HospitalInspections.org

Based on observations and interviews, the hospital failed to ensure Coronavirus Disease ("COVID-19") screening for employees included questions related to exposure to others with suspected or confirmed SARS-CoV-2 infection; limiting and monitoring entrances into the hospital; and posting visual alerts related to source control and hand hygiene. The failure to implement all possible strategies to prevent and control the transmission of COVID-19, as recommended by the United States Centers for Disease Control and Prevention ("US CDC") has the potential to affect all patients.

Findings:

1. The US CDC "Interim Infection Prevention and Control Recommendation for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic", updated 2/10/2021, states, "Screen and Triage Everyone Entering a Healthcare Facility for Signs and Symptoms of COVID-19...symptom screening remains an important strategy to identify those who could have COVID-19 so appropriate precautions can be implemented...Establish a process to ensure everyone (patients, healthcare personnel, and visitors) entering the facility is assessed for symptoms of COVID-19, or exposure to others with suspected or confirmed SARS-CoV-2 infection and that they are practicing source control".

The Down East Community Hospital procedure titled, "COVID-19 DECH Screening Process and Management" states the following: "All employees are required to have a temperature and symptom check upon arrival to work..."

A review of the "Daily Employee COVID-19 Screening" log asked the employee to initial a box indicating that they were attesting to their temperature was taken and was below 100 degrees Fahrenheit and that they had no flu or cold symptoms (such as new onset of fever/chills, cough difficulty breathing, shortness of breath, congestion, runny nose, sore throat, nausea, vomiting, diarrhea, or new loss of taste or smell).

There was no evidence that the hospital was screening employees for exposure to others with suspected or confirmed SARS-CoV-2 infection as recommended by the US CDC.

On 5/5/2021 at 1:00 PM, Infection Preventionist ("IP") #1 and IP #2 were interviewed. They confirmed the screening log did not ask about exposure to others with suspected or confirmed SARS-CoV-2 infection as recommended by the US CDC.

Based on the above, the hospital failed to screen for exposure to others with suspected or confirmed cases of COVID-19 upon entrance to the hospital.

2. The US CDC "Interim Infection Prevention and Control Recommendation for Healthcare Personnel During the COVID-19 Pandemic", updated 2/23/2021, states everyone is to be screened entering the facility and the points of entry should be limited and monitored.

The Down East Community Hospital procedure titled, "COVID-19 DECH Screening Process and Management" states the following: "All employees are required to have a temperature and symptom check upon arrival to work. Orange binders have been distributed by each department leader and will be kept in the best location for that department. Forms for sign-in are in a binder, along with directions for use of the thermometer. Your department leader will explain the log-in procedure and answer your questions. Sign-in is once per day, no need to re-sign if you leave and come back in the same day."

On 5/4/2021 at 1:00 PM, interviews were conducted with IP #1 and IP #2 who stated there were four (4) entrances to the hospital. The Main Entrance and the Emergency Department Entrance remains open all the time; the entrance adjacent to the obstetrics department is locked and staff can access the building through this entrance with an employee badge swipe; and the the main back entrance is locked from 7:00 PM to 6:00 AM and staff can access the building with an employee badge swipe. IP#1 and IP#2 stated staff access the hospital via all four (4) of the entrances.

On 5/4/2021 at 1:05 PM, the entrance adjacent to the obstetrics department and the main back entrance to the hospital were observed. Neither of these entrances were monitored. These observations were confirmed by IP#1 and IP#2 who were present during the surveyors observations.

On 5/4/2021 at 2:30 PM, Environmental Services Staff member ("EVS") #3 and EVS #4 were interviewed together. They stated during the week they enter the hospital at the main entrance for a COVID-19 screening and then conduct a self-initiated COVID-19 screening in their department and on the weekends, they enter through the back entrance of the hospital and proceed to their department for a self-initiated COVID-19 screening.

On 5/4/2021 at 2:50 PM, EVS #1 and EVS #2 were interviewed and stated they enter the hospital through the entrance adjacent to the obstetrics department then proceed to their department for self-initiated COVID-19 screening.

On 5/5/2021 at 6:00 AM, staff reporting for work through the entrance adjacent to the obstetrics department were observed. No COVID-19 screening was performed upon entrance to the hospital. The staff had to proceed to a department to conduct COVID-19 screening.

On 5/5/2021 at 6:20 AM, Certified Nursing Assistant ("CNA") #1 and CNA #2 from medical/surgical department, were observed entering the hospital through the front entrance then they proceeded to their department where they self-initiated a COVID-19 screening.

On 5/5/2021 at 6:30 AM, Registered Nurse ("RN") #1, from surgical services, was observed entering the hospital through the main entrance and then the RN proceeded to the surgical department to self-initiate a COVID-19 screening.

On 5/5/2021 at 7:25 AM, RN #3, from the obstetrics department, was interviewed and she stated, she enters the hospital at the main back entrance then walks through the hospital to her department where she self-initiates a COVID-19 screening.

On 5/5/2021 at 8:00 AM, a surveyor entered the hospital through the main back entrance and proceeded through the hospital to the main entrance for a staff assisted COVID-19 screening.

On 5/5/2021 at 8:00 AM, CNA #3, from the obstetrics department, was interviewed and she stated she enters the hospital and proceeds to her department where she self-initiates a COVID-19 screening.

On 5/5/2021 at 8:10 AM, RN #2, from the medical/surgical department, was interviewed and she stated she enters the hospital and proceeds to her department where she self-initiates a COVID-19 screening.

On 5/5/2021 at 8:20 AM, CNA #2, from medical/surgical department, was interviewed and she stated, she enters the hospital and proceeds to her department where she self-initiates a COVID-19 screening.

On 5/5/2021 at 8:25 AM, MD #1 was interviewed and he stated no one screens him for COVID-19 at the hospital and he screens at home.

On 5/5/2021 at 8:50 AM, MD #2 was interviewed and she stated she does not need COVID-19 screening but she used to before being vaccinated.

On 5/5/2021 at 9:30 AM, RN #4 and RN #5, from the infusion clinic were interviewed and they stated they enter the hospital and proceed to their department where they self-initiate a COVID-19 screening.

On 5/5/2021 at 9:45 AM, Cardiopulmonary Staff ("CP") #1 and CP #2 were interviewed and they stated they enter the hospital and proceed to their department where they self-initiate a COVID-19 screening.

On 5/5/2021 at 10:00 AM, RN #6 and CNA #4 from the cardiac rehab department, were interviewed and they stated they enter the hospital and proceed to their department where they self-initiate a COVID-19 screening.

On 5/5/2021 at 1:00 PM, IP #1 and IP #2 were interviewed. They confirmed the hospital wide standard screening procedure for COVID-19 is for employees to enter the hospital from any of the four entrances and proceed to their respective department to self-initiate the screening and record results on the screening log.

On 5/5/2021 at 2:30 PM, Radiology Staff ("XR") #1 and XR #2 were interviewed and they stated they enter the hospital and proceed to their department where they self-initiate a COVID-19 screening.

On 5/6/2021 at 8:00 AM, a surveyor entered the hospital through the main back entrance and proceeded to the main entrance to perform a staff assisted COVID-19 screening.

Based on the above information, the hospital failed to ensure everyone is screened upon entering the facility, instead of proceeding through the hospital to their respective departments, and the points of entry are limited and monitored. In addition, the hospital has failed to ensure all who enter the hospital are screened upon entrance.

3. The US CDC "Interim Infection Prevention and Control Recommendation for Healthcare Personnel During the COVID-19 Pandemic", updated 2/23/2021, states: "Post visual alerts (e.g., signs, posters) at the entrances and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide instructions (in appropriate languages) about wearing a well-fitting form of source control and how and when to perform hand hygiene."

On 5/4/2021 at 1:00 PM, interviews were conducted with IP #1 and IP #2 who stated there were four (4) entrances to the hospital. The Main Entrance and the Emergency Department Entrance remains open all the time; the entrance adjacent to the obstetrics department is locked and staff can access the building through this entrance with an employee badge swipe; and the the main back entrance is locked from 7:00 PM to 6:00 AM and staff can access the building with an employee badge swipe. IP#1 and IP#2 stated staff access the hospital via all four (4) of the entrances.

On 5/4/2021 at 1:05 PM, the entrance adjacent to the obstetrics department was observed. There were not visual alerts at this entrance. This observation was confirmed IP#1 and IP#2 at the time of the surveyor's observation.

On 5/4/2021 at 1:15 PM, the main entrance to the hospital was observed. This entrance did not display visual alerts in relation to how and when to perform hand hygiene. This observation was confirmed IP #1 and IP #2 at the time of the surveyor's observation.

On 5/4/2021 at 1:25 PM, the main back entrance to the hospital was observed. This entrance did not display visual alerts in relation to how and when to perform hand hygiene. This observation was confirmed IP #1 and IP #2 at the time of the surveyor's observation.

On 5/4/2021 at 1:35 PM, the emergency department entrance was observed. This entrance did not display visual alerts in relation to how and when to perform hand hygiene. This observation was confirmed IP #1 and IP #2 at the time of the surveyor's observation.

Based on the above information, the hospital failed to followed US CDC recommendations related to visual alerts at all entrances.