HospitalInspections.org

Based on random observation, interview, and policy review, the provider failed to ensure:
*Glucometers were cleaned after each patient's use for patients in isolation.
*Staff performed hand hygiene in accordance with acceptable standards of practice.
Findings include:

1. Observation on 8/30/11 at 10:30 a.m. of registered nurse (RN) A and patient care technician (PCT) B transferring patient 1 from the bed to the chair revealed:
*The staff lifted the patient with a mechanical lift and obtained his weight. After handling the urinary catheter and the wound vacuum container one staff used a marking pen to write the patient's weight on the communication board in the room.
*Without changing gloves RN A disconnected the intravenous (IV) line during the transfer and placed the line over the IV pump.
*After pushing the lift outside the patient's room PCT B gave the patient a drink of water, assisted RN A to make the patient's bed, removed her gloves, and performed hand hygiene.

2. Observation on 8/30/11 at 11:40 a.m. of patient 2's fingerstick blood sugar test revealed:
*Personal protective equipment (PPE) gowns, gloves, and masks were maintained in a cabinet on the patient's door. A sign was posted indicating the patient was on contact isolation.
*After donning PPE RN C used the plastic covering from isolation gown and covered the glucometer.
*After obtaining patient 2's fingerstick blood sugar the glucometer was dropped on the shelf outside the patient's room used by the nurses for documentation.
*The glucometer was not cleaned after use on that patient.

3. Observation on 8/30/11 at 12:50 p.m. of respiratory therapist (RT) D providing a breathing treatment and suctioning of patient 1's tracheotomy revealed:
*After attaching the nebulizer to the patient's tracheotomy the staff member did not change his/her gloves.
*While wearing contaminated gloves:
-Removed a stethoscope from the supply cart and hung it on an IV pole next to the patient's bed, raised the patient's bed, and removed suction supplies from the supply cart.
-Put on sterile gloves over the contaminated gloves worn during the nebulizer treatment.
-Suctioned the patient's tracheotomy.
-Removed the outer contaminated pair of gloves and at the same time discarded the suctioning equipment by wrapping the tubing into the gloves.
-Removed dressing supplies from the clean supply cart, cleansed around the tracheotomy site, put on a clean dressing, reconnected the oxygen tubing, returned the unused tracheotomy dressing back to the supply cart, suctioned the patient, let the head of the bed down, and listened to the patient's breath sounds.
*The first pair of gloves put on by the RT at the beginning of the case was not changed during the patient's care.

Review of the provider's revised 3/9/06 tracheostomy (airway) care policy revealed hand hygiene had not been addressed in the policy.

4. Observation on 8/31/11 at 10:10 a.m. of patient 3's dressing change revealed RN E:
*Performed hand hygiene, put on clean gloves, and removed the bloody dressing from the wound.
*Removed the contaminated gloves, did not perform hand hygiene, put on a pair of clean gloves, opened a tube of sterile saline, and irrigated the wound.
*Removed the contaminated gloves, used hand gel, and put on clean gloves.
*Opened sterile supplies, cut clear adhesive padding and the wound vacuum sponge, to dress the wound.
*Using a pair of scissors cut an opening in the adhesive pad over the wound, packed the wound with the cut wound vacuum sponges, applied suction tubing, and connected the tubing to suction.
*Gathered unused supplies handled during the dressing change and the contaminated scissors and placed them in the clean supply cart.
*Performed hand hygiene and left the room.

5. Review of the provider's undated equipment cleaning policy revealed equipment can serve as a vehicle for transmitting pathogens.
Review of the revised January 2010 hand hygiene policy revealed hands should have been washed:
*Before each patient contact.
*Between patient care activities within the same episode of care if not using gloves or if glove integrity was compromised.
*When moving from high contamination patient care activities to cleaner activities.
*Before donning sterile or non-sterile gloves.
*After any contact with body fluids, dressings, and patient linen.
*After removing gloves.

Interview on 8/31/11 at 10:35 a.m. with the director of patient care revealed:
*All observations listed above included patients in isolation.
*Staff should have been removing gloves and performing hand hygiene when going from a dirty area to a clean area.
*Sterile gloves should not be worn over contaminated gloves.
*Supplies if contaminated during a dressing change should not be returned to the clean supply cart.
*Contaminated scissors should not have been stored in the clean supply cart. The scissors should have been cleaned after completing the dressing change.
*Staff received infection control training annually.

Review of the Centers for Disease Control and Prevention (CDC) Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007 revealed:
*Page 50:"During patient care, transmission of infectious organisms can be reduced by adhering to the principles of working from "clean" to "dirty", and confining or limiting contamination to surfaces that are directly needed for patient care. It may be necessary to change gloves during the care of a single patient to prevent cross-contamination of body sites."
*Page 51: Hand hygiene following glove removal further ensures that the hands will not carry potentially infectious material that might have penetrated through unrecognized tears or that could contaminate the hands during glove removal."
*Page 61: In all healthcare settings, providing patients who are on Transmission-Based Precautions with dedicated noncritical medical equipment has been beneficial for preventing transmission. "When this is not possible, disinfection after use is recommended."