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Based on observation and interview, the CAH (Critical Access Hospital) failed to ensure the facility ice machine was maintained in a safe and sanitary manner. This practice had the potential to affect all patients who received ice in the CAH.

Findings include:

During a tour of the inpatient medical/surgical department with the registered nurse supervisor (RN)-C on 11/3/15, at 8:30 a.m. 2 facility ice machines, identified by RN-C as utilized for patients of the CAH, were observed located in rooms posted as employee lounge and family lounge. Both facility ice machines were observed to have a black, thick, gooey substance inside and surrounding the opening of the funnel and spouts of the ice machines. RN-C indicated she was unaware of the dirty ice machines and stated she was unsure of who was responsible for routine cleaning of the ice machines. RN-C confirmed the dirty ice machines could be a potential infection control issue for the patients.

On 11/5/15, at 10:30 a.m. the director of maintenance (M)-A stated the ice machines were supposed to be cleaned daily and de-scaled weekly. The M-A stated he expected the ice machines to be cleaned daily and free of debris. The M-A confirmed the facility did not document any cleaning of the ice machines.

On 11/5/15, at 12:30 registered nurse infection control officer (RN-ICO) confirmed the current facility policy and stated she expected the facility ice machines to be cleaned routinely. She confirmed the dirty ice machines were a potential infection issue for the patients.

The CAH's policy and procedure titled, Infection Control Equipment Cleaning, reviewed 12/14, revealed the policy was in place to assure clean equipment and environment to prevent the transmission of microorganisms. The policy directed staff to clean the funnels and spouts of the of the machine, around access areas with soap and water weekly and as needed. The policy also directed maintenance to clean the machines internally every six months.

Refer to life safety code deficiencies at K18, K29, K50, K52 and K56 for additional information

Based on observation, interview, and document review the critical access hospital (CAH) failed to utilize proper infection control procedures for 1 of 1 patient (P1) observed during medication administration.
Findings include:
On 11/3/15, continuous observation was conducted from 9:00 a.m. to 9:30 a.m. P21 was observed seated in a recliner at his bedside, with a intravenous(IV) bag and tubing observed hanging close to P21. Registered nurse (RN)-D entered P21's room to administer his medications. RN-D did not wash her hands upon entering P21's room. RN-D proceeded to open 8 individual packets of oral medications and placed the individual medications in a paper medication cup. After assisting P21 to take the oral medications, RN-D immediately reached out, picked the IV tubing, and wiped the IV port with an alcohol pad and injected fluid via a syringe into P21's IV port. RN-D immediately reached out and pulled P21's gown away from his left upper chest and applied a topical nitroglycerin (medication used for chest pain) patch to P21's left upper chest area. RN-D proceeded to wipe P21's left lower abdominal area with a alcohol pad and injected a syringe of Heparin (blood thinner) into P21's abdominal area. RN-D had not performed hand hygiene nor worn gloves for the entire medication administration observation.
On 11/3/15, at 9:45 a.m. RN-D confirmed she had not washed her hands or donned gloves prior to or between administering medications to P21. RN-D confirmed this was not the usual facility practice.
On 11/5/15, at 12:30 p.m. registered nurse infection control officer (RNICO) stated she expected nurses to wash their hands when entering a patients room, prior to exiting patient rooms and before medication administration. RNICO also stated she expected nursing personnel to wear gloves when administering IV, SQ or topical medications.
The CAH's Infection Prevention Policy, Hand Hygiene dated 5/15, directed staff to perform hand hygiene upon entering patient rooms and before and after direct contact with patients.
The CAH's Medication, Preparing and Administration policy revised 1/2015, did not address hand hygiene prior to and during medication administration.