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Based on observations, interviews, and document review, the facility failed to ensure direct patient care staff followed proper infection control practices.

The failure created the potential for an increased risk of infection transmission and the potential exposure to blood borne pathogens.

Findings:

According to the policy, Exposure Control Plan, because the infectious status of patients is often unknown, healthcare workers are to observe Standard Precautions when dealing with all patient body materials at all times. Most important is the avoidance of blood-contaminated penetrating injuries from sharp needles and knives, etc. The use of Standard Precautions is therefore to be practiced in all circumstances.

Standard Precautions: The routine and consistent use of appropriate barrier protection to prevent skin and mucous membrane transmission of microorganisms resulting from contact with blood and body fluids, and as part of the practice of general hygiene.
The following engineering/work practice controls are used throughout the facility: contaminated needles or sharps are not bent, sheared, broken, recapped or removed. If recapping or needle removal is necessary, it is accomplished through the use of an engineered safety device.

According to policy, Infectious Waste Management, sharps will be placed directly into impervious, rigid, leak-proof and puncture resistant containers to eliminate the hazard of physical injury. Safer sharps devices will be used whenever commercially available as a substitute for a specific device.

According to policy, Management of Clean Equipment, when equipment is shared, disinfection of equipment should take place prior to next patient use.

According to policy, Section 4.2 Type and Duration of Isolation, standard precautions must be used in care of all patients. For Droplet Precautions, dedicated equipment should be used, and large reusable items: should be washed with approved germicide.

1. Direct patient care staff failed to follow proper infection control practices, which potentially exposed both staff and the patient to blood borne pathogens.

a) On 04/15/15 at 9:58 a.m., during an Emergency Department (ED) observation, Registered Nurse (RN) #4 placed a peripheral intravenous (IV) catheter in Patient #11. After removing the catheter from the patient, RN #4 placed the exposed needle next to the patient's left leg, and then continued to collect blood samples from the IV site. During the 4 minute period after insertion, RN #4 pressed the safety feature located on the device and retracted the exposed needle safely. At 10:02 a.m., RN #4 removed the glove from his/her right hand, then with his/her bare right hand, placed a transparent dressing over Patient #11's IV site, which was covered with blood.

b) On 04/15/15 at 10:10 a.m., Employee #5 was observed exiting the trauma room, after performing a test on Patient #11, with blood located on his/her left arm sleeve. At 10:15 a.m., an interview was conducted with Employee #5 who stated his/her disposable lab coat was changed at the end of the day or if soiled. Employee #5 further stated s/he checks the lab coat after contact with a patient. During the interview, Employee #5 acknowledged the blood on his/her left sleeve, and stated s/he was not aware his/her Personal Protective Equipment (PPE) was soiled.

c) On 04/16/15 at 9:22 a.m., an interview was conducted with the Assistant Director of Nursing, who stated PPE should be worn if there was potential of staff being exposed to blood during patient care. S/he further stated the PPE should be taken off when exiting a patient's room.

d) On 04/16/15 at 1:27 p.m., an interview was conducted with the Facility's Administrator, who stated s/he expected staff to follow Centers for Disease Control (CDC) guidelines and wear PPE (including gloves) prior to patient contact.

e) On 04/16/15 at 2:43 p.m., an interview was conducted with the Director of Nursing (DON), who stated gloves should be worn at any time when there is potential contact with body fluids, including blood. The DON further stated, s/he expected staff to use safety features on IV catheters, and the catheters should be disposed of safely, as soon as possible.

2. Facility staff failed to disinfect patient care equipment after patient care provided.

a) On 04/15/15 at 10:10 a.m., during an ED observation, Employee #5 completed an electrocardiogram (EKG) on Patient # 11, removed the EKG wires from the patient's chest, and then exited the trauma room without disinfecting the equipment after use.

An interview was conducted immediately after Employee #5 was observed storing the EKG machine in the laboratory area. Employee #5 stated s/he had not disinfected the EKG machine in the past, and was not aware who would be responsible for disinfecting the machine. S/he further stated the machine can be disinfected with water.

During the same interview, the Laboratory Manager, standing nearby, stated equipment should be disinfected when visibly soiled, and was unaware of a policy that stated otherwise.

This was in contrast with the facility policy that stated when equipment was shared, disinfection of the equipment should take place prior to next patient use.

b) On 04/15/15 at 10:40 a.m., during a medication pass observation, Licensed Practical Nurse (LPN) #3 placed his/her stethoscope on Patient #14, then walked to the sink in the patient's room, and cleaned the stethoscope with running water. LPN #3 placed the stethoscope around his/her neck, and then exited the room. Patient #14 was on Droplet Precautions, which would require designated equipment or proper disinfection of equipment after use. LPN #3 stated s/he cleaned the stethoscope with water, due to disinfectant wipes not being available in room. LPN #3 stated s/he should have used disinfectant wipes to disinfect the stethoscope after patient use, and prior to exiting the room.

c) On 04/16/15 at 9:22 a.m., an interview was conducted with the Assistant Director of Nursing, who stated patient care equipment should be disinfected with disinfectant wipes after use.

d) On 04/16/15 at 1:27 p.m., an interview was conducted with the Facility's Administrator, who stated patient equipment needed to be disinfected after use, with disinfectant wipes, alcohol, or per manufacture recommendations.

e) On 04/16/15 at 2:43 p.m., an interview was conducted with the DON, who stated s/he expected staff to disinfect patient care equipment after use. The DON further stated s/he observed staff for compliance with equipment disinfection, but has not documented observations on paper.