HospitalInspections.org

Based on document review and interview, it was determined that the Hospital failed to demonstrate appropriate compliance to infection control practices, potentially placing 22 patients in the census, as well as Hospital staff, at risk for cross contamination. As a result, the Condition for Participation, Infection Control, 42 CFR 482.42 was not met.

Findings include:

1. The Hospital failed to ensure timely notification of reportable conditions to the Chicago Department of Public Health (CDPH). See deficiency cited at A-0748

2. The Hospital failed to timely implement isolation precaution measures for the suspected infectious disease. See deficiency cited at A-0749.

Based on document review and interview, it was determined that the Hospital failed to ensure timely notification of reportable conditions to the Chicago Department of Public Health (CDPH). This potentially affected approximately 22 patients in the census, as well as staff, for cross contamination.

Findings include:

1. On 5/1/19 at approximately 12:30 PM, the Hospital's document titled, "Norovirus Cluster Event Summary, 12th Floor Medical Psychiatric Unit," dated 5/1/19, was reviewed and included, " ... March 22, 2019, Friday, Case Count (persons with signs and symptoms): 5 patients and 14 associates (staff) ... IPC (Infection Prevention and Control) was notified (regarding) multiple associate(s) (staff) call-ins and multiple patients with similar s/sx (signs and symptoms): vomiting & diarrhea ...Cluster event confirmed with (MD #1/Medical Director, Infectious Disease) ... March 25, 2019 ... reported Norovirus (infection causing sudden onset of severe vomiting and diarrhea commonly spread through food and water) cases and shared info (information) on cluster event/containment strategies with the CDPH Outbreak Expert ... Case Count as of April 1, 2019: Total patients: 12; Total Associates (staff) 30." The event summary indicated that the CDPH was notified more than 48 hours after identification of the unusual case or cluster of events.

2. On 5/1/19 at approximately 2:00 PM, the Hospital's policy titled, "Disease and Conditions Reportable to Illinois Department of Public Health" (effective 7/2018) was reviewed and included, " ... This policy describes the process for reporting of infectious diseases to the Chicago Department of Public Health (CDPH) as required by the State of Illinois ... Procedure A. The following are declared to be contagious, infectious, communicable, and/or dangerous to the public health and each suspected ... case shall be reported to the (CDPH) ... B ... During CDPH working hours (8 am - 4 pm, Mon-Fri except holidays): call ... All other times: call ... ask for the "Communicable Disease person on call" ... C. When a Class 1B reportable disease or condition is identified, the same process will occur. 1. Report within 24 hours ... Class 1b: Any unusual case or cluster that may indicate a public health hazard ..."

3. On 5/1/19 at approximately 2:15 PM, the Hospital's census for the 12th Floor Medical Psychiatric Unit from 3/22/19 to 3/25/19 was reviewed. The census indicated that there were approximately 22 patients in the unit.

4. On 5/1/19 at approximately 2: 20 PM, an attestation letter dated 5/1/19 from E #1 (Manager, Infection Prevention and Control) was reviewed. The attestation letter included, " ... Initial CDPH Notification of the Cluster Event ... On the morning of March 25th ... (E#1) notified CDPH by a phone conversation that there has been a cluster of patients and associates with the same signs and symptoms: nausea, vomiting, and diarrhea ... (E #1) mentioned that few of the patients tested positive for the Norovirus. She (E #1) briefly mentioned the timeline of events from the time notification by the 12th floor staff was made on March 22nd ... (Signed by E #1)."

5. On 4/30/19 between 12:53 PM and 2:15 PM and on 5/1/19 between 2:14 PM and 2:30 PM, interviews were conducted with E #1 (Manager, Infection Prevention and Control). E #1 stated, " ... I am aware of all infection-related issues or concerns in the Hospital ..." Regarding the Norovirus outbreak, E #1 stated, "Day 1 (about March 22, 2019), we received a call from the 12th floor behavioral unit charge nurse (E #14/Charge RN Medical Psychiatric Unit) ...There were two patients (Pt. #1 and Pt. #2) having similar symptoms ... diarrhea ...There were also staff members calling off ... The Infection Control Chair (MD #1/Medical Director, Infectious Disease) was notified ... She (MD #1) needed to confirm that there was a cluster ... The cluster was identified on March 22 ... I notified Chicago Department of Public Health (CDPH) of the outbreak ... cluster of cases on March 25, Monday ..."

6. On 5/1/19 at approximately 10:37 AM, a telephone interview was conducted with MD #1 (Director, Infectious Disease). MD #1 stated, "I was notified by (E #1) about patients having diarrhea in the hospital on March 22 (2019) ... Associates (staff from 12th Floor Medical Psychiatric Unit) were also having abdominal pain and diarrhea ..." MD #1 agreed that these were unusual cases or cluster occurring in the hospital at the time. MD #1 stated, "The unusual cluster may affect the functioning of the unit ..."

Based on document review and interview, it was determined that for 1 of 4 patients' (Pt. #1) clinical records reviewed with positive result for Norovirus testing (infection causing sudden onset of severe vomiting and diarrhea commonly spread through food and water), the Hospital failed to timely implement isolation precaution measures for the suspected infectious disease.

Findings include:

1. On 5/1/19 at approximately 12:15 PM, the clinical record of Pt. #1 was reviewed. Pt. #1 was a 41 year old male patient admitted on 3/16/19 with a diagnosis of bipolar disorder. The clinical record indicated that Pt. #1 had episodes of watery stool on 3/20/19. The clinical record also included a physician's order for empiric Flagyl (medication that can be used for C-diff/stomach infection causing diarrhea) dated 3/21/19. However, the clinical record indicated that Pt. #1 was not placed in contact isolation (Isolation precaution measures used to prevent spread of infectious diseases. Health care workers making contact with a patient on contact isolation are required to wear gloves, and in some cases, a gown) until 3/22/19.

2. On 5/1/19 at approximately 2:15 PM, the Hospital's policy titled, "Isolation Procedures" (effective 7/2018) was reviewed and included, " ... This policy describes the prevention of the spread of an infection among patients, personnel or visitors ... Procedure: A. The nurse is responsible for initiating the appropriate precautions with or without the physician order ... Isolation precautions can be instituted at the discretion of the physician, RN, Nursing Supervisor or Manager, or the Infection Preventionist. Criteria for initiating isolation: Patients with ... suspected communicable disease/diagnosis are placed in appropriate isolation precautions until infectious disease is ruled out ..."

3. On 5/1/19 at approximately 10:37 AM, a telephone interview was conducted with MD #1 (Medical Director, Infectious Disease). When asked about physician's order of empiric Flagyl for a patient having acute watery stool, MD #1 stated, "We try to make an educated guess ... If there is suspicion of infection ... Flagyl could be used while ruling out C-diff ... Patient should be placed in isolation ..."