed side stand/dresser.