HospitalInspections.org

The facility failed to fully implement an effective system for controlling infections and communicable disease. The facility failed to ensure:

1. Staff and physicians appropriately utilized personal protective equipment (PPE) while in in the operating room(OR).

2. Staff cleaned / disinfected the OR per policy between cases.

3. Storage of clean and sterile supplies per professional standards.

Findings include:

TX 00228628

Appropriate Use of PPE in OR:

Observation on 01-14-16 at 11:40 a.m. in OR # 7 revealed various facility staff preparing for Patient #1's surgical procedure ( ventral hernia repair). Patient # 1 was in the room at this time and laying on the OR table. The following observations were made:

*Registered Nurse (RN) # 6 entered the room and obtained a pair of exam gloves from a box on the wall. One of the gloves fell on the floor. RN # 6 picked up the contaminated glove from the floor and put it on. Wearing this same contaminated glove, RN # 6 proceeded to prep Patient #1's abdomen prior to the surgical incision.

*RN # 7 was repositioning various equipment in the room. Long cables fell to the floor from a cart that contained an unknown piece of patient equipment. RN # 7 retrieved the contaminated cables from from the floor and placed them into the equipment draw without properly wiping with a disinfectant.

*Certified Registered Nurse Anesthesist (CRNA) # 8 failed to have his face mask properly tied and secured at the back of his neck. The lower ties were visibly loose. CRNA # 8 tugged at the bottom of his face mask below his mouth multiple times before and during the procedure.

*CRNA # 8 unwrapped the laryngoscope blade and went directly and touched the computer screen. He then donned gloves without first performing hand hygiene.CRNA # 8 proceeded to intubate Patient # 1.

*RN # 6 and Surgeon # 9 both failed to have their hair properly secured under their head coverings. Both had visible hair at the nape of their necks.

Review of facility policy titled: "Surgical Attire," dated 08/14, read: "..Purpose: To provide guidelines for the appropriate use, care, and handling of attire worn in the restricted and semi restricted area of the surgery department...Procedure:...2. head and facial hair, including sideburns and neckline, should be covered when in the semi-critical areas of the surgical suite ...8. Wear a single mask in surgical environment where open sterile supplies or scrubbed persons may be located. A mask should cover both mouth and nose and be secured in a manner that prevents venting..13...a. Gloves should be selected & worn..( sterile/unsterile) depending on tasks to be performed..b. Gloves must be changed..after contact with contaminated items... "

Review of "Perioperative Standards & Recommended Practices ( Association of periOperative Registered Nurses "(AORN) 2012, read: "...Recommendation ...V1a...A mask that is securely tied at the back of the head and behind the neck decreases the risk of healthcare personnel transmitting nasopharyngeal and respiratory microorganisms to patients or the sterile field..."

Review of facility policy titled "Hand Hygiene," dated 08/13, read: " Procedures: 1. Indications for handwashing and hand antisepsis:...C. Decontaminate hands before having direct contact with patients...H..Decontaminate hands after contact with inanimate objects, including medical equipment, in the immediate vicinity of the patient...I. Decontaminate hands after removing gloves..." ...

Disinfecting of the OR between cases:

Observation on 01-14-16 at 11:20 a.m. in OR # 7 revealed Patient Care Assistant (PCA) # 13 and OR Aide # 14 cleaning and disinfecting the OR between cases.

OR Aide # 14 was observed wiping down the equipment with disposable disinfectants wipes. Continued observation failed to reveal OR Aide # 14 removing the pad from the OR table. He did not wipe underneath the OR pad or the OR table itself underneath the pad with disinfectant.

Interview with OR Aide # 14 directly upon finishing the cleaning, he stated " I try my best to clean under the pad and the table; especially if it is a bloody case because blood can seep down. We are supposed to pick up the pad and wipe it with disinfectant wipes."

Continued observation of the cleaning of OR # 7 revealed PCA #13 mopping the OR floor. He was not wearing shoe covers. During the procedure, PCA # 13 walked over an area of the floor with blood stains and proceeded to retrace his steps over an area he had already mopped. PCA # 13 exited OR # 7 and proceeded down the hall wearing the same shoes ; no shoe covers.

Interview at the time of observation with RN # 6, she stated staff should wear shoe covers when cleaning the OR and remove the shoe covers immediately prior to leaving the room.

Review of facility policy titled "Infection Control/OR Cleaning," dated 08/14, read: "...Purpose: To establish a consistent process for providing a clean environment for the surgical patient and reduce exposure to infectious waste.. Procedure:...3. Between surgical cases: ...C. All equipment and furniture used during the procedure..will be cleaned with a hospital approved disinfectant D. the floor will be damp mopped last using a clean mophead with a hospital-approved disinfectant....2. Appropriate protective barriers ( gloves, gowns, eyewear, masks, shoe covers) will be utilized when indicated...."

Storage of clean & sterile patient supplies:

Observation during tour of the surgical services area on 01-14-16 at 10:30 a.m. revealed a supply closet. Inside the closet the following observations were made:

* two(2) large pieces of uncovered foam padding located directly on the floor.

* wire shelving that contained multiple packages of instruments and sterile patient supplies.

* the air temperature in the room felt very warm. There was no thermometer observed in the room.

During an interview at the time of observation with the Interim Director of Surgical Services # 15, she stated the foam padding was used for patient positioning and should not be stored uncovered, on the floor. She discarded it.

The Interim Director of Surgical Services went on to say the supplies in the closet were used for surgeries using the DaVinci robot in the OR next to the supply closet. She confirmed there was no thermometer in the supply room and the temperature was not being monitored.

Review of facility policy titled: " Storage of Sterile Supplies and Sets," dated 03-14-14, read: All sterile instrument sets, peel packs, supplies used the OR shall be stored in accordance with the following procedure:...VII. The environmental conditions should be maintained at 68-72 degrees with a humidity of between 30% - 60%.."