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Based on observation, staff and patient interview, and medical record review, it was determined the CAH failed to ensure precautions were taken to prevent the spread of communicable diseases. This affected the care of 2 of 2 patients (#33 and #48) who had isolation precautions ordered and whose records were reviewed. This resulted in the potential to spread infections. Findings include:

1. Patient #48's medical record documented a 71 year old female who was admitted to the CAH on 2/04/15 and was discharged on 2/09/15. Her diagnosis was a kidney infection early sepsis syndrome. A History and Physical Examination, dated 2/04/15, stated a urine culture, done 1/22/15, grew MRSA. An order, dated 2/04/15 at 5:30 PM called for "ISOLATION PRECAUTIONS-CONTACT." The order stated Patient #48 was a "MRSA carrier."

Patient #48 was interviewed on 2/09/15 beginning at 1:15 PM. A sign was on her door stating she was on Contact Precautions and persons entering the room needed to wear protective clothing. The Health Safety Nurse assisted the surveyor to don a gown and gloves when entering the room. Patient #48's husband was sitting in the room in his street clothes, not wearing a gown and gloves. He stated staff wore protective clothing when in the room. He stated staff told him he did not have to wear the protective clothing. The surveyor then asked the Health Safety Nurse who stated the husband should wear protective clothing in the room.

Patient #48 was discharged home on the afternoon of 2/09/15. She was observed again on 2/12/15 beginning at 9:00 AM. She was in the outpatient department receiving intravenous antibiotics. She stated she was coming to the CAH daily for treatment. She was in her regular clothes and no isolation precautions had been taken. The RN caring for the patient was asked about precautions. She stated she did not know Patient #48 had a history of MRSA. She also stated she was not aware Patient #48 had been on contact precautions while an inpatient.

The CAH failed to enforce isolation procedures for persons entering Patient #48's room and failed to plan for her outpatient treatment.



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2. Patient #33 was an 80 year old female admitted to the CAH from the ED on 2/09/15. She was brought to the ED by her family due to confusion, high blood pressure and recent history of falls.

Patient #33's record included a History and Physical, dictated by her physician on 2/09/15 at 8:13 PM. The physician's assessment stated, "Diarrhea of unclear etiology [cause] ...suspicious for Clostridium difficile..."

The Centers for Disease Control website, accessed on 2/13/15, defined Clostridium Difficile as a germ that can cause diarrhea. It stated contact precautions should be used in the hospital to prevent the spread of Clostridium Difficile (C. Diff) to other patients. Additionally it stated, "The elderly and people with certain medical problems have the greatest chance of getting C. Diff. C. Diff spores can live outside the human body for a very long time and may be found on things in the environment such as bed linens, bed rails, bathroom fixtures, and medical equipment. C. Diff infection can spread from person-to¿-person on contaminated equipment and on the hands of doctors, nurses, other healthcare providers and visitors."

Patient #33's record included an order for a C. Difficile toxin and antigen laboratory test, dated 2/09/15 at 7:39 PM, and signed by her physician. This test is used to detect the presence of clostridium difficile in the stool. Her record also included an order for contact isolation precautions, dated 2/09/15 at 7:16 PM, and signed by her physician.

A policy titled "Isolation Precautions, Transmission Based" effective 11/30/13, described contact isolation precautions. It included, "Wear gloves and a disposable, one-time-use isolation gown with any direct contact with the patient and/or their environment, including when entering the room/bay."
On 2/10/15, at 10:50 AM, Patient #33 was observed in her inpatient room. Staff members in the room were noted to wear gowns and gloves. However, a visitor was present in the room in street clothing, without a gown or gloves.

During an interview on 2/10/15 at 3:15 PM, the DON confirmed visitors had not been instructed to wear a gown and gloves while in Patient #33's room. She stated staff education related to infection control and isolation procedures included precautions for visitors, and confirmed Patient #33's visitors should wear a gown and gloves while in her room.

The facility did not take measures to control the spread of communicable disease by including visitors in their isolation precautions.