HospitalInspections.org

I. Based on document review and staff interview, the Critical Access Hospital (CAH's) administrative staff failed to ensure the surgical services staff did not use Immediate Use Steam Sterilization (IUSS) to avoid obtaining sufficient quantities of surgical instruments on 13 of 14 incidents of IUSS reviewed. The CAH's administrative staff identified an average of approximately 5 patients per month who underwent either ear tubes or cataract procedures.

Failure to not use IUSS for routine sterilization of surgical instruments could potentially result in the sterilization process failing to fully sterilize the equipment and potentially transmit an infection between patients.

Findings include:

1. Review of the document "Immediate-Use Steam Sterilization," not dated, revealed in part, "Instrument inventories shall be sufficient to meet anticipated surgical volume and permit the time to complete all critical elements of reprocessing."

2. Review of the document "Immediate Use Log," between 10/25/16 and 6/21/17, revealed 14 instances where the surgical services staff used Immediate Use Steam Sterilization. The log contained 6 instances where the surgical services staff members used IUSS to quickly reprocess (the process where the surgical staff clean and sterilize surgical instruments) surgical instruments for the removal of cataracts on 10/25/16 (2 sets of instruments), 12/6/16 (3 sets of instruments) and 5/23/17 (1 set of instruments). The log contained 4 instances where the surgical services staff members used IUSS to quickly reprocess surgical instruments for the placement of ear tubes on 3/1/17, 3/29/17, 4/5/17, and 5/31/17. The log contained 3 instances where the surgical services staff members used IUSS to quickly reprocess surgical instruments for the removal of tonsils on 12/21/16 and 3/29/17 (2 instances).

3. During an interview on 6/20/17 at 4:00 PM, the Surgical Services Manager acknowledged the surgical services staff had used IUSS in 13 instances to quickly reprocess surgical instruments. The Surgical Services Manager stated the facility lacked sufficient quantities of the surgical instruments to meet the expected surgical volume, so the staff used IUSS to quickly prepare the used surgical instruments for use with another patient the same day.


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II. Based on observations, document review and staff interview, the facility failed to handle and serve food under sanitary conditions in order to reduce the risk of contamination and food-borne illness. The Critical Access Hospital (CAH) identified a census of 6 patients. The Dietary Manager reported the department provides an average of 40 patient meals per day.

Failure to handle food in a sanitary manner could potentially result in the contamination of the patients' food and potentially cause food borne illness.

Findings include:

1. Observation on 6/20/17, from 7:15 AM to 7:25 AM, revealed Staff B, cook, assigned to prepare and serve hot food items at the breakfast meal and had donned gloves prior to the beginning of the observation. Staff B wore the same gloves during the entire observation period and touched a variety of surfaces including, but not limited to, cooking spray oil can, liquid margarine bottle, patient meal order tickets, heated plate bases, base heater, toaster, towel (used to wipe off grill), margarine spread container, bread wrapper and drawer handles. During the observation Staff B touched ready-to-eat (RTE) food with the contaminated gloves, including toast and bacon served to 4 patients.

2. Observation on 6/21/17, from 7:15 AM to 7:40 AM, revealed Staff C, cook, assigned to prepare and serve hot food items at the breakfast meal and had donned gloves prior to the beginning of the observation. Staff C changed gloves 11 times during the observation, but failed to wash her hands prior to donning the fresh gloves on each occasion. Staff C touched a variety of surfaces, including but not limited to, refrigerator and freezer drawers, glove box, steamtable lids, utensil drawer, bread, waffle and french toast wrappers, toaster, liquid margarine bottle, cooking spray oil can, garbage can rim, heated plate bases, base heater and a dishcloth (used to wipe off grill). During the observation Staff C touched RTE food with the contaminated gloves, including waffles, french toast, toast, bacon and cheese slice served to 7 patients.

During an interview on 6/21/17, at 11:30 AM, Staff A, Dietary Manager, reported dietary need to wear gloves to handle RTE food but can use a spoon or tongs to avoid touching food. She identified staff should wash their hands prior to donning clean gloves and acknowledged if other surfaces are touched, the gloves can become contaminated and would need to be changed. Staff A reported she has provided dietary staff with education and training on glove use but did not have any recent documentation of the training. She identified all dietary staff, except for one new staff have completed Serv Safe certification (which covers proper glove use with food handling), including Staff B and Staff C , but could not locate the certificate of completion for Staff C.

During an interview on 6/21/17, at 11:55 AM, Staff C, Cook, reported she wears gloves when she needs to touch food and change them frequently. She identified she would change the gloves if she handled something "messy" and wash her hands, but for items like toast, would not necessarily change gloves and would continue with other tasks unless she touched something "dirty".

During an interview on 6/22/17, at 9:15 AM Staff B, Cook, reported she knew she needed to use gloves to handle RTE food but had not thought about all the surfaces she touched with the same gloves, including the food. She acknowledged that when she touched a variety of surfaces with the gloved hands, it would be no different than a bare hand.

The 2013 Food Code, published by the Food and Drug Administration and considered a standard of practice for the food service industry requires food employees to wash their hands immediately before engaging in food preparation, including before donning gloves for working with food in order to prevent cross contamination when changing tasks. Single-use gloves are to be used for only one task, such as working with ready-to-eat food or with raw animal food, and used for no other purpose, and discarded when damaged or soiled, or when interruptions occur in the operation.