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Based on observation, interview, and record review, the nursing staff failed to ensure the visitor wore the PPE when visiting one of four sampled patients (Patient 2) as per the hospital's P&P. This failure created the risk of spreading the infection in the hospital.

Findings:

Review of the hospital's P&P titled Isolation: Transmission Based Precautions dated 9/21/23, showed the following:

* Isolation or precaution techniques are to be used when patients have certain communicable or infectious disease. The techniques have the purpose of preventing the spread of the diseases to other patients, personnel and visitors.

* In addition to Standard Precautions, use Transmission -based Precautions for patients with documented or suspected infection or colonization with highly transmissible or epidemiological-important pathogens for which additional precautions are needed to prevent transmission. The contact precautions:

* Use of PPE:

- Wear gloves whenever touching the patient's intact skin or surfaces and articles on close proximity to the patient (e.g., medical equipment, bed rails) when anticipated, don gloves upon entry into the room if touching of anticipated.

- Wear a gown whenever anticipating that clothing will have direct contact with the patient or potentially contaminated environmental surfaces or equipment in close proximity to the patient. When anticipated, don gown upon entry into the room or cubicle. Remove gown and observe hand hygiene before leaving the patient-care environment.

On 2/21/25 at 0910 hours, the ICU was toured with the PI Director and ICU Director. Patient 2 was observed in one of the ICU bays. RN 1 was observed at Patient 2's bedside. A temporary notice of contact precaution was observed outside of the curtain of Patient 2's bay. The second of the contact isolation sign was observed posted at the end of the patient's bed. A visitor was observed wore on the street clothes, walked to the patient's care area, talked to the patient, and hugged the patient. The visitor did not don the PPE. RN 1 was observed walked and talked to the visitor and advising the visitor the requirement of the PPE. The visitor was observed walked back the PPE box and donned a gown and gloves. There was no hand hygiene observed by the visitor before donned the PPE. During the concurrent interview with RN 1, RN 1 stated Patient 2 was admitted with colonized E. coli infection. RN 1 stated the visitor was the patient's family and visited the patient yesterday.

The PI Director and ICU Director confirmed the findings on 2/21/25 at 1600 hours.

Based on observation, interview, and record review, the hospital failed to ensure the nursing staff clarified with the physician of the RASS target when administering propofol (sedative medication) to one of four sampled patients (Patient 2). This failure had the potential to result in poor health outcomes to the patient.

Findings:

Review of the hospital's P&P tilted Medication Administration dated 3/21/24, showed medication management requires a system-based approach to evaluate and monitor the medication-use process providing safe and effective use of medications throughout the health system. Prior to administration, the practitioner will discuss any unresolved, significant concerns about the medication with the prescriber or physician covering the patient and/or relevant staff involved with the patient's care, treatment, and services.

Review of the hospital's P&P tilted Propofol Infusion Guidelines for Ventilated Patient dated September 2024 showed the following:

* The purpose is to provide safe and effective use of propofol infusion for patients receiving mechanical ventilation in a critical care setting.

* All infusion orders must be complete and contain a titration goal.

* The propofol infusion must be administered using an infusion pump and a physician's order must relate a therapeutic goal (RASS Scale), sedation level or the desired level of sedation. For most patients, RASS target is 0 to -2; there are clinical exception to this range; however, a range must be specified in all orders.

* The RASS score is range from - 5 to + 4. The RASS score of -2 indicates the patient has light sedation, was briefly awakens to voice which the eye opening or contact is less than 10 seconds. The RASS score of - 4 indicates the patient has deep sedation, no response to voice, but movement or eye opening to physical stimulation.

On 2/21/25 at 0910 hours, the ICU was toured with the PI Director and ICU Director. Patient 2 was observed intubated and received the continuous propofol infusion. RN 1 was at Patient 2's bedside. During the concurrent interview with RN 1, RN 1 stated revealed the physician ordered to administer the propofol infusion to the patient and the RASS goal was -4. The patient assessed and had the RASS score of -2. RN 1 stated the patient was slightly moving her head. The patient would be given the narcotic medication for pain.

On 2/21/25 at 1244 hours, review of Patient 2's medical record was conducted with the ICU Director.

Patient 2's medical record showed the patient arrived to the ED on 2/18/25 at 2100 hours.

Review of the physician's order dated 2/18/25 at 2239 hours, showed the propofol infusion order to be started on 2/18/25 at 2245 hours and the RASS target was less than - 4 (deep sedation). There was no range of the RASS score specified for Patient 2 as per the hospital's P&P.

Further review of Patient 2's medical record showed on 2/21/25 at 1500 hours, the physician's order for propofol infusion was modified; and the RASS Goal was - 2 to - 4.

The ICU Director could not locate documented evidence to show the nursing staff verified with the provider/physician of the RASS target range from /18/24 at 2245 hours to 2/21/24 at 1453 hours.