HospitalInspections.org

Based on observation, staff interview, review of facility documents and CDC (Center for Disease Control) guidelines, it was determined that the facility failed to ensure a clean and sanitary environment for the provision of neonatal intensive care services.

Findings include:

Reference: Sani-Cloth Plus Germicidal Disposable Cloth Instructions for Use (IFU) states, "... General Guidelines for Use ... 2. ... When not in use, keep lid closed to prevent moisture loss. ..."

Reference: Diversey Oxivir 1 One Step Ready-To- Use Hospital Disinfectant Cleaner Safety Data Sheet states, "...7. Handling and Storage ...Storage: Keep tightly closed in a dry, cool and well ventilated place ... "

During a tour of the Neonatal Intensive Care Unit (NICU) on 12/14/22, in Pod/Room 205 at 11:34 AM, a PDI Super Sani-Cloth germicidal disposable wipe container, located on the counter by the entrance to the pod was noted to have the lid open with a wipe protruding out from the open lid. The wipe was dry to touch. Upon interview, Staff #7 confirmed that the lid should have been closed and removed the dry wipe and closed the lid to the container. At 11:40 AM, in the soiled room, a Diversey Oxivir 1 wipe container was noted to have the lid open with a wipe protruding out from the open lid.

Reference: Facility policy titled "Standard Precautions and Transmission Based (Isolation) Precautions," Last Reviewed 4/29/22 states, "... Transmission Based Precautions: Contact Precautions ... Donning [put on] PPE [Personal Protective Equipment] upon room entry and discarding before exiting the patient room will be done. ... "

Reference: CDC Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007) states, " ...II.E. Personal Protective Equipment (PPE) for Healthcare Personnel ... II.E.2. Isolation gowns ....When applying Standard Precautions, an isolation gown is worn only if contact with blood or body fluid is anticipated. However, when Contact Precautions are used (i.e., to prevent transmission of an infectious agent that is not interrupted by Standard Precautions alone and that is associated with environmental contamination), donning of both gown and gloves upon room entry is indicated to address unintentional contact with contaminated environmental surfaces
Part III: Precautions to Prevent Transmission of Infectious Agents ...III.B.1. Contact precautions .... Healthcare personnel caring for patients on Contact Precautions wear a gown and gloves for all interactions that may involve contact with the patient or potentially contaminated areas in the patient's environment. ..."

During a tour of the NICU on 12/14/22 at 11:18 AM, Staff #6 indicated that Pod/Room 206 was being utilized as the units isolation room and currently there were five MRSA colonized patients within the Pod/Room. The Pod/Room was staffed with two Registered Nurses (RNs). Contact Isolation Precaution signage was posted outside of the room and an isolation cart containing PPE was stationed outside of the doorway. Upon entering the Pod/Room, Staff #17 was observed sitting at the desk within the room with no PPE donned. Staff #17 and Staff #6 indicated that PPE is donned when providing care and having contact with the infants. At 1:26 PM, during an interview with Staff #3, the Infection Control Preventionist, he/she indicated that because of the layout of the room, a decision was made that staff only need to don PPE (gown and gloves) when having contact with the patient. Although signage is posted on the outside of the pod, the expectation is that gown and gloves are donned when providing care, doffed (removed) when care is completed, then hand hygiene is performed. A new gown and gloves are not donned again, until care is provided. The entire room is not contact isolation precautions, only each patient area. Staff #3 indicated that the facility implemented this process mid-year.

There were three patient isolettes/bassinets located on one side of the room and two located on the other side of the room. There were no curtains or dividers between the patient isolettes/bassinets and there was no clear indication between what areas within the room are considered clean (no isolation precautions required) and what areas are dirty (contact isolation precautions required). Without a clear indication between clean and dirty areas, there is a potential for unintentional contact with contaminated environmental surfaces and cross contamination.