HospitalInspections.org

Based on observation and staff interview it was determined health service worker (HSW) #1 failed to follow the expectations of the Infection Control Nurse. This failure has the potential to adversely affect all patients.

Findings include:

1. A tour of the facility was conducted on 12/7/20 at 11:45 a.m. Upon arrival to Unit A-5, the COVID holding unit, infection control signage was noted. The signage stated in part: "Step 1-sanitize hands, Step 2-apply shoe covers, Step 3 Apply PPE, Full PPE Required To Enter All Patient Units: Including gown (or coveralls), N95 mask, and face shield (or PAPR) shoe covers, and gloves." The entrance had signage that stated, "ENTRANCE ONLY! EXIT OUT THE BACK." During the tour of Unit A-5 the surveyor observed HSW #1 coming out of the Entrance Only area. HSW #1 had on a gown that was removed in the Entrance Only area. He did not remove shoe covers or a face shield when exiting the unit.

2. An interview with the Chief Compliance Officer was conducted on 12/7/20 at 12:35 p.m. She stated that it was the expectation of the Infection Control Nurse that everyone entering the COVID Holding Unit wear full personal protective equipment (PPE). She stated they are not allowed to use the same door to enter and exit the unit. She concurred the HSW created a breach in infection control.