HospitalInspections.org

Based on facility document review, policy review and staff interviews, it was determined the facility failed to implement correctly the hospital's infection control policy and procedure for urine culture collection in 1 of 10 sampled patients (Patient #3).

The findings included:

Patient #3

Review of the Policy and Procedure for Indwelling Urinary Catheter Standards and Practice revealed, a urine specimen for culture should be obtained prior to initiating antimicrobial therapy. This Policy and Procedure's original date was 06/2016 and release date was 06/2017.

During an interview with the Chief Clinical Officer, she stated they have made several changes to reduce their Catheter Acquired Urinary Tract Infections (CAUTIs) which were 8 - 10 infections per month in 2016 & 2017.

02/13/18 at 5:52 PM, the patient, who has a Foley Catheter, had an elevated temperature of 102.4. The attending physician ordered Acetaminophen for the elevated temperature.

02/14/18 at 9:18 AM, the attending physician ordered change the Foley to a Silver Tip Foley, collect a urinalysis, and chart the effectiveness of the acetaminophen given at 8:40 AM.

02/14/18 at 10:02 AM, the attending physician ordered start on Intravenous Cefepime and Vancomycin, and consult with infectious disease physician.

02/14/18 at 10:35 AM, the Vancomycin was administered.

02/14/18 at 10:42 AM, the medical director discontinued the order written at 9:18 AM, from the attending physician, for the urinalysis.

02/14/18 at 10:43 AM, the medical director ordered a urinalysis and culture to start on 02/15/18 at 11:00 AM.

02/14/18 at 11:21 AM, the Cefepime was administered.

02/14/18 at 4:52 PM, the Infectious Disease physician examined the patient and his impression was fever and leukocytosis, possible urinary tract infection has a suprapubic tenderness with fever and leukocytosis.

02/14/18 at 4:52 PM, the Infectious Disease physician ordered continue Vancomycin and do urinalysis and urine culture straight catheter today. No need to culture the wound which does not look infected.

02/14/18 at 6:43 PM, a urine analysis was collected by straight catheter and sent to the laboratory.

The patient continued to receive Vancomycin and Cefepime daily.

02/18/18 the Urine Culture came back positive with Pseudomonas aeruginosa and was Sensitive to Cefepime.

02/20/18, the Vancomycin was discontinued as the organism is sensitive to Cefepime.

During an interview with the Medical Director, he stated that he was not aware their policy stated that a urine specimen for culture should be obtained prior to initiating antimicrobial therapy.