HospitalInspections.org

Based on observation, interview, and record review, the facility failed implement the COVID-19 (a mild to severe illness caused by a Coronavirus, is transmitted chiefly by contact with infectious material [such as respiratory droplet] and is characterized especially by fever, cough, and shortness of breath and may progress to pneumonia and respiratory failure) infection control practices when:

1. Patient Care Technician (PCT) 1 and Housekeeper (HSKR) 2 did not perform hand washing before putting on and removing gloves during patient care and cleaning of patient rooms respectively in the Emergency Department (ED) area.

2a. PCT 1 did not follow infection control practices in the ED suspected COVID-19 area while wearing cloth face coverings (textile [cloth] covers are intended to keep the person wearing one from spreading respiratory secretions when talking, sneezing or coughing) when she took the oral temperature of one of xx sampled patients (Patient 2).

2b. Emergency Department Director (EDD) and Emergency Department Supervisor (EDS) were wearing cloth face coverings during rounds in the ED area.

2c. HSKR 1 and HSKR 2 were wearing cloth face coverings while cleaning the floor in the ED patient room.

3. Social distancing was not maintained in the registration area of the ED.

These failures had the potential to result in the spread of COVID-19 infection to all patients in the ED, staff, and visitors.

Findings:

1. During an observation and interview on 7/1/20, at 1:25 PM, with PCT 1, in the Emergency Department's (ED) suspected COVID-19 area, Patient 1 presented to the ED wearing a cloth face covering with complaint of shortness of breath and was observed coughing. PCT 1 took Patient 1's vital signs (clinical measurements, specifically pulse rate, temperature, respiration rate, and blood pressure, that indicate the state of a patient's essential body functions) wearing gloves. PCT 1 was observed wiping the vital sign machine and Patient 1's chair with disinfectant (chemical agents designed to inactivate or destroy the growth of harmful organisms) solution. PCT 1 removed her gloves and put on new gloves without washing her hands. PCT 1 stated she should have washed her hands before putting on new gloves and after taking off gloves.

During an observation on 7/1/20 at 2:08 PM, in the main ED patient care area, HSKR 1 and HSKR 2 were observed wearing cloth mask in the hallway. HSKR 2 pushed a closed trash can on wheels outside the patient bay. HSKR 2 went inside the patient bay with gloved hands, took a trash liner bag containing trash from the trash can. HSKR 2 went outside of the patient bay, removed the lid of the closed trash can on wheels and dumped the trash liner bag. HSKR 2 did not removed his gloves or wash his hands before entering the patient bay or after exiting the patient bay. HSKR 2 continued pushing the closed trash can on wheels down the hallway using the same gloves. HSKR 2 adjusted his cloth face covering with his gloved hand after trash removal.

During an observation and interview on 7/1/20, at 2:10 PM, with HSKR 1 and HSKR 2, in the main ED patient care area, HSKR 1 stated she was training HSKR 2. HSKR 1 verified HSKR 2 did not remove his gloves or washed his hands when he entered or exited the patient room. HSKR 1 confirmed HSKR 2 should not adjust his cloth face covering with his gloved hands.

2a. During an observation and interview on 7/1/20, at 1:30 PM, with PCT 1, in the ED suspected COVID-19 area, Patient 2 presented to the ED wearing a cloth face coverings with complaint of shortness of breath and was observed coughing. PCT 1 with gloved hands, had Patient 2 take his cloth face covering down exposing his mouth and nose while PCT 1 took Patient 2's temperature by mouth. PCT 1 took off his gloves after taking Patient 2's temperature. PCT 1 stated she should have wash her hands after she removed her gloves.

During a review of the untitled document (ED census), (undated), the ED census indicated, Patient 1 checked in 7/1/20, at 1:53 PM, reason for visit, SOB (Shortness of breath)- shortness (sic). Patient 2 checked in 7/1/20, at 4:26 PM, reason for visit SOB - shortness (sic).

During an interview on 7/1/20, at 1:40 PM, with Director of Infection Prevention and Employee Health (DIPEH), DIPEH confirmed PCT 1 did not performed hand washing after removing gloves. PCT 1 should have performed hand washing after removing gloves. DIPEH stated PCT 1 should not have had Patient 2 pull mask down to take a temperature by mouth.

2b. During an observation and interview on 7/1/20, at 1:50 PM, with the the Emergency Department Director (EDD) and the Emergency Department Supervisor (EDS), in the ED area, they were observed wearing cloth face coverings. The EDD stated they can wear cloth face coverings because they do not do patient care. EDD confirmed they are not confined to the office and do rounds in the ED. EDD and EDS were present, with cloth face coverings, as the survey was conducted in ED's suspected COVID-19 area.

2c. During an observation and interview on 7/1/20, at 1:55 PM, in the main ED area, Housekeeper (HSKR) 1 and HSKR 2 were observed wearing cloth face coverings. Housekeeper 2 was observed cleaning the floor around the feet of an unmasked patient standing in the doorway of his room. HSKR 1 stated she cleaned rooms with patients, while wearing the cloth mask. HSKR 2 stated the Director of Environmental Services (DEVS) allows them to wear cloth or surgical masks in cleaning patient care areas during their shift.

During an observation and interview on 7/1/20, at 2 PM, with HSKR 2, in the main ED area, HSKR 2 was observed wearing a cloth mask. HSKR 2 stated he cleans patient rooms, floors, makes beds, wipes down equipment, and empties trash with or without patient's presence.

During an interview on 7/1/20, at 2:05 PM, with DIPEH, in the Main ED patient care area, DIPEH stated staff can wear cloth face coverings in the ED hallway. Hallways are not considered patient care areas. She also stated staff including housekeepers are not to wear cloth face coverings in patient care areas or patient rooms.

3. During an observation and interview on 7/1/20, at 1:45 PM, with Revenue Cycle Manager (RCM) and Emergency Department Director (EDD), in ED registration area, the patient chairs were positioned across from the registration clerk's desk without a designation of 6 feet or a barrier. The RCM confirmed there were no marks designating 6 feet from the registration clerks or a barrier. RCM stated she "never thought about" social distancing in the registration area. RCM verified the distance between the registration clerks and the patient chair should be 6 feet. The EDD measured the distance from the registration clerk and patient chair and stated it is less than 6 feet.

During a review of the facility's policy and procedure (P & P) titled, "Isolation Precautions-Standards," dated 11/18, the P & P indicated, "B. Standard Precautions 1. Standard precautions are used by all care providers...2. Standard precautions are used when handling patient equipment. 3. Standard precautions include hand hygiene...and requires the use of personal protective equipment (PPE) based on type of activity... 4. Personal Protective Equipment (PPE) a. Gloves...4) Before leaving room, remove gloves and discard... 5) Wash hands immediately after removing gloves or use alcohol based hand rub. 7) Wearing gloves does not replace the need for hand hygiene. d) Hand Hygiene... 2) Hand hygiene is performed upon entering and at the time of exiting patient room regardless of whether or not any contact occurred with the patient or environment. 3) Perform hand hygiene as promptly between patient contacts and after contact with... equipment or articles contaminated by them."

During a review of the Kern County Public Health Services Department URGENT HEALTH BULLETIN titled, "Universal, Masking in Healthcare Settings, Resuming Deferred HealthCare Services, Discontinuation of Isolation, Community-Based COVID-19 Testing Sites, Serology Testing, Coordination with skilled Nursing Facilities, dated 5/6/20, the Urgent Health Bulletin indicated, "On April 14, 2020, a Health Officer Order was issued which requires universal masking of all healthcare workers and patients while in a healthcare facility. This includes acute care settings...Healthcare workers should wear a facemask at all times while in facility...Healthcare workers assessing or caring for a suspected or confirmed COVID-19 patient must continue to wear appropriate PPE, including an N-95 respirator (or facemask if respirator is not available..Cloth face coverings are not appropriate for healthcare workers while on duty. Maintaining 6 feet away from others (social distancing) and appropriate hand washing are the most effective methods for reducing the transmission of COVID-19. Wearing a mask does not replace these measures."