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Based on observation, medical record review, facility documentation and interview, the facility failed for 3 of 32 open records (patients #55, #51, and #35) to ensure the implementation of appropriate infection control measures.
Findings:

1. In observation of the tube feeding bag for Patient #55 was conducted on 1/22/2013 at 1:10 PM. The resident was observed in his bed at that time with the G-Tube infusing at a rate of 60 ml/hour. The bag was identified and confirmed with the Unit Manager on 1/22/2013 at 1:20 PM to be an " open-bag " feeding system. The bag was documented as having approximately 200 cc ' s remaining at that time. The label on the bag indicated the bag had been started on 1/21/2013 at 10:15 (no AM or PM documented) with an infusion rate at 50 ml ' s/hour.

An interview was conducted with the Unit Manager, Charge Nurse and Registered Nurse caring for the patient at 1:25 PM. The staff was asked to validate how much feeding had initially been placed in the bag when the bag was hung un 1/21/2013. The nurse was unable to state, and through review of the patient ' s medical record, was unable to validate the number of milileters of feeding formula was added. It was stated the patient receives Osmolite 1.2 with each can consisting of 8 fluid ounces.

The nurse indicated 2 cans 16 oz. or 480 ml) were added earlier the morning of 1/22/2013 but was uncertain how much was remaining in the bag when this amount was added.

It was confirmed the new fluid was added over the fluid remaining in the bag. It was confirmed with the staff the pouring of new formula over existing was an infection control concern and potential for contamination. Staff reconfirmed the new had been poured over that which was remaining in the bag at that time.

A copy of the policy for " open bag " systems was reviewed and found no facility policy specific to the hang-time of open-bag enteral feeding systems.

Research conducted with ASPEN (The American Society for Parental and Enteral Nutrition) indicates " open-bag feeding systems " should not be hung for no longer than 24 hours. It also indicates the open system was and remains a critical infection control issue. The adding of new formula over that already existing and having been hung for an unknown amount of time is contraindicated and a high risk for contamination.

It was reconfirmed with the Unit Manager and staff nurses on 1/22/2013 at 1:30 PM, staff had added multiple cans on top of feeding which had been previously placed in the bag, time unknown and then added additional. There was no documentation as to the amount of feeding which had been added at each addition which was initially hung on 1/21/2013 at 10:15 AM, exceeding the 24-hour period.

2. On 01/24/13 at 9:45 AM RN #51 was observed during medication administration in room 576 administering a subcutaneous injection of Fragmin (anticoagulant) without wearing gloves.

On 01/24/2013 at approximately 5:00 PM the RN was interviewed and revealed she was nervous about being watched by the surveyor and forgot to put on the gloves for the injection. She confirmed the hospital policy for wearing gloves during the administration of injections.

A review of the personnel records revealed the RN had received infection control and blood borne pathogens training on 10/01/07 and had annual competencies updated on infection control 05/15/2012. The infection control training included exposure control, standard precautions, hand-washing, and blood borne pathogens.

On 01/24/2013 an interview with the Infection Control Coordinator revealed the Coordinator is involved with the training on infection control. The Policy Infection Prevention and Control Revision Date: 08/08/11 Title: Standard Precautions was reviewed. The policy stated: Standard Precautions are a group of infection prevention practices that include hand hygiene and the use of personal protective equipment (PPE) such as gowns, gloves, masks, eye protection, or face shields depending on the anticipated exposure. The use of Standard Precautions should be applied to all patients in the healthcare setting, regardless of their diagnosis. The basic concept of standard Precautions is to treat all patients' blood or body fluids as if they are infectious material.

3. On 01/23/2013 at 9:15 AM in the ED (Emergency Department) phlebotomist (employee #35) collected a blood specimen from patient #13. With the gloves on she drew a blood specimen into the vials (tubes) from patient #13, released the tourniquet, covered the site with sterile gauze, placed the tubes of specimen on the lab cart, then with soiled gloves leafed through the chart for labels and applied the labels to the specimen tubes. She then removed her gloves and applied hand sanitizer to her hands and with her clean hands picked up the tubes of specimen and dropped them into a specimen bag for transport to the laboratory.

On 01/24/2013 the Infection Control Coordinator was asked to describe the infection control process for blood specimen collection by lab personnel. She revealed the infection control practices were the same for all blood and body fluids and hand hygiene. She confirmed the soiled gloves should have been removed and hand hygiene performed prior to handling of the patient's chart and gloves worn when handling the tubes after the blood specimen had been collected.

4. A review of the policy Infection Prevention and Control Title: Reporting EMS Exposure Revision Date: 07/12/12 stated the Emergency Department personnel will notify the Infection Control Practitioner, or the Administrative Supervisor in his/her absence, of any patient brought into the facility by Emergency Services that is suspected or diagnosed with any communicable infectious disease. Nursing unit personnel which admit patients diagnosed with communicable infectious disease will notify the Infection Control Practitioner immediately upon patient arrival. The Infection Control Practitioner will notify the employer of the exposed EMT or paramedic via telephone. Information to be reported include: Disease signs and symptoms, date of exposure, incubation period, mode of transportation, recommendation for follow-up treatment with a medical doctor. All information reported is extremely confidential; patient's name or other identifying information will not be released.

On 01/25/2013 at 11:30 AM per Patient Safety Coordinator, the facility has no policy to notify paramedics in writing of exposure to infectious disease.

On 01/25/2013 at 4:30 PM the Risk Manager confirmed the hospital had no policy in place to notify emergency medical personnel of an infectious disease exposure in writing within 48 hours of confirmation of the patient's diagnosis.