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Based on record review, policy and procedure review, and staff interviews, the governing body failed to take action and provide adequate directions to hospital management for the prevention of cross contamination and exposure of a communicable disease by a member of the medical staff.

Findings Include:

Review of the medical record for Patient #1 revealed he was admitted to the hospital on 4/16/13 after failing a course of Flagyl (an antibiotic) to treat a diarrhea illness. He became dehydrated and malnourished, requiring hospitalization for intravenous fluids (IV). He was placed on 2 additional antibiotics to treat C-difficile (C-diff) and began to improve. Patient #1 was discharged on 4/20/13. His discharge instructions included staying off work, following up with gastroenterology in 1-2 weeks for repeat stools prior to returning to work.
Review of the policy and procedure for Work Restrictions: Infectious/Communicable Disease in Healthcare Workers revealed employees of the hospital are required to be cleared by employee health after an illness prior to returning to work. The policy does not include physicians as hospital staff, only employees.
An interview with the Infection Control Officer on 5/17/13 at 10:30 AM revealed if a healthcare worker has C-diff then they cannot work. The healthcare worker needs to complete their course of antibiotics, be asymptomatic, and have a note from a physician giving them clearance to return to work. However, she stated "When it is a physician that is one place I cannot control. It depends on the honesty of the physician and them doing what is right." When asked if she was aware of any physicians having C-diff she stated, "Yes, we have one person who was taken off work recently for that reason. Unfortunately, he returned to work on Monday (5/13/13), and was performing surgery in the operating room (OR). When the OR staff notified me of him having patients on the schedule I quickly removed him from work again because I had not received his clearance to return to work. Later that same day, he became symptomatic with diarrhea and he had a positive C-diff test." She revealed they had to once again start identifying patients and staff that he exposed. The Infection Control Officer revealed that Patient #1 had been hospitalized for several days after he failed outpatient treatment for nausea, vomiting, and diarrhea. While he was hospitalized it was suspected that he had C-diff and a special test was performed to confirm it. When he was discharged from the hospital, he was given instructions to complete the antibiotics and schedule an appointment in 1-2 weeks with the gastroenterologist to be tested and cleared to return to work. When asked if Patient #1 followed the discharge instructions, she stated she did not know.
An interview with the Director of Quality and Outcomes on 5/17/13 at 4:10 PM revealed that the Infection Control Officer reviews all infection cases with the Quality Department and then they do the follow-up calls from that list. She revealed when they were made aware of the physician with C-diff, the Quality Department made follow-up calls to all identified exposed patients and asked them a specific set of questions regarding signs and symptoms. She revealed they would be continuing to make follow-up calls until the case is resolved. When asked if she was aware of Patient #1 returning to work without medical clearance, she stated, "No, I was not aware of that". She stated the action plan was developed by the Infection Control Officer, and Quality does not have a separate action plan. She stated there is not a policy for physicians to follow with regard to returning to work after being on sick leave.
An interview with the Chief Medical Officer on 5/17/13 at 4:35 PM revealed there is not a policy for non- employed physicians to follow regarding returning to work after a sick leave. He revealed he was made aware of Patient #1's condition prior to his hospitalization. The Chief Medical Officer stated he met with Patient #1 while he was in the hospital and set a course of therapy, gave him a timeline, and discussed his need to be off work for a period of time. He stated he was not aware that Patient #1 had returned to work until he came back from a 10-day vacation and was notified. When asked if Patient #1 had any documentation clearing him to return to work, he again stated there is not a policy requiring medical clearance of a non- employed physician returning to work. The Chief Medical Officer stated the hospital has never had to deal with a case of a physician exposing patients and staff to a communicable disease. Patient #1 was advised that he needed to be cleared before he came back to work. The Chief Medical Officer stated that when he talked to Patient #1, he did not feel that he had come back too soon. He further stated he did not know if Patient #1 followed-up with the gastroenterologist.

Based on medical record review, staff and patient interviews, and facility policy and procedure review, the facility failed to ensure that infection control practices were maintained to prevent the cross contamination of patients and staff when a physician with a communicable disease was not screened for clearance to return to work in the facility.

Findings Include:

1. Review of the medical record for Patient #1 revealed he was admitted to the hospital on 4/16/13 after failing a course of Flagyl (an antibiotic) to treat a diarrhea illness. He became dehydrated and malnourished, requiring hospitalization for intravenous fluids. He was placed on 2 additional antibiotics to treat Clostridium Difficile (C-diff, a communicable diarrhea illness) and began to improve. Patient #1 was discharged on 4/20/13. His discharge instructions included staying off work, following up with gastroenterology in 1-2 weeks for repeat stools prior to returning to work.

2. An interview with the Infection Control Officer on 5/17/13 at 10:30 AM revealed if a healthcare worker has C-diff, then they cannot work. The healthcare worker needs to complete their course of antibiotics, be asymptomatic, and have a note from a physician giving them clearance to return to work. However, she stated "When it is a physician, that is one place I cannot control. It depends on the honesty of the physician and them doing what is right." When asked if she was aware of any physicians having C-diff she stated, "Yes, we have 1 person who was taken off work recently for that reason. Unfortunately, he returned to work on Monday (5/13/13), and was performing surgery in the operating room (OR). When I was notified by the OR staff of him having patients on the schedule, I quickly removed him from work again because I had not received his clearance to return to work. Later that same day he became symptomatic with diarrhea and he had a positive C-diff test." She revealed they had to once again start identifying patients and staff that he exposed.
The Infection Control Officer revealed that Patient #1 had been hospitalized for several days after he failed outpatient treatment for nausea, vomiting, and diarrhea. He became dehydrated and needed fluids. While he was hospitalized it was suspected that he had C-diff and a special test was performed to confirm it. The PCR is a new specialized test that looks at DNA analysis to identify C-diff spores. Patient #1 was treated with Flagyl, Vancomycin, and Fidaxomicin (all antibiotics), and he improved. When he was discharged from the hospital, he was given instructions to complete the antibiotics and schedule an appointment in 1-2 weeks with the gastroenterologist to be tested and cleared to return to work. When asked if Patient #1 followed the discharge instructions, she stated she did not know.

3. An interview with the Director of Quality and Outcomes on 5/17/13 at 4:10 PM revealed there is not a policy for physicians to follow with regard to returning to work after being on sick leave.

4. An interview with the Chief Medical Officer on 5/17/13 at 4:35 PM revealed there is not a policy for non-employed physicians to follow regarding returning to work after a sick leave. The Chief Medical Officer stated he was made aware of Patient #1's diagnosis by the Infection Control Officer. He stated he did not remember the details, just that Patient #1 was very sick and admitted to the hospital. The Chief Medical Officer stated he met with Patient #1 while he was in the hospital and set a course of therapy, gave him a timeline, and discussed his need to be off work for a period of time. He stated he was not aware that Patient #1 had returned to work until he came back from a 10-day vacation and was notified. When asked if Patient #1 had any documentation clearing him to return to work, he again stated there is not a policy requiring medical clearance of a non-employed physician returning to work. The Chief Medical Officer revealed that he talked to Patient #1 and was told that he was asymptomatic, so he thought it was ok to work. After he finished operating on 5/13/13, he became symptomatic again. He went in on 5/14/13 and had a test done that came back positive for C-diff. The Chief Medical Officer stated the hospital has never had to deal with a case of a physician exposing patients and staff to a communicable disease. Patient #1 was advised that he needed to be cleared before he came back to work.

5. An interview with Patient #1 on 5/17/13 at 5:00 PM revealed he was once again on antibiotics and feeling better. He stated when he originally talked with Infectious Disease, he understood that he had to take 3 weeks off work. He stated that he had spoken to the Infection Control Officer and the Chief Medical Officer, and they advised him he could return to work. He then stated, "I guess I must have misunderstood. I was in contact with Infectious Disease and the Chief Medical Officer, and I was told if I was asymptomatic I would be cleared to come back to work." He revealed that he finished his antibiotics on 5/8/13, and then was asymptomatic for 4 days, so he scheduled a surgery for 5/13/13. When asked if he was seen by a gastroenterologist and received clearance, he stated he was in telephone contact with his personal physician. When asked if he was seen by his personal physician and cleared to return to work, he repeated that he was in telephone contact with his personal physician.

6. Review of the policy and procedure for Work Restrictions: Infectious/Communicable Disease in Healthcare Workers revealed employees of the hospital are required to be cleared by Employee Health after an illness prior to returning to work. The policy does not include physicians, only employees.

Based on staff interviews, infection control policy and procedure review, the hospital administration failed to develop and implement a plan to prevent cross contamination and exposure of a communicable disease by a member of the medical staff.

Findings Include:

An interview with the Infection Control Officer on 5/17/13 at 10:30 AM revealed if a healthcare worker has C-diff, then they cannot work. The healthcare worker needs to complete their course of antibiotics, be asymptomatic, and have a note from a physician giving them clearance to return to work. However, she stated "When it is a physician, that is one place I cannot control. It depends on the honesty of the physician and them doing what is right." When asked if she was aware of any physicians having C-diff she stated, "Yes, we have 1 person (Patient #1) who was taken off work recently for that reason. Unfortunately, he returned to work on Monday (5/13/13), and was performing surgery in the operating room (OR). When I was notified by the of him having patients on the schedule, I quickly removed him from work again because I had not received his clearance to return to work. Later that same day, he became symptomatic with diarrhea and he had a positive C-diff test." She revealed they had to once again start identifying patients and staff that he exposed. When he was discharged from the hospital, he was given instructions to complete the antibiotics and schedule an appointment in 1-2 weeks with the gastroenterologist to be tested and cleared to return to work. When asked if Patient #1 followed the discharge instructions, she stated she did not know. The Infection Control Officer stated she spoke with Patient #1 about possible breaches in hand-washing in the OR. She further stated that he was educated on proper hand-washing techniques and its importance. She revealed all staff and physicians have been educated on hand-washing and signs and symptoms of C-diff. She revealed the Volusia County Department of Health will get a copy of her final report when everything is complete.
An interview with the Director of Quality and Outcomes on 5/17/13 at 4:10 PM revealed that the Infection Control Officer reviews all infection cases with the Quality Department, and then they do the follow-up calls from that list. She revealed when they were made aware of the physician with C-diff, the Quality Department made follow-up calls to all identified exposed patients and asked them a specific set of questions regarding signs and symptoms. She revealed they would be continuing to make follow-up calls until the case is resolved. When asked if she was aware of Patient #1 returning to work without medical clearance, she stated, "No, I was not aware of that". She stated the action plan was developed by the Infection Control Officer and Quality does not have a separate action plan. She stated there is not a policy for physicians to follow with regard to returning to work after being on sick leave.
An interview with the Chief Medical Officer on 5/17/13 at 4:35 PM revealed there is not a policy for non-employed physicians to follow regarding returning to work after a sick leave. He revealed he was made aware of Patient #1's condition prior to his hospitalization. The Chief Medical Officer stated he met with Patient #1 while he was in the hospital and set a course of therapy, gave him a timeline, and discussed his need to be off work for a period of time. He stated he was not aware that Patient #1 had returned to work until he came back from a 10-day vacation and was notified. When asked if Patient #1 had any documentation clearing him to return to work, he again stated there is not a policy requiring medical clearance of a non-employed physician returning to work. The Chief Medical Officer stated the hospital has never had to deal with a case of a physician exposing patients and staff to a communicable disease. Patient #1 was advised that he needed to be cleared before he came back to work. The Chief Medical Officer stated that when he talked to Patient #1, he did not feel that he had come back too soon. He further stated he did not know if Patient #1 followed-up with the gastroenterologist.
Review of the policy and procedure for Work Restrictions: Infectious/Communicable Disease in Healthcare Workers revealed employees of the hospital are required to be cleared by Employee Health after an illness prior to returning to work. The policy does not include physicians as hospital staff, only employees.