HospitalInspections.org

Based on observation, document review, and interview, the facility failed to ensure that an effective infection prevention process was in place to prevent the transmission of COVID-19 in accordance with the CDC Guidelines and facility policy. The facility failed to effectively implement and monitor their COVID-19 screening process at 2 (Entrance #1 and Entrance #2) of 2 hospital entrances.


This deficient practice had the likelihood to cause serious harm, injury, and possibly subsequent death. Failure to adhere to the CDC's recommendations and guidelines placed all patients and staff at a higher risk for contracting and transmitting COVID-19.


Findings Include:


An observation tour was conducted on 12/7/2020 after 9:30 AM with Staff #1. The following was observed.


Emergency Room Entrance (Entrance #1)

Upon entering Entrance #1 two staff members were observed at the registration desk screening visitors and patients for COVID-19 symptoms as they entered the facility. To the left of the registration desk Staff #14 sat at a small table.

An interview was conducted with Staff #14 on 12/7/2020 after 9:30 AM. Staff #14 was asked to explain his role. Staff #14 replied, "We mostly just direct traffic and make sure we don't have too many people in here at one time and we try and keep people separated." Staff #14 was asked if they provided any COVID-19 screening for incoming patients and visitors. Staff #14 replied, "We will help if the clerks get too busy." Staff #14 was asked if he completed any training on the COVID-19 screening process. Staff #14 stated, "I have not had any specific training but, we only help them if they get swamped."

A review of the document titled, "Screening Log" used at Entrance #1 dated 10/28-11/25/2020 did not reveal the name or initials of the personnel completing the COVID-19 screening.

Staff #1 confirmed the findings.



Lower Level Entrance (Entrance #2)

Observed at Entrance #2:

A table was placed near a back door. Next to the table an I-Pad was observed on a stand.

An interview was conducted with Staff #1 on 12/7/2020 after 10:00 AM. Staff #1 was asked to explain the screening process at Entrance #2. Staff #1 stated, "This door is used for employee and physician entrance. We used to have a person that sat down here and did a screening on each person that came in the door. We changed the process on 11/2/2020. We now use the I-Pad to check temperatures on personnel. The employee or physician must stop and place their face in front of the I-Pad. It checks a temperature and takes a picture of their face. That information is uploaded into a program for us to see. It will also alert me or the House Supervisor if someone has a temperature greater than 100 F.

Staff #1 was asked if a person could bypass the temperature check and still be allowed into the facility. Staff #1 replied, "They know they have to stop and get their temperatures checked before starting their scheduled shift, but I guess they could walk by it."

This surveyor was able to enter the back door and walk passed the I-Pad without triggering an alarm of any kind. This surveyors face could not be detected by the I-Pad for ID purposes.

Staff #1 was asked how she ensured that all personnel entering the facility were properly screened for COVID-19 symptoms, travel, and exposure. Staff #1 stated, "I will sometimes look to see who is working and then go back to the program and see if the employee stopped for a temperature screening. We no longer have a staff person screening personnel that come through the back door. We had the employees sign an acknowledgment back in September that they would report any signs or symptoms of COVID-19 or exposure to COVID-19." Staff #1 was then asked if the Physicians, Advanced Practice Providers, or contract employees were asked to sign the acknowledgement forms also. Staff #1 stated, "No."




A review of the Care.ai computer program (the program used for monitoring and reporting temperatures) for 12/2/2020 revealed no information was transferred to the program from the I-Pad at Entrance #2. Staff #1 confirmed there was no documented COVID-19 screening for anyone entering the facility through Entrance #2 on 12/2/2020. Staff #1 also confirmed only facial photos and temperature readings were available on the program. There was no name that identified the photo. Staff #1 had to consult with Staff #16 to identify a photo of Staff #17. Staff #1 stated, "I don't recognize a lot of the faces from the weekend and night staff. We do have FEMA Nurses helping us right now, so I don't really know what they look like, especially wearing a mask." Staff #1 could not confirm that all staff were properly screened for COVID-19 at Entrance #2.


Staff #1 confirmed there was no documented monitoring of the COVID-19 screening process for Entrance #2.




A review of the facility policy titled, "COVID-19 Employee Screening Process" Policy Stat ID:8516917; Approved 9/2020; Effective 9/2020 was as follows:

" ...POLICY:
An effective, consistent screening process is necessary for entry to *************. Any individual attempting to gain access to the facility must comply with the screening process at the designated employee entrance points. Employee access will be contained and restricted throughout the facility, for the safety of our patients, visitors, and staffing. ********** will be limiting access. All employees including contract workers and physicians will be screened prior to being allowed to enter the facilities, per CDC guidelines.

PROCEDURE:

The Lower Level (Rehab Entrance point):

A. Each staff member entering through the lower level (Rehab entrance point) dedicated employee entrance must attests that they have no signs or symptoms of COVID-19 when signing the employee Screening Log each day prior to the start of their shift ...

C. Each staff member entering through the lower level employee entrance will maintain safe social distancing and have their temperature read via the temperature monitoring station. The device utilized to monitor the employee's temperature is Care.ai ..."


A review of the document titled, "COVID-19 Plan" Policy Stat ID: 8416228; Approved 9/2020; Effective 9/2020 was as follows:

" ...SCREENING GUIDANCE:

All individuals who enter our hospital, as well as physician practices and clinics will be screened according to CDC guidelines. This includes patients, visitors, and employees. In addition to evaluating individual for potential respiratory symptoms and asking about travel history, we will now be conducting temperature checks at the door ..."


A review of the current CDC Recommendations and guidelines was as follows

" ...Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic
Infection Control Guidance
Updated Nov. 4, 2020


1. Recommended routine infection prevention and control (IPC) practices during the COVID-19 pandemic
Screen and Triage Everyone Entering a Healthcare Facility for Signs and Symptoms of COVID-19
Although screening for symptoms will not identify asymptomatic or pre-symptomatic individuals with SARS-CoV-2 infection, symptom screening remains an important strategy to identify those who could have COVID-19 so appropriate precautions can be implemented.

Establish a process to ensure everyone (patients, healthcare personnel, and visitors) entering the facility is assessed for symptoms of COVID-19, or exposure to others with suspected or confirmed SARS-CoV-2 infection and that they are practicing source control.

Options could include (but are not limited to): individual screening on arrival at the facility; or implementing an electronic monitoring system in which, prior to arrival at the facility, people report absence of fever and symptoms of COVID-19, absence of a diagnosis of SARS-CoV-2 infection in the prior 10 days, and confirm they have not been exposed to others with SARS-CoV-2 infection during the prior 14 days.

Fever can be either measured temperature ?100.0°F or subjective fever. People might not notice symptoms of fever at the lower temperature threshold that is used for those entering a healthcare setting, so they should be encouraged to actively take their temperature at home or have their temperature taken upon arrival.

Obtaining reliable temperature readings is affected by multiple factors, including:

The ambient environment in which the temperature is measured: If the environment is extremely hot or cold, body temperature readings may be affected, regardless of the temperature-taking device that is used.

Proper calibration of the thermometers per manufacturer standards: Improper calibration can lead to incorrect temperature readings.

Proper usage and reading of the thermometers: Non-contact infrared thermometers frequently used for health screening must be held at an established distance from the temporal artery in the forehead to take the temperature correctly. Holding the device too far from or too close to the temporal artery affects the reading ...."


During an interview on 12/7/2020 after 3:00PM Staff #1 and Staff #3 confirmed there was no process in place to ensure COVID-19 screening was completed according to CDC Guidelines and facility policy at Entrance #1 and #2.

No documentation was provided for review of the monitoring of the screening process for COVID-19 for Entrance #1 or Entrance #2.

Staff #1 and Staff #3 confirmed the above findings.