HospitalInspections.org

Based upon observation, interview, and document review the facility failed to have policy and procedure for employee screening of COVID-19 symptoms resulting in the potential of failure to identify employees with signs and symptoms of COVID-19 and the spread of infectious disease amongst all patients in the facility. Findings include:

On 8/4/2020 at 0845 it was observed that employees gaining entry to the facility failed to be screened during entry to the facility. Employees were observed showing employee badges and walking past the screening station without answering screening questions that were asked of non-employees. A few employees were observed displaying cell phone devices to be viewed by screeners while the majority of employees passed through the screening station only showing employee badges. Temperatures were not observed to be obtained for any individuals entering the facility.

On 8/4/2020 at 0855 an interview occurred with Staff BB, a entrance screener. Staff BB was queried if temperatures were being obtained for individuals coming into the facility. Staff BB stated, "No. We only ask the questions if someone had signs or symptoms of COVID (COVID-19). Staff BB was then asked if temperatures had ever been obtained as part of the entry process for individuals coming into the facility. Staff BB replied, "No Ma ' am...we have never taken temperatures for screening."

On 8/4/2020 at 0925 an interview was conducted with Staff A, a facility greeter. Staff A was queried why staff were allowed to walk past the screening station without being asked screening questions. Staff A explained that the facility had an online application for employees to utilize for prescreening of COVID-19 signs and symptoms prior to getting to the entrance of the facility for employees and vendors. Staff A stated that employees were to utilize the online application and show their device screen with a green checkmark to indicate the employee had been prescreened and cleared for entry to entrance screeners.

An interview was conducted on 8/4/2020 at 1020 with Staff E, the Director of Epidemiology and Infection Prevention. Staff E was queried about the monitoring for COVID-19 and policy and procedures directly developed for COVID-19. Staff E was asked what the policy was for the monitoring of visitors, staff, and patients for the facility. Staff E explained that patients exhibiting any signs or symptoms of COVID-19 are immediately tested upon entry to the facility. Staff E also explained that staff are monitored through an online application for signs or symptoms of COVID-19 and are required to report any signs or symptoms to employee occupational health and directly to their manager (https://healthscreen.umich.edu/). Staff E stated a policy did not exist for the use of the online application by staff. Staff E stated staff members with any signs or symptoms of COVID-19 are required to stay home until they can be tested by employee occupational health. Staff E was asked why temperatures were not actively taken for employees or visitors. Staff E explained that it was determined that taking temperatures created an unreasonable number of individuals crowding outside of the facility because of annex entrances were closed for entry. Staff E stated the crowding of large groups of individuals outside of the facility without the space to socially distance created a higher risk for transmission of COVID-19 to a greater number of individuals including staff members. Staff E stated it was not unusual to have over 200 people outside of the facility waiting to gain entry for medical appointments, procedure appointments, or to visit someone in the hospital. Staff E was asked if guidelines from Centers for Disease Control were being followed. Staff E responded, "Yes."

A document review was conducted on 8/4/2020 at 1300 of the facility's policies and procedures related to COVID-19. The policy titled, "Interim Guidance Document: COVID-19 (SARS-CoV-2)," with a revision date of 8/3/2020 was reviewed. The policy references the resources used as the Centers for Disease Control (CDC) (https://www.cdc.gov/coronovirus/2019-ncov/index.html) and the World Health Organization (WHO) (https://apps.who.int/iris/bitstream/handle/10665/331498/WHO-2019-ncov-IPCCPPE use-2020.2-eng.pdf?sequence=1&isAllowed=y). The policy failed to address the screening of employees with use of the online screening application.

According to the CDC article, "Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic," updated 7/15/2020, (www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html), it states, "Actively take their temperature and document absence of symptoms consistent with COVID-19. Fever is either measured temperature =100.0°F (Fahrenheit) or subjective fever."

According to the WHO article titled,"Q&A: Tips for health and safety at the workplace in the context of COVID-19," dated 6/26/2020 (https://www.who.int/news-room/q-a-detail/q-a-tips-for-health-and-safety-at-the-workplace-in-the-context-of-covid-19), the article states, "Thermal screening at the workplace can be considered part of a package of measures to prevent and control COVID-19 at the workplace."