HospitalInspections.org

Based on observation, staff interview, policy and procedure review, and in the process of complaint investigation, it was determined the facility staff failed to maintain clean floors in the emergency department.

The findings include:

The survey team toured the emergency department (ED) on 4/17/12 at approximately 10:50 a.m. The team was accompanied by the manager of clinical effectiveness and the nursing director, who was also the ED director. The surveyors focused on the cleanliness of the department, due to a complaint allegation of the ED floors being dirty.

The nursing director stated the environmental services staff was available in the morning hours to remove trash, clean the sinks and non-patient areas. She stated the nursing staff was responsible for cleaning the ED rooms between patient visits. Environmental services staff could be called if a large area needed to be cleaned. Environmental services were not available during the evening or night shift, except via an on-call person.

When the surveyors asked to see a clean ED room, the nursing director stated there was one clean room available. The surveyors toured room 12 at 11:35 a.m. An area of dried matter was noted on the floor, on the left side of the bed. The area was approximately the size of an adult palm, with multiple dime sized splatters. Some of the dried matter was dark brown in color. The nursing director than used a spray cleanser and cloth to clean the spill. The matter was removed with the cleansing.

On 4/17/12 at 1:25 p.m. the survey team interviewed the director of facility services and site leader for environmental services. In 2010 the environmental services department lost several staff members through a reduction in force and another staff member in 2011. With the changes in environmental staffing, nursing staff needed to take on added duties, such as mopping floors, changing sheets, and emptying trash. Both stated several new employees were recently hired for environmental services. They acknowledged there was no plan for the emergency department cleaning process to change with the addition of new staff. The staff verified the emergency department was the busiest department within the hospital.

The survey team met with the manager of clinical effectiveness on 4/18/12 at 9:25 a.m. The manager stated the emergency department staff had previously informed management the ED was not as clean as it had been prior to environmental staff losses in 2010. She stated the recent new hires in the environmental department were not expected to impact the current method for cleaning in the ED.

The survey team interviewed an ED registered nurse (RN) on 4/18/12 at 9:44 a.m. The nurse stated ED staff (clinical and non-clinical) was trained to clean rooms between patients by wiping all high touch surfaces and the bed. The floors were not cleaned between each patient. Environmental staff could be called to clean large spills, after patients with known contagious infections, etc. A surveyor asked if the RN had noted any changes in the cleanliness of the ED. The RN stated the ED was less clean after the reduction in environmental staff and with the increase in the number and acuity of patients seen in the emergency department.

The survey team requested the facility policy and procedure on cleaning rooms, on 4/17/12. The facility staff provided a copy of the policy titled, "Cleaning: Patient Room". The purpose statement included the following: "Occupied patient rooms shall be cleaned daily to maintain a clean and sanitary environment for patients ..." The policy did not directly address the cleaning of the emergency department patient areas.