HospitalInspections.org

Based on observation, interview and record review the facility failed to ensure the privacy of patients were protected when patient's names were posted in public view and when staff did not pull curtains and close doors when providing care. The census was 237.

Observation on 5/4/10 at 1:39 p.m. revealed erase boards approximately 2 x 3 feet with the patient's full last name, nurse's name, tech's name, physician's name and some details such as feeding tube. This erase board was on the wall of the patient's semi private room which would have been visible to any visitor.

Observation on 5/4/10 at 3:05 p.m. revealed Registered Nurse L and Technician K proceeded to provide perineal (the genital area between the legs) care to a patient without drawing the curtain to provide privacy. The patient was in a semi private room with a visitor present with the other patient.

During an interview on 5/4/10 at 3:20 p.m. the Regulatory Compliance Coordinator B stated she would expect privacy to be given by closing the curtain.

Observation o 5/5/10 at 9:35 a.m. in the Medical Intensive Care Unit (MICU) revealed several staff giving care to a patient who was exposed down to his groin. This patient would have been visible to any visitor.

Observation on 5/5/10 at 9:45 a.m. revealed Phlebotomist CC entered the patient's room to draw ordered Arterial Blood Gases (ABG) which measure how much oxygen and carbon dioxide are in the blood which is an indication of how well the lungs are working) and lab. The Phlebotomist proceeded to draw the blood without closing the curtain to provide privacy to the patient.

Based on observation, interview and record review the facility failed to ensure the staff follow the facility's hand hygiene policy when staff did not cleanse their hands when entering and leaving a patient's room or between glove changes. The facility census was 237.

Observation on 5/4/10 at 2:20 p.m. revealed Registered Nurse (RN) J and Technician K proceed to turn patient to his/her right side. The patient was incontinent of urine. RN J proceeded to tuck soiled incontinence pad under the patient and provided perineal (the genital area between the patient's legs) care. RN J then wearing the same soiled gloves applied another dry pad under the patient and straightened the patient's gown. The gloves were not removed nor was hand cleansing done before the dry pad was applied or the straightening of the patients gown. Tech K threw the urine soaked pad onto the floor at the patient's bedside.

Observation on 5/4/10 at 3:03 p.m. revealed RN L cleansed the perineal area of patient and placed the soiled wipes on a clean wipe which was on the patient's bed. RN L then reached into the clean wipe package with his/her dirty glove and then moved the urinary catheter bag from one side of the bed to the opposite side of the bed. The RN and Tech then repositioned the patient to her left side. RN L at no time removed his/her dirty gloves, cleansed her hands or re-gloved until the patient care was completed.

During an interview on 5/4/10 at 3:14 p.m. RN Charge Nurse I stated that she would expect staff to wash hands when entering the room and to wear gloves if doing perineal care and wash their hands after removing gloves. RN I stated, "I would expect them to put the dirty linens in the hamper; not on the floor."

Observation on 5/5/10 at 9:45 a.m. revealed Phlebotomist CC entered the patient's room without washing his/her hands with soap and water or hand sanitizer. He/she then removed a band aid from the left antecubital (inner elbow) and adjusted the patient's oxygen cannula. He/she drew the ordered ABG's (Arterial Blood Gases) (blood drawn from an artery which measures the levels of oxygen and carbon dioxide in the blood to determine how well the lungs are working) and removed the non sterile gloves and bagged the specimens. No hand cleansing was done after removing the gloves. He/she left the room and re-entered the room with no hand cleansing done. He/she drew the ordered labs; removed the non sterile gloves; labeled and bagged the specimens and left the room to use the telephone. No hand cleansing was done after the gloves were removed.

Record review of the facility Hand Hygiene policy NBR.H01 reviewed 4/08 in part revealed the following information:
Procedure
A. Hands shall be washed:
3. Before and after each contact with patient or object used by patient
5. After handling waste materials, secretions, drainage or blood from patients.
6. After entering or working in an ara that is likely to be highly contaminated, such as isolation room, utility room etc.
8. After removal of gloves.