HospitalInspections.org

Based on policy and procedure review, observation, and staff interviews, facility staff failed to perform appropriate hand hygiene prior to performing patient care and after exiting a patient's room in 4 of 6 patients observed (#6, #9, #10, and #14).

Findings include:

Review of the hospital's policy and procedure titled "Hand Hygiene", with the last review date of 08/12, revealed "...Indications for hand washing...Prior to donning (putting on) gloves...". The policy also states, "If hands are contaminated with bacteria spores, such as C. difficile (Clostridium difficile - a bacteria that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon)...soap and water are preferred over alcohol rub, for physical removal of the spores from the hands...". Review of the hospital's policy and procedure titled "STANDARD PRECAUTIONS AND TRANSMISSION-BASED PRECAUTIONS...Revised Date: ...10/14" states, "...Wearing gloves does not replace the need for hand cleansing...".

1. Observation of the hospital's 3rd floor patient care area, on 08/11/2015 at 1145, revealed Social Worker (SW) #1, preparing to enter room of patient #6. SW #1 was observed standing at patient #6's door with clipboard in hand. SW #1 stated "I have paperwork for the patient to sign." Signage on patient #6's door states "CONTACT PRECAUTIONS" (procedures, such as wearing masks, gowns and gloves, that reduce the risk of spreading infections through direct or indirect contact) with "SPECIAL ENTERIC" (relating to, or affecting the intestines) instructions in red "Perform hand hygiene before entering room AND wash hands with soap and water before leaving room." SW #1 was observed putting on an isolation gown and gloves. SW #1 did not perform hand hygiene prior to donning gloves and entering the patient's room. SW #1 carried the clipboard into the patient's room. Upon exiting patient #6's room, SW #1 removed her gown and gloves and disposed of them in the trash receptacle in the patient's room and cleaned her hands with hand sanitizer. SW #1 was observed walking to the nurse's station where she placed her clipboard on the counter.

Interview with SW #1 revealed "I cleaned my clipboard with hand sanitizer." SW #1 did not reply when questioned if the process for cleaning your hands is different when exiting a patient's room with suspected C. difficile (C-diff) versus MRSA (Methicillin-resistant Staphylococcus aureus - a bacteria that is resistant to many antibiotics).

Interview with hospital's Infection Preventionist (IP) #2, in the presence of SW #1, revealed "You should wash your hands with soap and water when you leave a C-diff room." IP #2 also informed SW #1 that she should clean her clipboard with the bleach wipes that are provided in the isolation caddy on the patient's door to kill the C-diff spores.

2. Observation of the hospital's 3rd floor patient care area, on 08/11/2015 at 1355, revealed a Nursing Assistant preparing to enter patient #9's room. According to the "Infection Control Isolation Census", patient #9 was placed on contact precautions pending MRSA culture results. The appropriate contact precautions signage was posted on patient #9's door and an isolation caddy with supplies was hanging on the patient's door. The Nursing Assistant was observed putting on an isolation gown and gloves prior to entering patient #9's room. The Nursing Assistant did not perform hand hygiene before donning her gloves.

Interview with the hospital's IP #2 on 08/11/2015 at 1530 revealed staff was consistently seen not washing their hands before putting on gloves. IP #2 reported, per the hospital's policy on hand hygiene, staff should be washing their hands before putting on gloves. "I see the problem."

3. Observation of the hospital's 3rd floor patient care area, on 08/11/2015 at 1400, revealed a Respiratory Therapist (RT) entering patient #10's room to perform a breathing treatment. The RT was observed putting on gloves upon entering patient #10's room. The RT did not perform hand hygiene prior to donning her gloves.

Interview with the hospital's IP #2 on 08/11/2015 at 1530 revealed staff was consistently seen not washing their hands before putting on gloves. IP #2 reported, per the hospital's policy on hand hygiene, staff should be washing their hands before putting on gloves. "I see the problem."

4. Observation of the hospital's 2nd floor patient care area, on 08/12/2015 at 0900, revealed RT #3 preparing to enter patient #14's room to perform a breathing treatment. According to the "Infection Control Isolation Census", patient #14 was placed on contact precautions for positive MRSA. An isolation caddy with supplies was visualized hanging on patient #14's door. The appropriate contact isolation signage was also visible on patient #14's door. RT #3 was observed putting on an isolation gown and gloves. RT #3 did no perform hand hygiene prior to donning her gloves.

Interview with the Director of Respiratory Therapy on 08/12/2015 at 0950 revealed the procedure or expectation of RTs before entry into a patient's room is to "wash hands then put on PPE (personal protective equipment - gown, gloves)."