HospitalInspections.org

Based on observation, facility documentation, and staff interview, review of Centers for Disease Control standards and hospital policies, the hospital staff failed to 1. ensure infection control measures were implemented to prevent the development and transmission of a communicable disease (COVID-19) among visitors and staff, and wear facemask's appropriately while in the hospital, in four of four observations.

Findings included ...

According to a revised, [undated], "HUH COVID-19 Visitor's Notice," signage posted on the outside of the front entrance doors to the hospital, revealed the following, "HUH (Howard University Hospital has revised its visitor's policy to effectively manage visitation during the COVID-19 pandemic ....All visitors must check-in at the Main Entrance (Georgia Ave) visitor's desk or the Tower's Entrance (Fifth Street) visitor's desk. Visitors may receive screening questions prior to entering inpatient and outpatient areas as well as treatment areas within the Emergency Department ... All visitors are required to practice social distancing at all times inside of the facility ...."


The facility staff failed to implement their planned visitors and staff screening process upon entrance into the facility and maintain social distancing, as exhibited during the following observations on 9/30/2020:

1. On 9/30/2020, at approximately 8:45 AM, the surveyors entered through the facility's front entrance without being screened for signs and symptoms of COVID-19.

On 9/30/2020, at approximately 9:10 AM, the surveyors observed a crowded elevator with more than four persons grouped up on the elevator, which disallowed social distancing of 6 feet on and within the elevator.

The surveyor conducted a face-to-face interview with Employee #74 (Security Officer) at the front desk on 9/30/2020 at approximately 9:05 AM, regarding the hospital's process of screening visitors and staff. He stated that the hospital stopped the screening process after moving into Phase 2.

The surveyor conducted a face-to-face interview on 09/30/2020 at approximately 10:15 AM with Employees #1 (Chief Executive Officer), and Employee #4 (Quality Director) during the entrance conference, regarding the hospital's screening criteria for visitors and staff and social distancing. Employee #4 stated that a screening process was in place before Phase 2 [Public Health Emergency]. Further stated, the staff is screened in their assigned departments, and patients are screened when they arrive for their designated appointments. Employee #1 stated the hospital was waiting for temperature scanners and social distancing markers to start the screening process again.

Both employees acknowledged and confirmed the findings.


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2. A review of the hospital's policy number CEO-614-20, titled "COVID-19 Universal Mask Policy" dated 03/16/2020, stated that the hospital provided guidelines for managing work or visitation during the COVID 19 pandemic. Further the policy indicated HUH followed established protocols to protect our patients and staff members by emphasizing the importance of using PPE, per federal and local guidelines. Staff were required to wear a mask at all times while inside the facility; No exceptions to this mandate, including the cafeteria. It also indicated Healthcare providers with direct patient contact must wear surgical/procedural masks.

The Center for Disease Control (CDC) updated the COVID-19 recommendations on 08/07/20, to include instructions for how to wear a facemask. The instructions showed:
"Wear your Mask Correctly
-Wash your hands before putting on your mask
-Put it over your nose and mouth and secure it under your chin
-Try to fit it snugly against the sides of your face
-Make sure you can breathe easily
CDC does not recommend the use of masks or cloth masks for source control if they have an exhalation valve or vent."

During a tour of the Surgical Intensive Care Unit (SICU) on 09/30/2020 at approximately 10:50 AM, in the presence of Employees #26 (Registered Nurse-RN and Director of ICU), #31 (Registered Nurse Manager) and #30 (RN and Charge Nurse of SICU), the surveyor observed Employee #31 wearing a cloth facemask in the direct patient care areas.

Employees #26, #30, and #31 acknowledged and confirmed the findings at the time of the observation.


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3. The surveyor conducted a tour of medical surgical Unit 5 North on 09/30/20 at approximately 11:35 AM in the presence of Employee #42 (Nurse Educator) and Employee #55 (Nurse Manager 5 North). Employee #52 (Environmental Services Housekeeper) was observed in the hallway wearing a facemask below the nose covering only her mouth. The surveyor queried Employee #52 as to the education provided her for the proper way to wear a facemask. Employee #52 pulled up her facemask to cover both her mouth and nose and stated that a facemask must cover the nose and mouth to be effective.

The surveyor observed Employee #52 in another hallway on Unit 5 North at approximately 11:45 AM with her face mask again not covering her nose. The surveyor pointed out to Employee #52 that her facemask was not being used as per hospital policy and she pulled up her face mask over her nose as required by Center for Disease Control recommendations. The second observation was in the presence of Employee #42 and Employee #55.

At the time of both observations, both Employees #42 and #55 acknowledged and confirmed the findings.

4. The surveyor conducted a tour of the Emergency Department (ED) on 09/30/2020 at approximately 10:00 AM with Employees #44 (ED Director of Nursing) and Employee #45 (ED Nurse Manager). The surveyor observed Employee #46, Patient Access, walking in the ED hallway without a mask. The surveyor queried Employee #46 about the hospital policy for wearing a face mask to prevent the spread of infection. Employee #46 responded that a face mask must be worn at all times when in the hospital.

At the time of the observation, Employees #44, and Employee #45 acknowledged and confirmed the observation.

5. The surveyor conducted a tour of Medical-Surgical Unit 5 East on 09/30/2020 at approximately 10:35 AM in the presence of Employee's #43 (Nurse Manager 4 East) and (Employee #42, Nurse Educator). The surveyor observed Employee #39, Registered Nurse, (RN), in the nursing charting room, wearing a facemask below the nose, leaving only the mouth covered.

The surveyor queried the RN about the standards for wearing facemask's and the relationship to infection prevention and control. Employee #39 responded that the face mask must cover both the nose and mouth to effectively prevent the spread of respiratory secretions into the environment. The Employee pulled up her face mask to the proper position at that time.

At the time of the observation, Employee's #43 and Employee #42 acknowledged and confirmed the observation.

Based on observations during the survey of the facilities Emergency Preparedness Plan, it was determined that written documentation was not available to show that the plan addressed the patient/client population that were at risk, and written documentation was not availale to show that a review was done.

Findings included...

The surveyor conducted a review of the facilities Emergency Preparedness Plan, on October 1, 2020 at 11:15 AM, in the presence of Employee's #5 (Safety Director), #23, (Assistant Safety Officer), #24 (Safety Officer), and #25 (Associate Safety Officer).

During the Emergency Preparedness Plan interview, the hospital staff reported a verbal understanding of the requirement, however written documentation was not available to address the patient population at risk, the type of services the facility had in place, and the ability to provide services during an emergency. There were no documented strategies in place to address the need of at risk and vunerable patients, delegations of authority, and continuity of operations. A documented review was not available to show that the plan was updated. These findings were acknowledged and confirmed duirng the survey.

Based on observations during the survey of the Emergency Preparedness Plan, it was determined that written documentation was not available to support the provision of Pharmaceutical Supplies for patients and staff during an emergency.

The findings Included:

The surveyor conducted a review of the Hospital's Emergency Preparedness Plan, on October 1, 2020, between 11:30 AM and 1:00 PM with Employee's #5 (Safety Officer), #23 (Assistant Safety Officer), #24 (Safety Officer), #25 (Associate Safety Officer).

The facility lacked written documentation to show that Pharmaceuticals Supplies were available for staff and patients during an emergency. These findings were acknowledged and confirmed during the survey.

Based on observations during the survey, it was determined that the Emergency Preparedness Training and Testing Program lacked documentation to substantiate that a written program was in place to support training and testing. Documentation was not in place, to determine if a written plan was reviewed.

Findings included:

The surveyor conducted a review of the Emergency Preparedness Plan, on October 1, 2020, between 11:30 AM and 1:00 PM with Employees #5 (Safety Officer), Employee #23 (Assistant Safety Officer), #24 (Safety Officer), and Employee #25 (Associate Safety Officer).

The surveyor determined that the facilities' training and testing was not documented to show that written training and testing was conducted as required, and documentation was not available to show that a review of the training was conducted. These finding were acknowledged confirmed during the survey.