HospitalInspections.org

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Based on observation, document review, and interview, the facility did not ensure that the patients' right to privacy was maintained.

This presence of specific patient information in public view prevents the right to privacy while receiving care in the facility.

Findings:

Observations in the facility's 11 East and 11 West Units during a tour between 10:00AM and 11:45AM on 08/16/16 identified the following:

Five (5) Medication Carts in the hallway had patients' first and last names visible to anyone in the hallway.

During an interview with Staff G (Director of Nursing) on 08/16/16 during the tour, the staff member confirmed the findings.

Observations in the facility's 9 East and 9 West Units during a tour between 2:00PM and 3:00PM on 08/16/16 identified the following:

Five (5) Medication Carts in the hallway had patients' first and last names visible to anyone in the hallway.

During an interview with Staff G (Director of Nursing) on 08/16/16 during the tour, the staff member confirmed the findings.

Observations in the facility's 7 East Unit during a tour between 9:15AM and 10:00AM on 08/17/16 identified the following:

Two (2) Medication Carts in the hallway had patients' first and last names visible to anyone in the hallway.

During an interview with Staff G on 08/17/16 during the tour, the staff member confirmed the findings.

The facility's Policy and Procedure titled "Patient Rights and Responsibilities" last revised 03/30/16 stated the following: "All Nassau Health Care Corporation patients have the right to: Confidentiality in ... all information regarding his / her care."
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Based on observation, document review and interview, the facility did not ensure that medications, needles, and syringes were secured.

This presence of medications, needles, and syringes left unattended and not secure in Unit Hallways places patients at risk for potential harm.

Findings:

Observations in the facility's 11 East and 11 West Units during a tour between 10:00AM and 11:45AM on 08/16/16 identified the following:

Two (2) unattended Medication Carts in the hallway: one (1) with a vial of Insulin and one (1) 3cc syringe with a needle and the other Medication cart with eight (8) syringes with needles on the top of the cart.

During an interview with Staff G (Director of Nursing) on 08/16/16 during the tour, the staff member confirmed the findings.

Observations in the facility's 7 East Unit during a tour between 9:15AM and 9:30AM on 08/17/16 identified the following:

One (1) unattended Workstation on Wheels in the hallway with nine (9) intravenous bags of fluid and one (1) bottle of Sterile Water.

One (1) unattended Medication Cart in the hallway with four (4) intravenous bags of fluid, four (4) 3cc syringes with needles and three (3) Normal Saline 10cc syringes on the top of the cart.

During an interview with Staff G (Director of Nursing) on 08/17/16 during the tour, the staff member confirmed the findings.

During an interview with Staff W (Quality Assurance Coordinator) on 08/17/16 at 11:45AM, the staff member stated that "there is no Policy and Procedure" for securing needles.

The facility's Policy and Procedure titled "Medication Storage and Handling until Administered" last revised 02/15, stated the following: "All medications shall be secure at all times .... Once removed from storage, the drug should not be left unattended."
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Based on observation, interview, and document review, the facility did not: (a) store cleaning and disinfectant supplies in accordance with Manufacturers' Instructions, and (b) separate clean patient equipment from dirty patient equipment.

These lapses in environmental safety may potentially place staff and/or patients at increased risk for hazardous chemical exposure or infection.

Findings pertinent to (a) above include:

Observation in the facility's Central Services Department during a tour on 08/16/16 between 9:30AM and 10:30AM identified the following in the Decontamination Area:

Two (2) opened five (5) gallon containers of the PowerCon Triple Enzyme Detergent, one (1) opened fifteen (15) gallon container of the Valsure Enzymatic Cleaner and two (2) opened PowerCon Instrument Lubricant containers, used in the machine intended for reprocessing (cleaning, disinfecting, sterilizing and drying) reusable critical equipment were located next to the Getinge Washer machine. The containers were opened with the machine dosing pumps inserted into their unsealed openings. Containers were not secured and stored directly on the floor. The machine's Dosing Pump Storage Cabinet door was open and contained old equipment, parts and discarded trash on its shelves.

Per interview with Staff M (Medical Supplies Supervisor) on 08/17/16 at 9:55AM, the staff member explained that the chemical agent containers are too large to fit into the machine's Dosing Pump Storage Cabinet which would normally house a one (1) gallon container. The caps for the larger containers are made of a hard plastic and cannot be pierced to keep the container sealed in the event of accidental spillage. This was confirmed with Staff C (Infection Control Officer) who agreed that the containers for the chemical agents should not be stored directly on the floor, and the parts / trash located in the cabinet should not be there.

The Material Safety Data Sheet (MSDS) for the PowerCon Triple Enzyme Concentrate Detergent, dated 04/01/14, states "Combustible liquid ... may cause eye irritation ... may cause skin irritation ... may cause respiratory tract infection. Vapours may cause drowsiness and dizziness ... do not breathe gas / fumes / vapor / spray ... use only in well-ventilated areas ... handle and open container with care ... keep container tightly closed ...."

The Product Label for the Valsure Enymatic Cleaner states "Contains Citric Acid, Ethanolamin. Causes skin irritation. Causes serious eye irritation. May cause allergy or asthma symptoms or breathing difficulties if inhaled. Avoid breathing mist, vapours, spray ...."

The facility's Policy and Procedure titled "Central Sterile Service" last revised 07/23/15 states "All clean / sterile items must be stored on shelves at least eight (8) to ten (10) inches from the floor ... floor storage is not permitted."

Findings pertinent to (b) above include:

Observation in the facility's Endoscopy Unit during a tour on 08/17/16 between 10:40AM and 12:00PM identified the following in the Endoscope Decontamination Area:

At 10:50AM, Staff O (Endoscopy Nurse) was observed entering the Decontamination Room (DR) where Staff P (Certified Clinical Technician 1) was observed actively pre-cleaning an endoscope in the sink. Staff O retrieved an empty endoscope transport container from the middle shelf of the three (3) shelf rolling cart located behind the DR door. Staff O exited the DR with the container in hand and entered an empty patient procedure room, without performing hand hygiene.

During concurrent interviews at the time of the observation, Staff O confirmed that she retrieved the "cleaned" transport container from the rolling cart in the DR. When asked where she would place the "dirty" transport containers once a dirty scope was encased, she stated "on the top shelf" of the rolling cart. Interview with Staff P revealed that the dirty scopes are placed in a transport bin, brought into the DR, and placed on the top shelf of the rolling cart. Staff P then starts the scope reprocessing process and cleans the transport bin. Once the transport bin is cleaned, it is then placed on the middle shelf, where it is collected by the staff for next use.

On 08/17/16 at 11:00AM these findings were discussed with Staff N (Director of Endoscopy) who confirmed: The clean transport containers should be kept in a separate area from the dirty containers; staff should retrieve clean items from the clean side, not from the decontamination side; and appropriate PPE (Personal Protective Equipment) should be donned and hand hygiene performed when entering or exiting the DR.

The facility's Policy titled "Endoscopy Department" last revised 08/21/15 did not specify where the transport containers are stored after cleaning or where staff should retrieve them when needed. This Policy did state "All personnel handling contaminated endoscopic equipment must wear appropriate PPE, including an impervious gown, gloves, mask, eye covers (other than one's own eyeglasses) [and] hands must be washed after removing PPE.
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Based on record review, interview, and observation, the facility failed to ensure that staff complied with the facility's Infection Control Practices, including the use of Personal Protective Equipment (PPE), Isolation Precautions, Hand Hygiene, appropriate Surgical Attire Procedures, and Environmental Cleaning of the Operating Rooms to avoid potential sources of cross contamination which increase the risk for the spread of infection.

This pattern of ineffective Infection Control Precautions places patients at risk for potential facility acquired infections.

Findings:

See Tag A 749
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Based on document review and interview, in two (2) of seven (7) Personnel Records reviewed, the Infection Control Officer failed to ensure that a current Infection Control Prevention Orientation Education was provided to the Chaplain Service staff.

This failure places patients at risk for potential facility acquired infections.

Findings:

The facility's Chaplain Department List documented that Staff Q (Chaplain) was hired on 10/26/15 and Staff X (Chaplain) was hired on 03/26/15.

During an interview with Staff Y (Sister) on 08/18/16 at 1:00PM, she stated that during Orientation I show new employees an Infection Control Video. There is no post-test. The "video is at least ten (10) years old." When asked if the video includes Isolation Precaution Procedures and the use of PPE (Personnel Protective Equipment) she replied "It does not have what you are looking for."

The facility denied the Surveyor's request to view the video and its contents.
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Based on observation, document review, and interview, the facility failed to ensure that staff complied with the facility's Infection Control Practices. Specifically the staff failed to: (a) follow Isolation Precautions, (b) perform hand hygiene between glove changes during the insertion of an indwelling urinary catheter and maintain aseptic technique during specimen collection, (c) effectively perform hand hygiene in the Operating Room, (d) clean the Operating Room without cross contaminating equipment, and e) don appropriate facial hair covering consistent with facility Policy.

These failure places patients at risk for potential facility acquired infections.

Findings pertinent to (a) above include:

Observations in the facility's 7 West Unit during a tour between 9:30AM and 11:00AM on 08/17/16 identified the following:

In Patient #13's Room, a patient on Contact Isolation, Staff BB (Physician) was observed auscultating the patient's abdomen with a stethoscope. When she completed the procedure, she draped the stethoscope around her neck. Staff BB then exited the Isolation Room without disinfecting the stethoscope.

During an interview with Staff BB on 08/17/16 at 9:50AM, when questioned about disinfecting the stethoscope, stated "I guess I should have wiped it (stethoscope). You should know this is my first day on the floor."

During an interview with Staff G (Director of Nursing) on 08/17/16 during the tour, the staff member confirmed the finding and had the Physician disinfect the stethoscope.

In Patient #12's Room, a patient on Contact Isolation, Staff Q (Chaplain) was observed with an ungloved hand anointing the patient's forehead. Contact Isolation requires staff and visitors to don a gown and gloves to enter the Isolation Room.

During an interview with Staff Q on 08/17/16 at 10:13AM, when the Chaplin was asked if he was aware he needed to wear gloves in the Isolation Room, repeatedly showed the Surveyor his bare hands and stated "I was anointing the sick".

During an interview with Staff G on 08/17/16 during the tour, the staff member confirmed the finding.

During an interview with Staff B (Infection Control Officer) on 08/17/16 at 10:30AM, the staff member stated that "He (the Chaplin) needs gloves to have contact with an (Isolation) patient. He is required to wear gloves as per Policy."

In Patient #13's Room, a patient on Contact Isolation, Staff AA (Aide) was observed entering the room without donning PPE (Personnel Protective Equipment). Staff AA entered the room holding linen. With her left arm she moved the curtain to the side and placed the linen on the table. When she released the curtain it draped across her back. Without performing hand hygiene she exited the room. Then Staff AA, using both hands, touched linen in the linen cart. Contact Isolation requires staff and visitors to don a gown and gloves to enter the Isolation Room. A sign outside the door requires hand hygiene entering and exiting the room.

During an interview with Staff G on 08/17/16 during the tour, the staff member confirmed the finding and instructed Staff AA to perform hand hygiene and discard the linen.

The Policy and Procedure titled "Infection Prevention and Control Manual" last revised 09/16/15 stated the following: "Non-disposable patient equipment such as ... stethoscopes, etc., must be cleaned and disinfected in between patient use with a hospital approved germicidal product such as germicidal wipes." With Contact Isolation "gowns and gloves are indicated for interactions that involve contact with patient and/or contaminated environment / items. Hands must be washed upon entering and exiting the room, after touching infective material, as well as before and after patient contact."

Findings pertinent to (b) above include:

The facility's "Insertion of Indwelling Urinary Catheter Competency" Checklist dated 12/2015 instructed staff to remove [non-sterile] gloves [used to prepare patient], and perform hand hygiene with the provided alcohol hand sanitizer prior to donning sterile gloves and inserting urinary catheter.

The "Isolation and Infection Prevention and Control Manual" dated 09/16/15, states " ... hand hygiene should be performed ... before donning sterile gloves and non-sterile gloves, upon removal of gloves, before performing sterile procedures [and] between contaminated and clean procedures on the same patient ...."

During observation of Patient #16's urinary catheter insertion on 08/18/16 at 9:35AM, Staff CC (Registered Nurse) utilized the alcohol hand sanitizer prior to donning non-sterile gloves while preparing the patient for catheter insertion. After preparing the urinary catheter insertion kit and placing a drape on the patient, Staff CC removed the non-sterile gloves and failed to perform hand hygiene prior to donning the sterile gloves. After inserting the urinary catheter, Staff CC removed her contaminated gloves and failed to perform hand hygiene prior to donning new non-sterile gloves to hang and label the catheter bag.

These findings were confirmed with Staff DD (Associate Director of Nursing) on 08/18/16 at 10:00AM. An interview with Staff B (Infection Control Officer) and Staff C (Infection Control Officer) on 08/18/16 at 10:35AM confirmed the purpose of the sanitizing wipes is to perform hand hygiene after removal of the non-sterile gloves and before donning the sterile gloves immediately prior to catheter insertion. Staff Members B and C also confirmed that hand hygiene should have been performed between all glove changes.

After insertion of Patient #16's urinary catheter on 08/18/16 at 9:35AM, Staff CC (Registered Nurse) was observed bending over to hang the catheter bag from the stretcher, and dropping a bandage scissor from her pocket onto the floor. Staff CC picked the scissor up from the floor with her gloved hand, failed to clean the scissor and returned the scissor to her pocket.

After Patient #16's urine specimen collection was completed on 08/18/16 at 9:49AM, Staff CC (Registered Nurse) was observed attempting to release the vacutainer holder on the specimen collection port of the urinary catheter. Staff CC reached into her pocket with her contaminated gloved hand, retrieved the scissor that had previously fallen onto the floor, utilized the scissor to loosen the vacutainer holder, then with her contaminated gloved hand, returned the contaminated scissor to her pocket.

These findings were confirmed with Staff DD on 08/18/16 at 10:00AM. An interview with Staff B and Staff C (Infection Control Officer) on 08/18/16 at 10:35AM confirmed that there was a break in aseptic technique.

The facility' Policy and Procedure titled "Prevention of Catheter Associated Urinary Tract Infection Guidelines" last revised 03/1/13, states " ... [for] specimen collection, obtain urine samples from a sampling port using an aseptic technique ...."

Findings pertinent to (c) above include:

Observations in the facility's Operating Room (OR) Suite during a tour between 10:00AM and 12:00PM on 08/17/16 identified the following:

Staff QQ (OR Registered Nurse) donned gloves, obtained a cleaning wipe and disinfected an electrical cord then without removing his gloves or performing hand hygiene he proceeded toward OR #8 with the machine and pushed the door with his dirty gloved hand.

Staff QQ then placed a "dirty" machine on the scrub sink counter, removed his gloves and used the alcohol hand sanitizer. Without allowing the hand sanitizer to dry, he entered OR #8 to obtain a cleaning wipe.

Staff S (OR Housekeeper) was observed removing gloves after holding a bag with dirty mop heads that she placed on the floor in the Cleaning Supply Room. Staff S removed her gloves, applied hand sanitizer, and without allowing it to dry, donned new gloves.

The same staff member was again observed removing her gloves after draining and discarding suction canisters. Without performing hand hygiene, she retrieved clean gloves from a box, placed the gloves on the counter and applied hand sanitizer. Without allowing the sanitizer to dry, she donned gloves.

Staff PP (RN) was observed moving a stretcher from OR #12 into the Semi-Restricted Area. Staff PP touched her hair, applied hand sanitizer, and without allowing it to dry, entered OR #12.

Staff R (OR Housekeeper) was observed removing dirty gloves during the cleaning of OR #5. Staff R applied hand sanitizer, and without allowing it to dry, donned new gloves.

These observations were made in the presence of Staff LL (OR Nurse Manager) and Staff II (Quality Management) who were present during the tour and acknowledged that staff should allow hand sanitizer to dry prior to donning clean gloves.

The facility's Policy and Procedure titled "Reduce the Risk of Health-Care Associated Infections" last revised 02/18/16 stated the following: "Alcohol based hand rub, if hands are not visibly soiled, use and alcohol-based hand rub for routinely decontaminating hands for all clinical situations. Allow hands to air dry. Decontaminate hands before donning gloves."

The facility's Manual titled "Infection Prevention & Control Department" (undated) stated (when using) Alcohol Hand Sanitizer "the alcohol hand sanitizer should adequately wet hands. Allow to air dry."

Findings pertinent to (d) above include:

Observations of the facility's cleaning procedures of Operating Room #9 on 08/16/16 at 10:05AM identified the following:

Staff U (OR Housekeeper) was observed cleaning the patient monitoring wires picked up from the floor. Without changing wipes, Staff U continued to clean the anesthesia equipment.

The same staff member was then observed cleaning wires on the anesthesia machine, but contaminated these wires, by touching the dirty anesthesia equipment when trying to place them on an IV pole.

This was observed in the presence of Staff W (OR Nurse Educator) and Staff LL (OR Nurse Manager).

Observations in the facility's Operating Room (OR) Suite #8 during a tour on 08/17/16 between 10:00AM and 12:00PM identified the following:

Staff QQ was observed in the Semi-Restricted Area carrying a Flowtron Machine (medical compression pump). The electrical cord was dragging on the floor as he entered OR #8.

Staff LL instructed Staff QQ to exit the OR and clean the electrical cord. Staff QQ exited the OR then wrapped the dirty cord around the clean machine and placed it on the scrub sink counter.

During an interview with Staff LL on 08/17/16 at the time of the observation, the staff member confirmed the findings.

Additional observations of the facility's cleaning procedures of OR #5 identified the following:

Staff S (OR Housekeeper) cleaned an IV pole then contaminated the IV pole by touching the dirty eye machine. The staff member was then observed cleaning the wires on the anesthesia machine, then contaminating these wires by touching uncleaned wires when placing them on an IV pole.

Staff R was observed cleaning a patient transfer board that was placed on the floor and leaned up against the wall. The staff member then cleaned the board and placed it in the same position after cleaning, without cleaning the wall, and with it touching the dirty floor that had not been mopped.

These observations were made in the presence of Staff KK (Director of Perioperative Services) and Staff LL who acknowledged the findings.

During an interview with Staff K (Director of Infection Prevention and Control) on 08/18/16 at 12:35PM the staff member stated that "the transfer board should not be on the floor (up against the wall) once cleaned." Staff K also stated that the Housekeeper should have cleaned the wall before placing the transfer board against it."

In OR #8 Staff S was observed cleaning the wires on the anesthesia machine, then contaminating these wires by touching uncleaned wires when placing them on an IV pole.

Staff R cleaned the Bear Hugger Machine and electrical cord picked up from the floor. Staff R then contaminated the Bear Hugger Machine by touching the machine with the dirty cleaning wipes.

The same staff member was then observed cleaning the arm extenders for the OR table. After cleaning the arm extenders, Staff R placed the clean extenders onto the dirty chair used to hold discarded dirty cleaning wipes.

These observations were made in the presence of Staff Members KK and LL who acknowledged that the staff member should not have touched the Bear Hugger Machine with the dirty cleaning wipes and placed the clean arm extender onto the dirty chair.

During interviews with Staff GG (Director of Environmental Services) and Staff HH (Housekeeping Supervisor) on 08/17/16 at 11:43AM, when asked about the facility's process for cleaning the OR, and when staff should change cleaning wipes, stated that "staff should be wiping all surfaces from top to bottom, from clean to dirty and using a new cleaning wipe for equipment on the floor."

The facility's Policy and Procedure titled "Surgical Services" last revised 07/07/16, and the "Topic of the Week" Training dated 06/06/16 to 06/10/16 direct staff during daily cleaning to clean horizontal surfaces, equipment, furniture and walls when soiled and to always use a new cloth on each piece of equipment. But they lack instructions on when to change cleaning wipes between dirty and clean tasks.

During an interview with Staff HH on 08/17/16 at 10:00AM, the staff member acknowledged these findings.

Findings pertinent to (e) above include:

Observations in the facility's Operating Room Suite during a tour between 10:00AM-12:00PM on 08/17/16 identified the following:

In the Semi-Restricted Hallway Staff MM (Medical Student) was observed without his beard covered.

In the Semi-Restricted Hallway Staff NN (Anesthesiologist) was observed without his beard covered.

These observations were made in the presence of Staff LL (OR Nurse Manager) and Staff KK (Director of Perioperative Services) who confirmed that they should have their facial hair covered.

The facility's Policy and Procedure titled "Perioperative Services-Operating Room Policy / Procedure: Attire" last revised 04/01/15 contained the following statements under Section 4.5 Surgical Hats / Hoods. "All personnel should cover head and facial hair including sideburns .... Bouffant hats, hoods and face shields that completely cover all head hair and facial hair are to be worn at all times in the Semi-Restricted and Restricted Areas."