HospitalInspections.org

Based on observation, review of facility documents, credential files (CF), medical records (MR), and interview (EMP) and (OTH), it was determined the facility failed to ensure hand hygiene was performed by staff and visitors for patients in isolation for Clostridium difficile infection (CDI), failed to ensure Personal Protective Equipment (PPE) was used by staff and visitors for patients in isolation for CDI, failed to ensure staff and visitors were provided with education regarding isolation for patients with CDI, failed to ensure the correct isolation signage was provided for a patient in isolation for CDI, failed to ensure housekeeping staff were wearing PPE correctly and performed hand hygiene as required, and failed to ensure nursing staff performed hand hygiene as required.

Findings include:

Review on June 4, 2015 of the facility policy "Care of a Patient with a Clostridium Difficile Infection," dated approved January 20, 2015, revealed "I. Policy To help prevent the transmission of the organism from patient to patient and to help clean and remove Clostridium Difficile (C-diff) spores from the contaminated environment. II 1. Use standard precautions for all patients regardless of diagnosis. 2. Patient presenting with active liquid watery diarrhea will have a c-diff stool obtained with first possible to obtain [sic] liquid watery diarrhea episode and immediately placed in contact isolation. (Standing order on CPOE orders) 3. Patients with a positive test for C. difficile will continue to be in C-diff isolation. a. Change gloves immediately if visibly soiled, and after touching or handling surfaces or materials contaminated with feces. b. Contact isolation signage will be posted outside the patient's room and will be removed by EVS [environmental services] after the patient is discharged and the room has been terminally cleaned with approved germicide. ... 5. Hand hygiene a. Perform hand hygiene upon removal of gown and gloves and exiting patient room. b. Hand hygiene is the only method to disinfect hands when caring for patient with CDI [C. difficile infection]. c. Hand washing. 6. Patient education a. Provide information about CDI and its transmission to patient and family. (FAQ). b. Instruct patient and family about contact precautions and importance of hand hygiene. (FAQ) c. Inform patient and family that information can be found in the Patient Guide. ..."

Review on June 4, 2015 of the facility policy "Contact Precautions," dated approved May 12, 2014, revealed "... Policy I. In order to reduce the risk of transmission of microorganisms, Contact Precautions will be routinely practiced by all Regional Hospital of Scranton personnel whenever indicated. ... II. Use of Personal Protective Equipment (PPE) A. Gloves 1. Wear gloves whenever touching the patient's intact skin or surfaces and articles in close proximity to the patient (e.g. medical equipment, bed rails). 2. Don gloves upon entry into the room or cubicle. B. Gowns 1. Wear a gown whenever anticipating that clothing will have direct contact with the patient or potentially contaminated environmental surfaces or equipment in close proximity to the patient. Don gown upon entry into the room or cubicle. 2. Remove gown and observe hand hygiene before leaving the patient-care environment. After gown removal, ensure that clothing and skin do not contact potentially contaminated environmental surfaces that could result in possible transfer of microorganisms to other patients or environmental surfaces. ..."

1) Observation tour on June 4, 2015, at approximately 11:00 AM of the 7 East nursing unit revealed a contact isolation sign on the door of MR2. EMP1 was observed garbing and entering the room to provide patient care. The protocol posted on the door was followed for hand hygiene and personal protective equipment. Shortly after EMP1 entered the room, OTH1 and OTH2 were observed exiting the room without gloves or PPE. OTH1 and OTH2 did not use the alcohol hand sanitizer outside the door of the patient room. EMP3, present during the observation, revealed the isolation for MR2 was actually for a C-difficile infection which required handwashing with soap and water and not the use of the alcohol foam. OTH2 was stopped and reminded to perform hand hygiene. OTH2 stated they would wash their hands shortly. OTH2 was not observed performing the required hand hygiene prior to leaving the area. OTH1 confirmed they were not provided with the family/patient instructions on contact isolation precautions or instructions on wearing PPE. Further review of the door signage revealed the sign was for contact isolation. The signage did not provide the information specific to the hand hygiene required for the C-Difficile infection. EMP3 confirmed the wrong signage was on the door.

Interview on June 4, 2015, at the time of the tour, with EMP4 confirmed the wrong signage was on the door for MR2. EMP4 confirmed the policy for "Care of a Patient with a Clostridium Difficile infection" was not followed.

Interview with EMP5 on June 4, 2015, at the time of the tour confirmed the isolation procedures were not followed. EMP5 stated the staff was often uncomfortable approaching medical staff that did not follow protocol.

Review of MR2 confirmed the patient had a C-difficile infection. There was no documentation of education provided to the family regarding the isolation precautions and the use of personal protective equipment.

Review of the credential file for OTH2 (CF1) revealed no documentation of education regarding isolation precautions, including garbing and appropriate hand hygiene.

2) Observation tour of the Intensive Care Unit on June 4, 2015, at approximately 9:35 AM revealed a room being cleaned by EMP6. EMP6 was wearing the Personal Protective Equipment (PPE) gown backwards while cleaning the room. EMP6 did not perform hand hygiene immediately following removal of the gown.

Interview on June 4, 2015, at 9:40 AM with EMP6 confirmed they were unaware the PPE gown was on backwards. When asked to provide their knowledge of the policy regarding cleaning an isolation room, EMP6 omitted the portion of the policy regarding hand hygiene.

3) Review on June 4, 2015, of the facility policy "Hand Hygiene/Artificial Nail Policy - CDC Guidelines," last reviewed January 22, 2015, revealed "I. Introduction: Hand hygiene is considered the single most important procedure for preventing healthcare associated infections. Bacteria are easily spread in the hospital environment from patient to patient via the hands of healthcare workers. Any contact with the patient or the patient's environment could result in the transfer of microorganisms to the hands. Following Standard Precautions, avoiding contamination of the hands and performing appropriate hand hygiene is essential in helping to prevent the spread of microorganisms. When hand hygiene is necessary, Regional Hospital of Scranton personnel will follow hand hygiene practices in accordance with current CDC or WHO guidelines. ... B. Indications for hand hygiene: ... 4. After touching wounds or any body surface likely to be contaminated with blood, body fluids or microorganisms. ... 7. After removing gloves. ..."

Observation tour of the Intensive Care Unit on June 4, 2015, at approximately 11:45 AM revealed EMP7 withdrawing blood from the patient's central line for a blood glucose monitoring specimen. EMP7 removed their gloves and attended to the Intravenous (IV) pump. EMP7 did not perform hand hygiene after removing their gloves.

Interview on June 4, 2015, at 11:45 AM with EMP7 confirmed they are supposed to perform hand hygiene when gloves are removed and before going on to perform another task.