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Based on observations, records reviewed and interviews the Hospital failed to consistently adhere to infection control standards and its policies related to expired sterile equipment, following the manufacturer's directions for use and following the physician's orders for positioning of two Patients (Patient #3 and #6) on mechanical ventilation.

1.) The Surveyor toured the Intensive Care Unit (3 ICU) at 8:30 A.M. on 10/18/17. There was a procedure cart that was opened and inspected which contained numerous expired supplies ready for use for various patient procedures. These included three Swan-Ganz catheters that had expired on 9/16/16, 1/12/17 and 1/14/17, two Venous Introducer kits that had expired 6/2017 and 9/30/17 and one Vessel Catherization kit that had expired 3/31/17.

The Surveyor interviewed the Clinical Coordinator at approximately 9:00 A.M. on 10/18/17. The Clinical Coordinator said these products should have been removed from the procedure cart.

2.) The Surveyor interviewed Registered Nurse (RN #2) who was caring for Patient #3. There were two opened bottles of Sterile Fluid in the Patient's ICU room. RN #2 said the night nurse left the opened fluids for her to use but that the bottles should have been dated when opened.

According to the manufacturer's directions for use, any unused portion of these sterile fluids must be discarded.

3.) According to the Center for Disease Control titled, Guidelines for Preventing Health-Care-Associated Pneumonia, 2003, "In the absence of medical contraindication(s), elevate at an angle of 30--45 degrees of the head of the bed of a patient at high risk for aspiration".

The Surveyor reviewed the Physician Order sets for Patient #3 and #6 that indicated these Patients were to be positioned at 30 degrees.

On 10/18/17 Patient #3's head of the bed position was at 26 degrees elevation. On 10/19/17 Patient #3's head of the bed position was at 25 degrees elevation.

On 10/18/17 Patient #6's head of the bed position was at 25 degrees elevation. On 10/19/17 Patient #3's head of the bed position was at 26 degrees elevation.