HospitalInspections.org

Based on observation, staff interviews, review of CDC guidance, and review of facility documents, it was determined the facility failed to ensure adherence to nationally recognized infection control guidelines that seeks to minimize the transmission of infectious diseases, including COVID-19.

Findings include:

Based on observation, staff interviews, review of facility documents, and review of CDC guidelines, it was determined the facility failed to ensure: 1. patients arriving to the ED with COVID-19 symptoms were placed in a separate waiting area; 2. chairs in the Emergency Department (ED) waiting room were arranged to encourage social distancing and symptomatic and asymptomatic employees awaiting COVID-19 testing practiced social distancing; 3. asymptomatic patients on the Inpatient Rehab Unit were retested for COVID-19 ninety-six (96) hours post admission, in accordance with facility policy. (Cross Refer Tag 0749)

Based on observation, staff interviews, review of facility documents, and review of CDC guidelines, it was determined the facility failed to ensure: 1. patients arriving to the ED with COVID-19 symptoms are placed in a separate waiting area; 2. chairs in the Emergency Department (ED) waiting room are arranged to encourage social distancing and symptomatic and asymptomatic employees awaiting COVID-19 testing practiced social distancing; 3. asymptomatic patients on the Inpatient Rehab Unit are retested for COVID-19 ninety-six (96) hours post admission, in accordance with facility policy.

Findings include:

1. Reference: Facility policy, "Triage in the Emergency Department" states, "... All patients presenting to the Emergency Department will be assessed by the triage nurse or designee. ... The triage nurse is responsible for rapid systematic collection of data relevant to each patient, a focused assessment, communication and documentation of such findings. ... ."

During a tour of the ED on 12/22/21 at 1:12 PM, in the presence of Staff #3, three (3) patients were observed entering the ED within minutes of one another, and approaching the front desk. There were no staff present at the front desk to greet the patients. There was no signage or registration information at the front desk advising the patients to sign in. The three (3) patients left the front desk and seated themselves in the main waiting area without signing in and without disclosing to staff, the reason for their visit.

One (1) of the three (3) patients was observed sitting immediately next to a mother and her young child (Patient #9), who were already seated in the main waiting room.

Upon interview at 1:16 PM, Staff #18 stated he/she was not at the front desk because he/she was triaging another patient at the time. Staff #18 stated there was a tech also working, however, the tech was unable to help because he/she was helping with antigen testing. Staff #18 stated, "Patients don't have to sign in. They leave their ID on the desk and that's how we know who they are."

Upon interview at 1:21 PM, Staff #19 stated that patients arriving to the ED should be greeted by staff at the front desk. He/She stated that patients are asked the reason for their visit and if they indicate that they have COVID-19 symptoms, they are asked to wait in a smaller waiting area separate from the main waiting area. At 1:25 PM, Staff #3 confirmed there were no staff at the front desk to greet patients at the time of the surveyor's arrival to the ED, that patients were observed seating themselves in the main waiting area, without disclosing to staff the reason for their visit, and that one (1) of the newly arriving patients sat immediately next to a mother and her young child (Patient #9).

Review of Patient #9's triage documentation revealed Patient #9 was being seen in the ED for COVID-19 symptoms of fever, headache, and vomiting. Patient #9 was seated in the main waiting area immediately next to patients and not in the separate waiting area for patients with COVID-19 symptoms.

2. Reference: Centers for Disease Control and Prevention (CDC), Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic, Updated September 10, 2021, https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendation.html states, "... Encourage physical distancing... In situations when unvaccinated patients could be in the same space (e.g., waiting rooms, cafeterias, dialysis treatment room), arrange seating so that patients can sit at least 6 feet apart, especially in counties with substantial or high transmissions. ... ."

During a tour of the ED on 12/22/21 at 1:11 PM, in the presence of Staff #3, approximately four (4) patients were seated in the main waiting area. Chairs in the main waiting area were not arranged in a manner that encouraged social distancing. Chairs were immediately adjacent to one another with no signage indicating that some chairs should not be used. At 1:12 PM, one (1) patient was observed entering the ED and seating him/herself in a chair immediately adjacent to Patient #9 and his/her mother in the main waiting area. Review of Patient #9's triage documentation revealed Patient #9 was being seen in the ED for COVID-19 symptoms of fever, headache, and vomiting.

During a tour of the ED on 12/22/21 at 1:38 PM, in the presence of Staff #3 and Staff #19, four (4) employees were observed sitting in chairs immediately next to one another in a hallway. Upon interview, Staff #19 stated "it's for symptomatic staff who are awaiting their (COVID-19) antigen test results. This is where we do it." There was no observance of social distancing for staff awaiting their COVID-19 test results.

3. Reference: Facility policy, "COVID Screening and Surveillance Policy" states, "... 5. COVID-19 Surveillance Testing for Inpatients... 1. Asymptomatic Inpatients still in the facility will be retested 96 hours after initial admission test regardless of vaccination status. ... ."

Upon interview on 12/22/21 at 10:25 AM, Staff #1 confirmed a COVID-19 outbreak on 5 North, an Inpatient Rehab Unit. Staff #1 stated that the first positive COVID case on the unit was identified on December 13, 2021. Staff #7 provided a timeline and summary of events, and the names of patients and staff members from 5 North who tested positive for COVID-19 during the outbreak. A request was made to Staff #1, Staff #5, and Staff #7 for evidence that Patients #1-8, identified as patients on 5 North who tested positive for COVID-19 during the outbreak, were retested for COVID-19, ninety-six (96) hours post admission, as indicated in the facility policy. No evidence was provided.

Upon interview on 12/22/21 at 3:20 PM, Staff #1 stated, "The policy to start testing inpatients ninety-six (96) hours post admission was a new policy that started hospital-wide on November 17, 2021. From this incident, we noticed that it was not being done on the Rehab Unit. There was no automatic order in the system for patient's on the Rehab Unit, so it was being missed."