HospitalInspections.org

21706


Based on observation and interview the facility failed to ensure that all infection control practices were followed and /or understood on 3 out of four units which were toured during a follow-up survey on September 17 and 18, 2012.

Findings include:

During the follow up survey on 9/17/12 at 2:00 p.m., of one of the four units toured it was observed that a member of the housekeeping staff was in a room that was identified by signage as being a "Contact Precaution" room. The staff member was gowned and gloved as they proceeded to clean the room. When the room was cleaned the staff member removed their gown and while outside of the room was observed to place their gloved hands on the handrail. The same staff person then returned inside the room and removed the garbage bag from the receptacle and tied off the bag. The staff person was then observed walking out of the room, around the nurse's station and down the hall to the dirty utility room. During this time the staff person was observed to drag the garbage bag on the floor and use their still gloved hands to open the door handle on the utility room to enter.

During tour on 9/17/2012 in the Intensive Care Unit staff were observed cleaning a room identified by signage as a "Precaution Room". The gown on one of the staff had become loosened in the back and while cleaning the room (after approximately five minutes) the gown had slipped around the front of their torso and was protecting around one third of their uniform. Further observation identified this staff person exiting the precaution room and removing their gown in the middle of the hallway. After disposing of the gown in the trash receptacle the staff person reached into their pocket and took out a key to open a lock on the housekeeping cart. The housekeeper then replaced the key into their pocket at all times wearing the same gloves they had on from when the precaution room had been cleaned.

On the same unit on 9/17/12 at approximately 12:00 p.m., when the housekeeping staff and Staff B (Housekeeping Director) were questioned what product they would use to clean a room where a patient had C-difficile, the housekeeper identified a product called "Virex 256" . This product was later identified by the director of housekeeping to not be effective against this bacterium.

During tour on the third of four units on 9/17/12 at approximately 1:00 p.m., an interview with a member of the nursing staff revealed that when asked for what type of infection would you use the "Gold topped cleaning wipes". The nurse answered "for Noro virus". When questioned if they would use the gold topped wipes for a patient room with a C-difficile infection they answered "no just Noro virus". The gold topped wipes contain a bleach solution to disinfect the environmental surfaces in a patient room who has a diagnosis of Noro virus or C-difficile. Subsequent interview with Staff H (Infection Control Practitioner) confirmed the gold topped wipes were used for both C-difficile rooms as well as Noro virus rooms. This practice was not verbalized by the the aforementioned member of the nursing staff.

During interview with Staff B (Director of Housekeeping) on 9/17/12 at approximately 1:00 p.m., in the ICU Staff B stated that it was the housekeeping department that provides the training for the cleaning and infection control issues as they pertain to the housekeeping staff. Interview on 9/18/12, with the Staff B and Staff H (Infection Control Practitioner) identified that the infection control aspects of the training are provided by Staff H. Staff B was not aware that Staff H provided initial infection control training on orientation.

Cross Refer to A748, A749

13504


Based on policy review and observation the facility failed to implement policies governing control of infections and communicable diseases.

Findings include:

Review of the facility's policy and procedures dated 3/2011 Title Contract Precautions policy no.:IC-ISOL.005 revealed:
Purpose: "To provide guidelines for reducing the risk of transmission of epidemiologically important microorganisms that can be transmitted by direct contact with the patient (hand or skin-to-skin contact) or indirect contact with environmental surfaces or patient-care items in the patient's environment".


STEPS IN PROCEDURE:...
#3. Gowns (clean non sterile) and gloves are required when entering the patient's room. Remove the gown and gloves before leaving the patient's environment and discard, being careful that clothing does not contact potentially contaminated surfaces. Gowns are not used again even for repeated contact with the same patient.

During tour of the Intensive Care Unit on 9/17/12 between 10:00 a.m. and 2:00 p.m., staff were observed cleaning a room identified by signage as a "Precaution Room". The gown on one of the staff had become loosened in the back and while cleaning the room (after approximately five minutes) the gown had slipped around the front of their torso and was protecting around one third of their uniform. Further observation identified this staff person exiting the precaution room and removing their gown in the middle of the hallway. After disposing of the gown in the trash receptacle the staff person reached into their pocket and took out a key to open a lock on the housekeeping cart. The housekeeper then replaced the key into their pocket at all times wearing the same gloves they had on from when the precaution room had been cleaned.

Based on record review, observation and interview with staff it was determined that the facility failed to implement professional standards for when infected hospital staff are restricted from providing direct patient care and/or are required to remain away from the healthcare facility entirely, and the facility failed to ensure that policies concerning the wearing of appropriate personal protective equipment were implemented in contact precaution rooms.

Findings include:

CDC (Centers for Disease Control and Prevention) Recommendation and Reports "http://www.cdc.gov/mmwr/preview/mmwrhtml/00014845.htm" accessed on 6/8/12 pg 4 of 7, states "All HCWs [Health Care Workers] ....HCWs who have exudative lesions or weeping dermatitis should refrain from all direct care and from handling patient-care equipment and devices used in performing invasive procedures until the condition resolves...."

AORN (Association of periOperative Registered Nurses) 2009 Edition Perioperative Standards and Recommended Practices, pg 480 Recommendation XI "Activities of personnel with infections, exudative lesions, nonintact skin, and /or bloodborne diseases should be restricted when these activities pose a risk of transmission of infection to patients and other health care workers. identification, evaluation by a physician, and assessment of fitness for work performance in the perioperative setting should be required...

#2. Health care workers who have exudative lesions or weeping dermatitis should refrain from providing direct patient care or handling medical devices used in performing invasive procedures. Restricting personnel who have exudative lesions, nonintact skin, or weeping dermatitis reduces the risk of transmission of bloodborne and other pathogens between workers and patients".


On review of the facility's policy:

Page 1 SH(IC).003 Function: Surveillance, Prevention and Control of Infection. "PURPOSE: In accordance with regulatory requirements governing infectious disease, Exeter Health Resources, Inc. (EHR) has developed a program for early identification and prompt intervention for reporting and controlling the spread of contagious diseases in the workplace. STEPS IN PROCEDURE:...

#2. Per Guidelines for Employees with Contagious Disease (attached), Staff Health or the manager/supervisor/CRN [Certified Registered Nurse] will determine if it is necessary to relieve the person from direct patient contact or restrict form the work place.
#3. When Staff Health is unavailable, HCW must report to their manager/supervisor/CRN who will determine if it is necessary to relieve the person from direct patient contact or restrict from the work place".

Page 2. "GUIDELINES FOR EMPLOYEES WITH CONTAGIOUS DISEASES"

In chart form: for skin disease of Abscess, Infected acne, boils, skin lesions, impetigo, wounds, paronychia; and infective material pus, lesions, secretions; and symptoms open, draining areas; page 2 relates:

Under: Can employee report to work (patient care) it states "May work if areas is adequately covered until healed".

Under: Can employee report to work (non-patient care) "May work if areas is adequately covered until healed".

Under: Comments "All open wounds must be covered".

On interview with Staff A (Manager of Cath Lab) on 6/7/12 at 10:30 a.m. and again at 2 p.m. it was revealed through interview that Staff B (Scrub technician) had 3 open lesions and a finger cut that needed stitches at times during Staff B's employment from date of hire on 4/11/11 until 5/16/12. On further interview with Staff A it was confirmed through interview that Staff B was asked to leave the work area several times due to weeping/discharge of fluids and blood like stains in Staff B's scrubs [clothing] including at least once during a procedure.

On review of the facility's Staff Health Services report dated 9/6/2011 for Staff B it states "...[Staff B] had a procedure ...last Monday in the office, got a note to return to work. While working Tuesday, Incision bled, went back Wednesday, had more procedure performed in the office, got not [note] to return to work. On Friday, started to bleed again and ended up in ...for surgery due to incision near a blood vessel...s/p [status post] surgery ...open incision/packing in place..".

On review of another report for Staff B by the facility's Staff Health Services dated 3/5/2012 it states, "...[physician] did the procedure on 2/27/12...[Staff B] oow [out of work] on 2/27, 2/28. 2/29, and 3/2/12....Incision clean and dry, healing well. No s/sx [signs and symptoms] of infection. [Staff B] is able to keep the area covered while at work. States that [doctor] told him that he could go back to work as of today, [Staff B] does not have a note...Supervisor [Staff A] notified that [Staff B] can RTW [Return to work] full duty as of today"


Review of the facility's policy and procedures dated 3/2011 Title Contract Precautions policy no.:IC-ISOL.005 revealed.
Purpose: "To provide guidelines for reducing the risk of transmission of epidemiologically important microorganisms that can be transmitted by direct contact with the patient (hand or skin-to-skin contact) or indirect contact with environmental surfaces or patient-care items in the patient's environment".

STEPS IN PROCEDURE:...
#3. Gowns (clean non sterile) and gloves are required when entering the patient's room. Remove the gown and gloves before leaving the patient's environment and discard, being careful that clothing does not contact potentially contaminated surfaces. Gowns are not used again even for repeated contact with the same patient.

During tour of the facility's surgical units on 6/7/12 4th floor east and south Staff C (Unit Manager) was asked which patients were under contact precaution. Staff C identified three rooms two were contact precaution and the third was droplet precautions. While on the unit a staff member was observed in a patent's room with the contact precaution sign outside the patient's door. The staff member was wearing a lab coat and was standing next to the patient's bed and did not have any contact precaution gear on. Staff C was asked during the observation who the staff member was in the patient's room, Staff C confirmed through interview that it was Staff E (Physical therapy) that was not wearing any contact precaution gear.