HospitalInspections.org

Based on observation, interview, and document review, it was determined that the facility failed to employ methods for preventing and controlling the transmission of infections within the facility by not screening visitors before entering the facility, having worn chairs in the Emergency Department waiting area, and by five (5) Staff Members not performing hand hygiene after touching masks (Staff Members #5, #6, #8, #9, and #10).

The findings include:

On September 22, 2020 at 10:00 a.m., upon arrival at the facility, Staff Member # 11, at the screening desk, obtained each surveyors temperature. Staff Member # 11 failed to ask the surveyors any screening questions. Staff Member # 11 allowed the surveyors to enter the facility without COVID-19 screening.
A tour of the facility revealed thirty nine (39) of sixty one (61) chairs in the Emergency Department (ED) waiting area with worn surfaces that could not be cleaned and sanitized between patients. There were chair rails along the walls in ED waiting area with worn surfaces that could not be cleaned and sanitized between patients. Staff Member # 1 was present and observed the worn surfaces.

At 10:45 a.m., Staff Member # 5 was observed registering a patient to be seen in the ED. Staff Member # 5 was observed wearing gloves and a surgical mask. Staff Member # 5 was touching the front of the mask and adjusting the mask with gloved hand. Staff Member # 5 failed to remove dirty gloves and perform hand hygiene after touching the front of the mask. Staff Member # 5 did not remove dirty mask after touching with dirty gloves.
At 10:50 a.m., Staff Member # 6 was observed entering the patient registration area with a surgical mask below the chin. Staff Member # 6 pulled the mask up above nose with ungloved hand. Staff Member # 6 failed to perform hand hygiene after touching the front of the mask. An interview with Staff Member # 6 revealed "I was eating and then pulled my mask up". Staff Member # 6 was then observed adjusting the mask by touching the front of the mask and then touching a computer cart with the same hand used to adjust the mask. Staff Member # 6 failed to perform hand hygiene after touching the front of the mask and before touching the computer cart. Staff Member # 1 was present and spoke with Staff Member # 6 immediately.
At 11:00 a.m., Staff Members # 8 and # 9 were observed sitting at the nursing station of Unit 2 Surgical. Staff Member # 8 was wearing a surgical mask and adjusted the surgical mask on at least three occasions while sitting at the desk and failed to perform hand hygiene. Staff Member # 9 was wearing an KN95 mask. Staff Member # 9 was observed touching the front of the mask without perform hand hygiene.
An interview with Staff Member # 8 revealed "The mask gets sucked into my mouth when I talk." Staff Member # 8 was informed that if the mask was soiled it should be changed and if it was touched, hand hygiene should be performed. Staff Member # 8 stated "That's going to be a lot masks." Staff Member # 1 was present during the observations.
At 11:15 a.m., Staff Member # 10 was observed wearing a surgical mask while holding goggles in hand. Staff Member # 10 was observed adjusting the mask by touching the front of the mask on at least four occasions and then touching the goggles in (Staff Member # 10) hand. Staff Member # 10 failed to perform hand hygiene after touching front of mask. Staff Member # 10 failed to clean and disinfect goggles or discard. Staff Member # 1 was present during the observations.
At 11:45 a.m., an interview with Staff Member # 1 revealed staff have been educated on wearing masks, goggles/face shields and hand hygiene. Staff Member # 1 was observed re-educating staff members throughout the tour of the facility.

Guidance provided by Staff Member # 1 on September 25, 2020 at 4:10 p.m. titled "Guidelines for Care" read in part "Hand Hygiene: Staff should perform hand hygiene using alcohol-based hand sanitizer (ABHS) before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE (personal protective equipment), including gloves."

Guidance provided by Staff Member # 1 on September 25, 2020 at 4:10 p.m. titled "Extended use and re-use of facemasks" read in part "the facemask should be removed and discarded if soiled, damaged or hard to breathe through. HCP (Healthcare Personnel) must take care not to touch their facemask. If they touch or adjust their facemask they must immediately perform hand hygiene. HCP should leave the patient care area if they need to remove the facemask."

Guidance by the Center for Disease Control (CDC) (www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html) reads in part "When putting on a facemask: Clean your hands and put on your facemask so it fully covers your mouth and nose." "Don't wear your facemask under your nose or mouth." "Don't touch or adjust your facemask without cleaning your hands before and after."