HospitalInspections.org

Based on observation, interview, and record review, the hospital's infection control program failed to ensure the prevention of spread of infection and cross contamination as evidenced by:

- No designated locations within the hospital to care for the COVID-19 positive patients;

- No dedicated nursing staff to care only for the COVID-19 positive patients during the shift; and

- Not updating the Policy and Procedure (P&P) titled COVID-19 to reflect the current CDC's recommendations for the use of face masks.


Findings:

Review of the CDC's recommended infection and prevention and control practices when caring for a patient with suspected or confirmed SARS-CoV-2 infection showed in part, as a measure to limit HCP exposure, the facilities could consider designating entire units within the facility, with dedicated HCP, to care for patients with suspected or confirmed SARS-CoV-2 infections. Dedicated means that HCP are assigned to care only for these patients during their shift.

On 7/3/20 at 1330 hours, a tour of the hospital was conducted with the House Supervisor to verify the locations of the confirmed COVID-19 positive patients.

* In the ICU, three COVID-19 positive patients were identified.

In a concurrent interview with RN 1, the nurse stated his assignment for the shift consisted of caring for two patients, one non-COVID-19 patient and one COVID-19 positive patient.

Review of the ICU patient assignment sheet showed RNs 2 and 3 were assigned to care for two patients each, one non-COVID-19 patient and one COVID-19 positive patient.

* In the Medical-Surgical Unit, two COVID-19 positive patients were identified.

The Medical-Surgical Unit did not have a designated location to care for the two COVID-19 positive patients. The two COVID-19 positive patients were in the rooms that were not in close proximity to each other.

Review of the Medical-Surgical Unit assignment confirmed that the unit did not have the dedicated nursing staff assigned to care only for the COVID-19 positive patients during their shift. For example:

- RN 4 was assigned to care for two COVID-19 positive patients and two non COVID-19 patients.

- Two Nursing Assistants were assigned to care for one COVID-19 positive patient each, in addition to providing care to the non-COVID-19 patients during their shift.

On 7/3/20 at 1630 hours, the Chief Nursing Officer and House Supervisor acknowledged the findings and expressed difficulty in designating a location within the hospital and having the dedicated nursing staff to care for the COVID-19 positive patients due to limited staffing.

2. Review of the CDC's guidelines for Considerations for Wearing Masks showed in part, masks are recommended as a simple barrier to help prevent respiratory droplets from traveling into the air and onto other people when the person wearing the mask coughs, sneezes, talks, and raises their voice. For the general public, the CDC recommends all people two years of age and older wear a mask in public settings and when around people who don't live in your household, especially when other social distancing measures are difficult to maintain. COVID-19 can be spread by people who do not have the symptoms and do not know that they are infected. That's why it's important for everyone to wear masks in public settings and practice social distancing (staying at least six feet away from other people).

Review of the hospital's P&P related to COVID-19 revised on 3/30/20, showed, "CDC does not recommend the use of face masks for the general public."

In an interview with the Infection Control Nurse on 7/9/20 at 1400 hours, she acknowledged the COVID-19 P&P needed updating to reflect the current CDC's guidelines.