HospitalInspections.org

Based on observations, staff interview, and review of hospital policy, it was determined the hospital failed to ensure that hospital kitchen staff practiced and enforced infection control interventions to prevent the possible spread of infections. The failure to maintain supplies and food to prevent the growth of bacteria had the potential to directly expose patients to illnesses. The findings include:

1. During a tour of the hospital's kitchen, on 1/06/10 starting at 2:00 PM and ending at 5:30 PM, concerns the Dietary Department's supplies and equipment noted as follows:

The hospital's Food Storage, Temperature Compliance, Temperature Logs, and Disposition policy, dated 2/11/08, stated "Containers will be clearly labeled and dated." The failure to not cover stored food increases the risk of food safety and quality. Uncovered food has a potential for cross-contamination of food borne bacteria. The failure to date food increased the risk of poor food safety and quality as the facility could not ensure that food was discarded within 7 days from when the food was opened.

The hospital's Dietary Department-Infection Control Policy, dated 11/23/09, stated foods shall be stored covered, labeled and dated. This policies were not complied with as followed:

a. During a tour of the hospital's kitchen, on 1/06/10 starting at 2:00 PM and ending at 5:30 PM, the following food was observed to be uncovered and/or unlabeled:

Freezer #1, pizza sticks were uncovered.

Refrigerator #2, a tray of pre-cut pieces of cake was uncovered. A tray of pre-cut pieces of cheesecake was unlabeled to include date of preparation and content.

Refrigerator #7, containers of salsa, oatmeal, tarter sauce, bags of cheese and multiple containers used to restock the salad bar were unlabeled to include the date of preparation and the content.

The kitchen's walk-in refrigerator contained an opened package of steaks, several opened packages of sandwich meats and a raisin filling that were not labeled to include the date the contents were opened and the content. The above items were covered and/or discarded during the tour by the hospital's Dietary Manager. He confirmed the items should have been covered and/or labeled.

The hospital failed to ensure kitchen staff had covered and/or labeled all food products to prevent cross-contamination and/or spoilage.

b. During a tour of the hospital's kitchen on 1/06/10 at 2:00 PM, an employee was eating peanut butter in a food prep area. Eating in food preparation areas increases the potential risk of cross contamination of bacteria and employee illnesses. The kitchen employee stated on 1/06/10 at 2:00 PM, that she did not know that she was not allowed to eat food in the kitchen's food preparation areas.

During a revisit to the hospital's kitchen on 1/07/10 at 8:20 AM, a second employee was noted eating French Toast as she prepared a consumer's breakfast.

During an interview with the kitchen's Dietary Manager on 1/07/10 at 9:00 AM, he stated that kitchen employees should not be eating in the kitchen's food preparation area.

The hospital failed to ensure kitchen staff did not consume food in food preparation.

c. The hospital's Dietary Department-Infection Control Policy, dated 11/23/09, stated sinks should contain the proper dilution of quaternary ammonium as indicated by Eastern Idaho Public Health Department (240 parts per million).

During a tour of the hospital's kitchen on 1/06/10 at 2:00 PM, a four compartment sink was observed. This sink was used to wash kitchen equipment. One sink was used to sanitize the equipment in quaternary ammonium. The quaternary ammonium was dispensed automatically through a system that mixed the quaternary ammonium with the water as it filled the sink.

On 1/06/10 at 3:30 PM, the Dietary Manager was asked to provide a quaternary ammonium test strip (this strip checks the concentration on the quaternary ammonium in the water), he could not find any test strips. He stated that the quaternary ammonium system was checked monthly by an outside vender for accurate dilutions. He stated that neither he, nor any other staff had periodically checked the system in between the vender's visits to ensure the quaternary ammonium was adequately diluted. However, the hospital did have a Four Compartment Sink Temperatures Log that did prompt staff to check the quaternary ammonium concentration level. This form was not being utilized and was part of the hospital's Food Storage, Temperature Compliance, Temperature Logs, and Disposition policy, dated 2/11/08.

The hospital's Kitchen Cleaning Instructions policy, dated 3/31/09, stated that mop buckets were to be filled with hot water and detergent, and to "Follow mixing instructions on detergent bottle."

The hospital's Dietary Department-Infection Control Policy, dated 11/23/09, stated all work surfaces and floors would be cleaned daily with approved disinfectant.

On 1/06/10 at 3:10 PM, during a tour of the kitchen, a mop bucket and mop detergent was observed. The directions listed on the detergent bottle directed to add 2 ounces of detergent to 1 gallon of water.

The Dietary Manager was interviewed on 1/06/10 at 3:12 PM. He stated that when he mixes the detergent to water he just listens to the "glug glug" of the bottle and stops.

A kitchen staff member, who mixes the mop water each morning, was interviewed on 1/06/10 at 3:15 PM. She stated that she "just pours in the detergent" and adds water.

Additionally, on 1/06/10 at 2:10 PM, a cleaning bucket, that contained a bleach/water solution, was observed and tested. The test results documented the bleach solution was at 10 parts per million. The Dietary Manager stated at that time the solution was to be at 50 parts per million, and had a staff member remove the bucket. These practices could result into the under-disinfecting of surfaces while allowing bacteria to colonize at which could put patients health safety at risk.

The hospital failed to ensure that kitchen staff had checked the quality of quaternary ammonium, bleach and detergent level qualities.

The hospital failed to ensure that hospital kitchen staff practiced and enforced infection control interventions to prevent the possible spread of infections.