HospitalInspections.org

I. Based on observation, document review, and staff interviews the hospital management failed to ensure that staff have the necessary knowledge and training on the specific chemical products stored in their department(s) or used in performing their job duties. Inpatient census reported as 154.

Failure to ensure that staff receives training on specific chemical products, which are stored and/or used in the hospital, has the potential to put patients at risk for exposure to hazardous chemicals and the potential of physical harm.

Findings include:

1. Observation in the Textile Plant, a building located approximately 250 feet northwest of the West Campus of Mercy Medical Center, revealed a large (250-gallon) Sodium Hydroxide tank. Observation showed, clearly posted on the side of the tank, a safety chart that described the Personal Protective Equipment (PPE), first aid guidelines, and emergency contact phone numbers. A safety shower and eyewash station was located in the southeast center of the building as you enter the clean laundry, within 25-foot distance from the area.

2. Review of Mercy Medical Center - North Iowa Competency Based Orientation (CBO) form for textile (laundry) personnel, reviewed 2/1/20, revealed the following information:
a. Attention Preceptor and Orientee: To ensure patient and associate safety, Competencies #1 and 2 must be introduced and discussed (specific to your department) at the beginning of the first shift of the orientees' employment.

b. Competency Checklist I A. Completes the following safety-related objectives as required by the Joint commission and other regulatory/accreditation groups: 2. Discusses correct procedures and associate's role in: ... i. Code Orange

c. Competency Checklists I and II lacks evidence that textile workers were instructed on the possible hazardous reactions related to the various specific chemical cleaning products that are stored or used for their job duties.

3. Review of Mercy Medical Center - North Iowa Competency Based Orientation (CBO) form for Custodial and Housekeeping personnel, reviewed 2/1/20, revealed:
a. Attention Preceptor and Orientee: To ensure patient and associate safety, Competencies #1, 2, 3, 4, and 5 must be introduced and discussed (specific to your department) at the beginning of the first shift of the orientees' employment.

b. Competency Checklist I A. Completes the following safety-related objectives as required by the Joint commission and other regulatory/accreditation groups: 2. Discusses correct procedures and associate's role in: ... i. Code Orange

c. Competency Checklists I, II, III, IV lacked evidence that custodians, housekeepers, and building service associates were instructed on the possible hazardous reactions related to the various specific chemical cleaning products that are used for their job duties.

4. During an interview on 1/27/10 at 11:30 AM, Staff L, Custodian Services Supervisor, acknowledged that "custodian employees only receive general training on chemical products in orientation. No further training is done unless a new product is purchased for custodian use." Staff L also acknowledged that custodian staff were not trained on the chemical product properties or possible hazards of the chemicals. Staff L stated "I don't know if the chemicals are safe or if there are any incompatibilities between the chemicals".

5. During an interview on 1/28/10 at 8:40 AM, Staff K stated that all new employees attend the general new employee orientation and are required to complete the CBO orientation checksheet. The CBO covers how cleaning products are used and where the MSDS book is located. It is the employee ' s responsibility to look at the MSDS sheets for specific products used in housekeeping. No further training on specific chemicals products is offered to employees unless there is a new product.

6. During an interview on 1/28/10 at 10:15 AM, Custodian Services Manager indicated that a competency based orientation is completed upon hire for custodial services staff, included in this is a " review " of chemicals. Custodial staff persons are "shown" where MSDS sheets are located. The "preceptor" would be responsible to "explain" each chemical to "new hires" if they are unable to read. The hospital is in the process of "developing" an education plan for hazardous materials and goals related to this incident. The Custodian Services Manager confirmed that he had concerns with the lack of knowledge/education of custodial staff for chemical usage, spills, hazardous materials etc ... He stated, " The fact they don't know, worries me too."

7. During an interview on 1/28/10 at 10:26 AM, General Manager for Textile Services presented copies of training documents for textile employees. He stated, "[Maintenance persons name] and I are the ones that received training for chemicals brought by the supplier into the textile facility. [Maintenance persons name] and I would be responsible for the ' in house ' chemical transfers. The employee who died did not have training nor would he have been expected to. " He added, " We do not specifically go through each chemical that we have with each employee, no. "

8. During an interview on 2/1/10 at 7:45 AM, the Safety Officer stated the department managers were responsible for the annual safety education of employees. The Safety Council decides what general safety education topics will be required annually for employees. The department managers are to make annual safety education plans and are responsible for providing the department specific training to their employees.

9. During an interview on 2/1/10 at 9:30 AM, the Logistics/Distribution Manger stated the Logistics/Distribution Department is responsible for receiving and distributing all materials used by the hospital. The manager acknowledged that hazardous chemicals (formaldehyde, xylene, sodium hydroxide, flammable liquids) are received, handled, and stored in the department. "Employees do not receive specific training on what hazards are associated with the chemicals in the department. They do not receive training on what to do if there is a spill or what chemicals should or should not be stored near each other." "I guess this is something we should do something about."

10. During an interview on 2/1/10 at 10:20 AM, the Operation Coordinator of Textile Services (Laundry) acknowledged "No training is done with the textile employees on the specific chemicals located in our department or what to do in case of an emergency involving these chemicals." One chemical that is located in the textile plant is sodium hydroxide (lye).



19125

II. Based on review of policies and procedures, environmental observation and random testing of water temperatures, document review and staff interview the hospital failed to monitor water temperatures and maintain them in a safe parameter in 3 of 4 off site locations/clinics reviewed (Clear Lake Medical Clinic, Regency Medical Center and the Women's Health Center). The Clear Lake Medical Clinic reported a daily census of approximately 90 patients. The Regency Medical Clinic reported a daily census of approximately 80 patients. The Women's Health Center reported a daily census of approximately 65 patients.

The hospital's failure to ensure safe water temperatures placed all patients at risk for scald burns and inadequate removal of possible harmful bacteria from the skin during hand washing.

Findings included.

1. The hospital lacked policies/systems for monitoring water temperatures in the off site locations/clinics.

2. During an interview on 1/27/10 at 10:10 AM, the Director of Support services and the Manager of Engineering confirmed the hospital lacked policies and systems in place for monitoring and maintaining water temperatures in a safe parameter, The Manager of Engineering reported the clinics would be responsible for monitoring water temperatures in the offsite locations. He stated, "Currently it is not being done at the clinics, I'll check with them and will discuss what we can do to remedy this situation."

3. During a follow up interview on 2/1/10 at 10:55 AM, the Manager of Engineering provided the survey team with template for monitoring and documenting hot and cold-water temperatures. He stated, "There is no system in place for clinics or offsite locations currently. We now know that we need to have this, and it was put in place on Friday (1/28/10) after the surveyors pointed it out." The document identified parameters for hot and cold-water temperatures and instructions for staff to contact the Manager of Plant Operations when water temperatures "are out of the prescribed ranges" so "follow thru can be completed."

4. During an interview on 2/1/10 at 8:20 AM, the Clinic Manager of the Clear Lake Medical Clinic verified the clinic did not monitor water temperatures. She stated, "We have not done water temperatures up to this point. I don't have a thermometer to do that. I spoke with the Manager of Engineering last week; he's helping the clinics be compliant with this. We have a grid developed to track water temperatures. I have not assigned that to anyone yet."

5. Random testing of water temperatures in patient care locations throughout the Clear Lake Medical Clinic revealed:
a. Exam room #17 - Hall D, on 2/1/10 at 9:00 AM: 102.4 degrees.
b. Exam room #15 - Hall C, on 2/1/10 at 9:04 AM: 102.4 degrees.
c. Patient restroom, Hall C, on 2/1/10 at 9:18 AM: 102.8 degrees.
d. Exam room #6 - Hall A, on 2/1/10 at 9:30 AM: 104.2 degrees.
e. Examination room #4 - Hall A, on 2/1/10 at 9:32 AM: 104.4 degrees.
f. Exam room #9 - Hall B, on 2/1/10 at 9:38 AM: 104.4 degrees.
g. Exam room #12 - Hall B, on 2/1/10 at 9:40 AM: 102.9 degrees. The Clinic Manager acknowledged patients have access to sinks in examination rooms and restrooms for hand washing.

6. The Project Consultant and Clinic Manager of the Clear Lake Medical Clinic confirmed the water temperatures at the time of the testing.

7. During an interview, on 2/1/10 at 11:42 AM the Nursing Supervisor of the Regency Medical Clinic verified the clinic had not monitored water temperatures until 1/28/10. She stated, "We tested water temperatures on Friday (1/28/10) after the Manager of Engineering contacted us. We were not monitoring water temperatures until then. Temperatures at that time were elevated up to 130 degrees." She reported the clinic had contacted a plumbing and heating company in Mason City, Iowa and they made "necessary adjustments this morning." She continued, "We started the monthly water temperature monitoring grid on 1/28/10. Nursing staff will be responsible for taking temperatures. I have informed the Manger of Engineering of the elevated temperatures. He will follow up to make sure we are compliant with this." The Clinic Manager acknowledged patients have access to sinks in examination rooms and restrooms for hand washing.

8. During an interview, on 2/1/10 at 1:25 PM the Clinic Manger of the Women ' s Health Center verified the center had not monitored water temperatures until 1/28/10. She stated, "Until all these inspections started last week we did not know we were supposed to take water temperatures." She indicated when water temperatures were taken on 1/28/10, they "were under" the parameters. She stated, "The Engineering Manager sent an e-mail to the off site clinic managers with a monthly water temperature monitoring log and let us know we needed to be doing this. The nurses are responsible for taking water temps monthly and documenting them on the monitoring sheets."

9. Random testing of water temperatures in patient care locations throughout the Women's Health Center revealed:
a. Exam room #10, on 2/1/10 at 1:25 PM: 104.5 degrees.
b. Exam room #12, on 2/1/10 at 1:37 PM: 104.9 degrees.
c. Exam room # 7, on 2/1/10 at 1:40 PM: 107.8 degrees.
d. Exam room #3, on 2/1/10 at 1:46 PM: 104.4 degrees.

The Project Consultant and Clinic Manager of the Clear Lake Medical Clinic confirmed the water temperatures at the time of the testing. The Clinic Manager acknowledged patients have access to sinks in examination rooms and restrooms for hand washing.