HospitalInspections.org

Based on policy and procedure review, direct observation during unit tours, and staff interviews, facility staff failed to maintain the facility in a manner to ensure an acceptable level of safety and quality by failing to store clean meters for measuring blood glucose in a clean location for 1 of 6 units toured.

The findings include:

Review of Hospital Policy and Procedure "Cleaning, Disinfection and Storage", dated 12/03/2014, revealed "...PURPOSE: Sound infection prevention and control practices limit the transmission of hospital acquired infections to patients and exposure of infection from patient to staff, physicians, visitors and others....Procedure:....4. Store patient care equipment when not in use in designated clean areas....Designated locations are areas that are free of: a. Soiled utility storage such as linen and trash....c. Food. ..."

Observation during tour of Unit A, an Obstetrical unit, on 01/27/2015 at 1350 revealed a soiled utility room with trash receptacles, a food cart for storage of previously distributed and collected food trays and other soiled items. Further observation revealed three (3) clean blood glucose meters in docking stations on a shelf in the soiled utility room as well as two black cases to hold the meters for transport, with control solutions and lancing devices inside.

Interview during tour with RN (Registered Nurse) #1 and NM (Nurse Manager) #1 revealed the department staff had been told there was no other place the meters could be stored because of cables connecting to the docking stations. Further interview with RN #1 revealed employees clean each meter with the approved cleaning agent prior to taking it to a patient room. Upon request, RN #1 demonstrated the cleaning process. Observation revealed RN #1 wiped all surfaces of the meter with the cleaning agent, then placed it into one of the cases and carried it from the room. Observation did not reveal cleaning the case or the meter once it was removed from the soiled utility room.

Interview with NM #1 and Director #1 on 01/29/2015 at 1000 confirmed that clean meters to measure blood glucose should not be stored in a soiled utility room. Further interview revealed a work order had been placed to relocate them.

NC00099935, NC00101014, NC 00096257, NC00100090, NC00096607, NC00101489, NC00100414, NC00102239, NC00101681, NC00100327.