HospitalInspections.org

Based on observation, review of P&P, review of CDC guidelines and interview with staff (B and F), in 4 of 5 staff observed (B, C, D and E) the facility failed to ensure contact precautions are used for potentially infectious patients, standard precautions are used handling potentially infectious material and environment is cleaned between patient use. This deficiency potentially affects all Pts treated at the facility.

Findings include:

Review on 10/28/13 in the PM of facility P&P titled Cleaning and Disinfection of Patient Care Equipment, effective 7/08, states under Purpose "To remove microorganisms from environmental surfaces and equipment where patients receive healthcare. To prevent the transmission of microorganisms and cross contamination from frequently touched surfaces. To provide a microbiologically safe environment for our patients, staff and visitors." Under Procedure it states "1. Select the appropriate level of disinfectant/cleaning based on the Spaulding Classification System (table 1)" Table 1 lists Non-critical items as "commodes, bedpans, blood pressure cuffs, crutches, bedrails lines, bedside tables, patient furniture and floors, shared play equipment, baby weigh scales" and to use the Sani-wipe product.

Per CDC Guidelines for Infection Control in Healthcare Facilities, dated 2003, under General Cleaning Strategies for Patient Care Areas (page 74) it states "Housekeeping surfaces can be divided into two groups - those with minimal hand-contact (e.g., floors, and ceilings) and those with frequent hand-contact ( " high touch surfaces " ). The methods, thoroughness, and frequency of cleaning and the products used are determined by health-care facility policy.6 However, high-touch housekeeping surfaces in patient-care areas (e.g., doorknobs, bedrails, light switches, wall areas around the toilet in the patient's room, and the edges of privacy curtains) should be cleaned and/or disinfected more frequently than surfaces with minimal hand contact. Infection-control practitioners typically use a risk-assessment approach to identify high-touch surfaces and then coordinate an appropriate cleaning and disinfecting strategy and schedule with the housekeeping staff.

Horizontal surfaces with infrequent hand contact (e.g., window sills and hard-surface flooring) in
routine patient-care areas require cleaning on a regular basis, when soiling or spills occur, and when a patient is discharged from the facility.6 Regular cleaning of surfaces and decontamination, as needed, is also advocated to protect potentially exposed workers..."

Per CDC Guideline for Hand Hygiene in Healthcare Settings (2003) it states under recommendations 1. I. "Decontaminate hands after contact with inanimate objects (including medical equipment) in the
immediate vicinity of the patient."

On 10/28/13 at 1:30 PM, P B performed a blood draw on an outpatient in the lab draw room. After completing the procedure, Staff B handled the lab vials without gloves, and did not perform hand hygiene once the vials were placed in the vial holding container. Staff B left the used tourniquet, gauze and tape on the side table, and did not return to the room to clean in preparation for the next patient. Per interview with Staff B on 10/28/13 at approximately 1:50 PM, "I only clean the room after lunch and at the end of the day."

On 10/28/13 at 3:50 PM, P C performed a blood draw on a patient in room 368. Staff C placed a roll of tape used to secure gauze to the patient's draw site, on the patient's bed. After completing the procedure, Staff B replaced the tape in the lab supply tray, handled the lab vials without gloves, and did not perform hand hygiene once the vials were placed in the vial holding container in the lab.

On 10/29/13 at 8:00 AM, CNA D delivered a breakfast tray to Pt #11 in room 367. There is signage outside the room indicating "Contact Precautions". CNA D did not don gloves or gown prior to entering Pt #11's room. During the same observation, RT E entered room 367, donning gloves and no gown to provide a medication to Pt #11. CNA D and RT E used foam for hand hygiene upon leaving the room. Per interview with RN F on 10/29/13 at approximately 8:10 AM, Pt #11 is on contact precautions due to suspected C-diff (a contagious gastrointestinal disease spread by contact). RN F confirmed CNA D and RT E should have donned both gloves and gown when entering the room, and soap and water should be used for hand hygiene rather than the foam product.