HospitalInspections.org

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Based on document review, observation, and interview, the Emergency Department (ED) did not ensure that patient environmental safety was maintained. This was evident in (A) the unsecure storage of Betadine and Peroxide solutions in Patient Treatment Rooms, and (B) six (6) of ten (10) unlocked Intravenous (IV) and Blood Draw Storage Carts in Patient Care Areas.

These lapses in environmental safety places patients and visitors at increased safety risk.

Findings for (A) include:

Material Safety Data Sheet (MSDS) for Betadine Solution 10%, last reviewed 05/08/13, stated "[Betadine is] harmful by inhalation, skin contact or ingestion ... High concentrations of iodine in the blood from inhalation or ingestion may cause thyroid disorder, renal disturbances, acidosis and electrolyte disturbances such as increased iodine levels and severe hyponatremia ..."

MSDS for Hydrogen Peroxide Solution 3% [no date], stated, "Emergency First Aid Procedures: If ingested, call a physician, pharmacist or a Poison Control Center." Section X titled "Other Information" stated "Keep this and all medication out of the reach of children."

Observation in the facility's Acute Green ED during a tour on 02/13/17 between 10:30AM and 12:00PM identified multiple bottles of Betadine and Peroxide solutions stored in the storage cabinet in Patient Treatment Room Green 4. Storage cabinet doors did not contain locking devices to prevent unauthorized (patient or visitor) access.

During an interview with Staff I on 02/13/17 at 11:45AM, Staff I stated that all Adult Patient Treatment Rooms in the ED contained these unsecured storage cabinets and confirmed that the Peroxide and Betadine solutions were stored in them. Staff I explained "there is no way to lock these cabinets" to prevent accidental ingestion by a visiting child or confused adult patient. The findings were discussed with Staff S on 02/15/17 at 1:45PM.

The Policy for the storage or security of Peroxide and Betadine solutions was requested at the time of the observation, but none was available.

Findings for (B) include:

Observation in the facility's Acute Green ED during a tour on 02/13/17 between 10:30AM and 12:00PM identified that the supply cart in Patient Treatment Room Green 4, containing Intravenous (IV) insertion needles and blood draw needles, was unlocked.

Four (4) additional unlocked supply carts containing needles were identified in the hallways of the Clinical Decision Unit (CDU).

On 02/14/17 one (1) unlocked supply cart containing needles was identified in Pediatric ED Room 5. These supply carts were observed to contain locks, but were found unlocked in Patient Care Areas.

Interview with Staff I on 02/13/17 at 11:40AM confirmed that supply carts are to be kept locked to prevent unauthorized access by patients or visitors.

The Policy for the storage or security of sharps / needles in Patient Care Areas was requested at the time of the observation but none was available.
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Based on observations, document review, and interview, the Emergency Department (ED) did not ensure that staff adhered to acceptable Standards of Practice for Infection Control. This was evident in the improper application of face masks in eight (8) of sixteen (16) staff members observed wearing masks.

These lapses in Infection Control Practices places patients and staff at increased risk for facility acquired infections.

Findings:

During observations of the facility's Triage Area at 10:50AM on 02/13/17, Staff F was observed in Room #2 with a mask under her chin, after providing care to an immunocompromised patient. Without removing the mask, Staff F proceeded to call another patient into the room.

During an interview with Staff F on 02/13/17 at 10:50AM, when asked why she was wearing the mask, Staff F stated that she was providing care to an immunocompromised patient and that she had forgotten to remove the mask.

This was observed in the presence of Staff I, who confirmed the findings and instructed the staff member to remove the mask.

During observations of the facility's Critical Care Area at 10:20AM on 02/14/17, Staff CC was observed in the Critical Care Area, documenting in a patient's Medical Record, with a mask under her chin after providing patient care.

Similar findings with the improper application of face masks was observed for Staff Members G, H, J, K, AA and BB during tours of the ED on 02/13/17 and 02/14/17.

During an interview with Staff I at the time of these observations, Staff I confirmed that the staff members should not have been wearing their masks under their nose or chin and should have removed the masks after providing patient care.

The facility's Policy and Procedure (P&P) titled "Standard Precautions: Surveillance, Prevention and Control of Infections", last revised 05/07/15, lacked specific instructions on proper donning of face masks or disposal.

However, the facility's Policy and Procedure (P&P) titled "Influenza Vaccination Policy", last revised 12/16/14, stated the following: "all personnel not vaccinated against influenza for the current influenza season must wear a surgical or procedure mask while in areas where patients may be present ... all masks should be changed when leaving the patient care room or completing care of a patient."