HospitalInspections.org

The Critical Access Hospital (CAH) reported a census of five patients. Based on observation, staff interview and document review CAH staff failed to follow their policy and assure safety of food storage for CAH patients for two of two observed dietary refrigerators.

Findings include:

- The CAH ' s policy Storage of Edible Food Products reviewed on 7/9/13 at 4:15pm directed " ...Opened perishable items stored in the refrigerator must be used within 72 hours or thrown away ... "

- Observation on 7/9/13 at 2:15pm in the Dietary Department of the walking refrigerator revealed the following products past disposal:
1. A plastic pitcher containing pineapple juice with an opening date of 7/2/13
2. A plastic pitcher containing tomato juice with an opening date of 7/5/13
3. A plastic pitcher containing apple juice with an opening date of 7/5/13
4. An open glass bottle containing mango nectar with an opening date of 7/3/13

- Dietary Manager Staff H interviewed on 7/9/13 at 2:15pm acknowledged the open containers of juices and their policy required staff to dispose of open items within three days.

- Observation on 7/9/13 at 2:45pm in the nutritional center refrigerator on the nursing floor revealed the following products past disposal:
1. A plastic pitcher containing prune juice with an opening date of 6/7
2. A container of fruit mix (pureed fruit used to administer medications) with an opening
date of 7/3/13
3. A container of applesauce with an opening date of 6/26
4. A chef salad without a date of preparation or disposal date
5. A container of Resource (a nutritional drink) with an outdate of 6/14/13
6. A container of Ensure (a nutritional drink) with an outdate of 4/1/13

Quality Assurance Coordinator Staff A interviewed on 7/9/13 at 2:45pm acknowledged outdated containers of juice, fruit mix, applesauce, Resource, and Ensure and the chef salad without a date when prepared or disposal date.

The Critical Access Hospital (CAH) reported a census of 5 acute and swing bed patients. Based on observation, document review, and staff interview, the infection control officer failed to develop an active infection control system to identify, report, investigate, monitor, and implement infection control practices for two of two observed cleaning of a discharged patient room, hand hygiene prior to direct patient contact, patient food preparation kitchen sink in the dietary department, one of one intravenous (I.V) saline solution bag used in the computed tomography (C.T.) scanner room,

Findings include:

- The CAH's Infection Control Plan reviewed on 7/10/13 at 9:00am directed "...Infection Control Plan is to developed, implement and maintains an active, hospital wide program for the prevention, control, surveillance, and investigation of infectious and communicable diseases...by adhering to and adopting hospital-wide guidelines, policies and procedures ...The plan will provide for ...a system for identifying, reporting, investigating, and controlling infections and communicable diseases of patients and personnel ..."

- Review of the manufacturer's guidelines for the use of the Re-Juv-Nal/Arsenal 16 disinfectant cleaner on 7/8/13 at 4:20pm directed, " ...To disinfect inanimate hard, non-porous surfaces ...allow to remain wet for 10 minutes...".

- Observation of Housekeeping staff C, staff D, and staff E on 7/8/13 between 11:15am to m cleaning room 12, a discharged patient room revealed the following breaches in infection control practices regarding disinfectant wet time per manufacturer's recommendations. For example:

- Staff C, D, and E, wearing gloves, applied Re-Juv-Nal/Arsenal 16 disinfectant cleaner to the bed mattress, over the bed table, pillow, bed frame, and chair. The surfaces remained wet between five to six minutes not the required 10 minutes for total disinfection.

- Staff C, D, and E interviewed on 7/8/13 at 12:15pm, acknowledged the cleaned surfaces failed to remain wet the required 10 minutes.

- The CAH ' s policy for Hand Hygiene reviewed on 7/8/13 at 4:20pm directed " ...Decontaminate hands before having direct contact with patients ...Decontaminate hands after removing gloves ... "

- Nurse Aide Staff F and Nurse Aide Staff G on 7/8/13 at 2:05pm entered Patient #12 ' s room and failed to perform hand hygiene before having direct contact with Patient #12.

- Registered Nurse L, observed on 7/8/13 at 11:15am, cleaning a patient room. Staff L applied disposable gloves and removed the linens from the patient care cart. Staff L
removed the gloves, applied another pair without performing hand hygiene. Staff L disinfected the patient care equipment and chairs, removed the gloves and applied another pair of gloves without performing hand hygiene.

- Observation on 7/9/13 at 2:00pm in the Dietary Department revealed a stainless steel counter with a double sink with one sink covered with a piece of cardboard box and taped down with duct tape.

Dietary Manager Staff H and interviewed on 7/9/13 at 2:00pm indicated the stainless steel counter area was for salad preparation and the cardboard covering placed approximately two weeks ago due to a non functioning disposal.

Staff H and Quality Assurance Staff A acknowledged cardboard is a non-cleanable surface.

- Observation of the Computed Tomography (CT) room on 7/9/13 at 9:20am revealed an intravenous stand with a 1000cc (cubic centimeter) bag of Normal Saline intravenous (IV) solution hanging with tubing attached with " 7/5/13, 8:00 " written on the bag with a black marker.

Radiology staff K, interviewed on 7/9/13 at 9:25am explained the fluid and tubing is dated and timed and used for up to 24 hours for multiple patients receiving a CT scan with contrast.

Radiology staff K, interviewed on 7/9/13 at 2:30pm, reported 20-30 patients receive scans each month.

- Observation of the Normal Saline solution on 7/9/13 at 9:20am, revealed the solution is a single patient use container.

Pharmacy staff M, interviewed on 7/9/13 at 1:40pm, acknowledged the Normal Saline IV solution is for single patient use, and must be discarded after use for a patient.

The Centers for Disease Control and Prevention report dated 5/2/12, directs " Vials labeled by the manufacturer as " single dose " or " single use " should only be used for a single patient. "

- Observation of the recovery room on 7/9/13 at 1:55pm revealed four open Yankauer suction tips (rigid hollow tube made of disposable plastic with a curve at the distal end used to remove thick secretions during pharyngeal suctioning connected to the suction tubing in the patient cubicles in the recovery room. The Yankauer package label states, "Sterile unless opened or damaged."

Administrative and Infection Control officer staff J interviewed on 7/9/13 at 2:30pm reported the hospital had provided education and had instructed staff to not open the Yankauer package prior to each patient's use.

Administrative and Director of Nursing staff B interviewed on 7/9/13 at 4:30pm reported the hospital had provided education and had instructed staff to not open the Yankauer package prior to each patient's use.

The CAH ' s practice of using single patient use only items for more than one patient placed those patients at risk for the transmission of infectious diseases.