HospitalInspections.org

Based on observation, interview and document review, it was determined that for 1 of 2 (Campus #2) Surgical Department reviewed, it was determined that the Hospital failed to ensure maintenance was performed in the Pre- Operative holding area by replacing heavily stained ceilings tiles, a potential infection hazard. This potentially affected all 12 patients scheduled for a surgical procedure on 10/7/2016.

Findings include,

1. On 10/7/2016 at 10:00 AM the Surgical Department at Campus #2 was toured. In the Pre-Operative holding area, there were 7 ceiling tiles above the Nurses' station and patients beds, heavily stained with a brown substance.

2. On 10/7/2016 at approximately 11:40 AM the "Regular Work Order" dated 9/23/2016 was reviewed. The report indicated "...Pre-operative holding area has several stained ceiling tiles to be changed..."

3. On 10/7/2016 at approximately 1:30 PM the Infection Prevention Coordinator (E #2) was interviewed. E #2 stated "I don't know why it was not a priority to replace the ceiling tiles in the Pre-Operative holding area. It should have been placed a one of their top priorities."