HospitalInspections.org

Based on observation, interview, and record review, the hospital failed to employ methods for preventing and controlling the transmission of COVID-19 as per the CDC's recommendation as evidenced by:

1. Failure to ensure the nursing staff was dedicated to care for patients with suspected or confirmed COVID-19 and failure to ensure the patient with non COVID-19 was placed in the non COVID-19 area.

2. Failure to ensure the visitors were screened for symptoms consistent with COVID-19.

These failure created the potential of spreading of infection throughout the hospital.

Findings:

Review of the section of COVID-19 Response of the hospital's Infection Prevention 2019 Program Assessment & 2020 Annual Plan dated 6/16/20, showed the following:

* The section of the low level activation: initial outbreak in China, with spread to other countries showed to closely follow progress of epidemic, monitored CDC website.

* The section of the mid level activation: travel-related cases in U.S., few person-to-person cases connected to travel showed to prepare interim policies and updated prn as CDC guidance evolved.

* The section of the high level activation: person-to-person transmission detected in multiple areas in U.S. showed to active screening at the entrances; report the PUIs and COVID-19 positive cases. "CDC guidance followed" and establish COVID-19 units.

1. According to the CDC's Coronavirus Disease 2019 (COVID-19) Interim Infection Prevention and Control Recommendations for HealthCare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic updated 6/19/20, the recommended infection prevention and control (IPC) practices when caring for a patient with suspected or confirmed SARS-CoV-2 infection include the facilities should consider designating entire unit within the facility, with dedicated HCP, to care for patients with suspected or confirmed SARS-CoV-2 infection as a measure to limit HCP exposure and conserve PPE. Dedicated means that HCP are assigned to care only for these patients during their shift.

On 7/9/20 at 1310 hours, an interview was conducted with the CNO. When asked, the CNO stated one side of the 4th floor was designated for the patients with suspected (PUI) or confirmed COVID-19.

On 7/9/20 at 1355 hours, a tour of the 4th floor was conducted and accompanied by the CNO and IC. The 4th floor was observed to have two sides (Sides A and B) that separated by the nursing station. The CNO stated Side B was designated for the patients with suspected or confirmed COVID-19 and Side A was designed for the patients who were not suspected or confirmed COVID-19. The CNO stated the staff would be designated to care for the suspected or confirmed COVID-19 only. Room I was located at Side B.

On 7/9/20 at 1549 hours, during an interview with the IC, the IC stated the hospital followed the CDC's guidelines related to COVID-19.

a. Review of the hospital's census printed on 7/9/20 at 1336 hours, showed the section of "Isolation" showed "Contact and Droplet" for Rooms A, B, C, D, E, F, G, H, J, and K located at Side B. The section of "Isolation" for Room I was left blank.

Review of the Assignment Sheet for the 4th floor dated 7/9/20, for the day shift, showed Patient 1 was assigned to Room I located at Side B.

Review of the hospital's floor plan showed Room I was located between Rooms H and J.

On 7/9/20 at 1549 hours, an interview and concurrent review of Patient 1's medical record was conducted with the IC.

Review of Patient 1's medical record showed Patient 1's COVID-19 test result dated 7/4/20 at 1449 hours, was negative.

The IC confirmed the findings.

On 7/28/20 at 1156 and 1612 hours, the CNO was informed and acknowledged Patient 1 had a negative COVID test result on 7/4/20, but was in Room I located at Side B.

b. Review of the Assignment Sheet for the 4th floor dated 7/9/20, for the day shift, showed RN 3 was assigned to Patient 2 who was in Room L located at Side A, and Patient 3 who was in Room H located at Side B.

On 7/9/20 at 1549 hours, an interview and concurrent review of the medical records for Patients 2 and 3 was conducted with the IC.

- Patient 2's medical record showed the Patient 2 was in Room L located at Side A. Patient 2 had not had a positive COVID-19 test result, and had had the nasopharyngeal swab for COVID-19 collected on 7/8/20 at 0334 hours.

- Patient 3's medical record showed Patient 3 was in Room H located at Side B. Patient 3 had the positive COVID-19 test result updated on 6/28/20 at 2203 hours.

The IC confirmed RN 3 was assigned to care for Patients 2 and 3 on 7/9/20.

On 7/9/20 at 1552 hours, during an interview with the CNO and IC, the CNO stated Patient 2 had the COVID-19 test before the GI procedure only.

c. On 7/9/20 at 1415 hours, a tour of ICU was conducted with the CNO and IC. The white board behind the nursing station showed the following:

* RN 4 was assigned to care for Patients 4 and 5.

* RN 5 was assigned to care for Patients 6 and 7.

During an interview with RN 6, RN 6 stated Patients 4 and 6 had the positive COVID 19 test result; Patient 7 did not have a positive COVID-19 results; and Patient 5's COVID-19 test result was pending.

On 7/9/20 at 1549 hours, an interview and record review was conducted with the IC. The following was identified:

- Patient 4's medical record showed Patient 4's COVID-19 test result updated on 7/9/20 at 1417 hours, was positive. This COVID-19 test was collected on 7/8/20 at 0542 hours.

- Patient 5's medical record showed Patient 5's COVID-19 test result updated on 7/4/20 at 1444 hours, was negative.

- Patient 6's medical record showed Patient 6's COVID-19 test result updated on 6/15/20, was positive.

- Patient 7's medical record showed Patient 7's COVID-19 test result updated on 7/3/20 at 1400 hours, was negative.

Review of the Assignment Sheet for the ICU dated 7/9/20, for the day shift, showed the following:

- RN 4 was assigned to care for Patients 4 and 5 when Patient 4's COVID-19 test result was pending, and Patient 5's COVID-19 test result was negative

- RN 5 was assigned to care for Patients 6 and 7 when Patient 6's COVID-19 test result was positive and Patient 7's COVID-19 test result was negative.

During the concurrent interview, the IC stated the hospital followed the CDC's guideline. The IC confirmed the findings.

2. According to the CDC's Coronavirus Disease 2019 (COVID-19) Interim Infection Prevention and Control Recommendations for HealthCare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic updated 6/19/20, symptom screening remains an important strategy to identify those who could have COVID-19 as appropriate precautions can be implemented. Everyone including the patients, HCP, and visitor will be screened for symptoms consistent with COVID-19 or exposure to other with SARS-CoV-2 infection and ensure they are practicing source control by actively taking their temperature, documenting absence of symptoms consistent with COVID-19, and asking them if they has been advised to self-quarantine because of exposure to someone with SARS-CoV-2 infection.

Review of the hospital's sign-in sheet for visitors (no dated) showed the instruction for entering the facility includes to complete the line entry; "if you answer YES to any of the questions, you will be RESTRICTED from entry." Further review of the hospital's sign-in sheet for visitor showed the boxes of "YES" and "NO" for the sections of cough, shortness of breath, fatigue, body aches, headache, new loss of taste/smell, runny nose, nausea/vomiting, and diarrhea.

On 7/9/20 at 1310 hours, the surveyors entered the hospital at the main entrance. Staff 1 checked the surveyors's temperatures and did not ask the surveyors whether the surveyors had cough, shortness of breath, fatigue, body aches, headache, new loss of taste/smell, runny nose, nausea/vomiting, and diarrhea.

On 7/9/20 at 1320 hours, an interview was conducted with the IC. The IC stated the staff had to check the visitors' temperatures and ask for symptoms of COVID-19. If the visitor had any symptoms, the staff would call the IC or administrative staff and the visitor would not be able to enter the hospital.

On 7/9/20 at 1630 hours, the CNO and IC was informed and acknowledge the findings.