HospitalInspections.org

Based on hospital policy review, medical record review, observation, and staff interviews, the hospital nursing staff failed to ensure sitter/certified nursing assistant (CNA) was wearing appropriate personal protective equipment (PPE) for 1 of 1 patients on contact precautions. (Patient #6)

The findings include:

Review on 02/11/2016 of the hospital's policy titled, "(Named hospital) Department of Infection Prevention Isolation Precautions...Contact...Protective Environment" last revised 11/2015 revealed "... Contact Precautions are indicated for patients who are known or suspected to be infected or colonized with ...microorganisms that can be transmitted by direct contact with the patient or indirect contact with environmental surfaces or patient care items in the patient's environment...Personal Protective Equipment (PPE)..Gloves are worn to enter patient room. Gown is worn to enter patient room...Gloves and gown are removed immediately prior to leaving room or patient environment..."

Record review on 02/11/2016 of Patient #6's revealed a 10 y.o. (year old) was admitted on 02/05/2016 to one of the hospital's general pediatric units with a diagnosis of post traumatic stress disorder (PTSD) and attention-deficit hyperactivity disorder (ADHD). Review revealed a history of self injurious behavior (cutting) and aggressive behaviors. Review of the History and Physical (H&P) dated 02/05/2016 revealed a history of Methicillin-Resistant Staphylococcus Aureus (MRSA), resulting in initiation of "Contact Precautions".

Observation on 02/11/2016 at 0930 during medication administration observation revealed Patient #6 had a staff member assigned one-to-one at the bedside. Observation revealed a sign on the patient room door stating "Contact Precautions," directing the use of gowns and gloves upon entry to the room. Observation revealed RN (registered nurse) #1 donned a gown and gloves upon entry to the patient room and provided same to surveyor. Upon entry, a Sitter also known as a Patient Safety Attendant(PSA)/ CNA (certified nursing assistant) #1 was observed sitting in a chair next to Patient #6 bed with scrub attire, without a gown or gloves. Observation revealed RN #1 did not direct the staff member to don PPE. During medication administration, Patient #6 requested something to drink and CNA #1 donned gloves and provided Patient #6 a drink. Observation revealed CNA #1 did not don a gown at any time during medication administration and that RN #1 did not provide instructions to do so.

Interview on 02/11/2016 at 0940 with RN #1, NM (nurse manager) #1, and VP (vice president) #1 revealed "Sitters are not required to wear gowns for patients on contact precautions for a history of MRSA. It really just depends on why the patient is on contact precautions. Nurses wear them to prevent cross contamination of other patients when providing care. The sitter's only assignment is to provide one-to-one observation for the assigned patient." Interview revealed "If the sitter is a Patient Safety Attendant (PSA) with no CNA training, hands on care is not provided; however, if the sitter is a CNA, they are expected to provided direct patient care."

Interview on 02/11/2016 at 1255 with NM #2 and AVP (assistant vice president) #1 revealed all nursing staff receive annual training on Infection Control via an independent study, module-based program. Interview revealed "Contact Precautions" and the use of PPE, including correct application, are both part of the annual training. Interview revealed CNA #1 worked in a different area of the named hospital and and often works overtime to help during staffing shortage. Interview revealed the expectation on CNA #1's routinely assigned unit is that staff wear PPE for all patients on Contact Precaution, regardless of reason.

Interview on 02/11/2016 at 1355 with VP #1 revealed, "We have reviewed the policy and sitters are required to wear PPE when assigned to a patient on contact precautions, regardless of reason. I think is was just miscommunication and it looks like we have an educational opportunity to improve the delivery of patient care. Leaders received an email advising that all sitters should be wearing PPE when patients are on contact precautions. We sent out an "education blast" to all direct care staff at 1248 and nursing education will continue every shift until all staff have received the information. The training will go out hospital wide. Included in the email is notation that PSA's are not allowed to sit until education is received and the study roster has been signed."

Interview on 02/11/2016 at 1415 with the hospital's Infection Control Preventionist (ICP) revealed "Any staff member going into a patient's room who is on contact precautions should donn PPE, which includes a gown and gloves. The only time a staff member should ever ignore precaution requirements is in an emergent situation. We clearly need to hone in on nursing as well as sitters to ensure understanding of the required PPE for patients on contact precautions. Nursing management was not aware of the requirement. It is evident we have a knowledge deficit and need a moment of education. This will certainly be added to the auditing process with monitoring to follow to ensure staff are aware and practicing appropriate use of PPE. It is apparent wide spread training is needed."

NC00112970