HospitalInspections.org

Based on document review, observations, and interviews, the hospital failed to ensure screening for Coronavirus Disease (COVID-19) was completed upon entry to the hospital, entrances were monitored, visual alerts related to face covering and handwashing were placed in strategic places, and chairs in waiting rooms were arranged to promote physical distancing. The failure to implement all possible strategies to prevent and control the transmission of COVID-19 has the potential to affect all patients.

Findings:

1. The US CDC's "Interim Infection Prevention and Control Recommendation for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic", updated 7/15/2020, states everyone is to be screened entering the facility and the points of entry should be limited and monitored.

The Employee Screening Forms for COVID-19 were reviewed. It was noted that self-screening was completed by employees upon arrival to work on several units within the hospital: Administration Department (second floor), Emergency Department, Operating Room, and Station #1-Medical Surgical Unit. These screenings were not completed at the entrance points to the hospital.

On 9/17/20 6:45 AM, an individual was observed entering the the hospital's main door by the ambulance entrance. No screening was conducted.

On 9/17/20 at 6:50 AM, an individual was observed entering the unlocked door of the hospital's garage. No screening was conducted.

On 9/17/20 at 6:55 AM, the Maintenance Man was observed opening the garage door, an individual entered the overhead garage door area, and the individual entered the hospital utilizing a badge. No screening was conducted.

On 9/17/20 at 7:10 AM, a staff member was observed entering the hospital through the hospital's Life Flight side door. No screening was conducted.

On 9/15/20 at 11:40 AM, the Screener in the Emergency Department stated, "Hospital employees get screened at their departments. It's the employee's choice to come to the Main Entrance."

On 9/15/20 at 12:47 PM, Environmental Services Technician (EST) #1 stated, all of housekeeping staff enters the hospital through the garage entrance and then proceeds through the building to the Main Entrance to be screened.

On 9/15/20 at 12:55 PM, EST #2 stated, she arrives and enters the hospital garage then goes through the building to the Main Entrance for screening.

On 9/15/20 at 12:57 PM, EST #3 stated, she arrives through the hospital garage and proceeds through the hospital to be screened at the Main Entrance.

On 9/15/20 at 1:00 PM, Registered Nurse (RN) #1 stated, she enters the hospital garage and is COVID-19 self-screened on the unit where she works.

On 9/15/20 at 1:15 PM, the Unit Coordinator of Station #1 stated she enters the building at the Main Entrance of the hospital for COVID-19 screening or through the hospital garage, and then she goes to Station #1 and self-screens on the unit.

On 9/15/20 at 1:40 PM, a Surgical Technician stated she enters through the hospital garage and is COVID-19 self-screened in the Operating Room (OR) suite.

On 9/15/20 at 1:45 PM, RN #2 stated she enters through the hospital garage entrance and is self-screened for COVID-19 in the OR suite.

On 9/15/20 at 2:00 PM, RN #3 stated she parks in the ambulance bay area, enters the main door, and that all Emergency Department ("ED") staff self-screen on the ED unit.

On 9/15/20 at 2:45 PM, the Human Resource Coordinator stated she parks by the billing door of the hospital and uses a key to enter the building, takes the elevator to the second-floor work area and self-screens by answering questions and has her temperature taken in the designated room of Health Information Department.

On 9/15/20 at 3:00 PM, the Information Technician (IT) stated he keys into the hospital, comes up by elevator to the second floor, and self-screens on the Administrative floor.

On 9/16/20 at 11:20 AM, the Assistant Director of Nursing states she parks her vehicle in the hospital side parking lot and self-screens on Station #1 Unit for COVID-19. Staff can screen in other hospital locations, such as front Main Entrance.

On 9/17/20 at 7:00 AM, an interview with the maintenance man stated, staff enter the hospital through multiple entrances; some staff enter through the garage side door as it is set to unlock automatically by IT; others enter when the garage overhead doors are opened; others enter through the Life Flight door; and others through the main door entrance next to the ambulance entrance.

On 9/17/20 at 8:30 AM, with the CEO confirmed staff enter the hospital from multiple points of entry (garage door, the ED main door, the Life Flight side door entrance, and the doctor's entrance) without screening upon entrance. Staff have to proceed to their places of work before self-screening for COVID-19 is completed.

Based on the above information, the hospital has failed to ensure that the entrances to the hospital were monitored and screening was completed upon entrance to the hospital.

2. The United States Centers for Disease Control and Prevention (US CDC)'s "Interim Infection Prevention and Control Recommendation for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic", updated 7/15/2020, states, post visual alert (e.g. signs, posters) at strategic places (waiting areas, elevators, and cafeterias) to provide instructions (in appropriate languages) about wearing a cloth face covering or face mask for source control and how and when to perform hand hygiene".

On 9/15/20 at 2:20 PM and 9/16/2020 at 11:30 AM, no visual alerts were observed at the entrance of or in the cafeteria.

On 9/15/2020 at 2:35 PM, no visual alerts were observed by the elevator to the second floor Administrative Offices.

On 9/17/20 at 8:30 AM, the Chief Executive Officer (CEO) confirmed there was no visual alerts with instruction next to the elevator.

On 9/17/2020 at 9:00 AM, the CEO confirmed there was no visual alert next to the cafeteria with instructions (in appropriate languages) about wearing a cloth face covering or facemask for source control and how and when to perform hand hygiene.

3. The US CDC's "Interim Infection Prevention and Control Recommendation for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic", updated 7/15/2020, states physical distancing of six (6) between people is an important strategy to prevent SARS-CoV-2 transmission and seating in waiting rooms should be arranged so patients can sit at least six (6) feet apart.

The hospital's "Waiting Room Contact" policy, dated 8/6/20, states, "Patients who are awaiting testing or outpatient services, and who have screened Negative for COVID-19 questions will be asked to sit in the appropriate waiting room at distance of 6 feet apart or greater, unless they live in the same household."

On 9/15/20 at 2:50 PM and 9/16/2020 at 11:25 AM, the ED and Outpatient Services waiting area was observed. The chairs in the waiting room were not arranged so patients could sit six feet apart.

On 9/17/20 at 9:00 AM, the CEO confirmed the six (6) chairs in the ED and Outpatient waiting area were not arranged so they were six feet apart.

On 9/17/20 at 12:40 PM, the Screener stated, "I have never been told how many people can sit in the waiting room. I guess as many people as there are seats for."