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Based on observation, interview, and record review, the hospital failed to ensure patients admitted to the Senior Lifestyle Unit (the geriatric psychiatric unit) are provided care in a safe setting in seven of seven patient rooms when the hospital failed to:

- Provide an environment aimed at preventing looping and hanging hazards; and
- To document the actual time of patient observation/rounding of the patients every 15-minutes.

This had the potential to affect nine of nine patients on the psychiatric unit. The facility census was 80.

Findings included:

1. Recognized Standards of Practice for a psychiatric facility include:
The Veteran's Health Administration (VHA) National Center for Patient Safety formed a national committee that developed The Environment of Care Checklist for the purpose of reducing environmental factors that contribute to inpatient suicides, suicide attempts, and other self-injurious behaviors. This initiative is consistent with the Joint Commission patient safety goals as well as the current literature on prevention of suicidal behaviors (Suicide Prevention Strategies: A systematic review. The Journal of the American Medical Association, (JAMA), 2005, v 294, 2064 -2074).

The Joint Commission (TJC), formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is a United States-based not-for-profit organization. The Joint Commission accredits over 19,000 health care organizations and programs in the United States.

JAMA, published continuously since 1883, is an international peer-reviewed general medical journal published 48 times per year. JAMA is the most widely circulated medical journal in the world.

The VHA, TJC and JAMA have all established accepted standards of practice for psychiatric inpatient facilities in the United States.

The VHA committee developed the Mental Health Environment of Care Checklist (MHEOCC) with the goal to prospectively identify and eliminate environmental risks for inpatient suicide and suicide attempts.

The following are items included on the MHEOCC to reduce environmental risks for inpatient suicide:
-Use doors with piano hinges or other hardware that reduces the risk of the hardware being used as an anchor. Use anti-ligature doors for non-corridor doors (e.g. bathrooms, stalls, showers);
- Plumbing enclosed in a tamper-resistant enclosure to prevent access by patients. Plumbing fixtures should be enclosed to minimize risks. All supply and waste plumbing should be concealed and inaccessible with tamper resistant fasteners;
- Faucets and spouts in sinks and showers should be an institutional type. There should be no handheld shower devices and no temperature adjusting devices with in the showers (unless recessed). Shower heads should be institutional type. Institutional faucets will not provide an anchor point for hanging. Consider using automatic on/off faucets to eliminate the faucet handles. Push button controls for the shower are also an acceptable alternative. Break away fixtures are also permitted but only if they can be tested without damaging the fixture;
- There should be no attachment points on furniture parts or doors;
- Platform beds are the safest for an acute psychiatric environment. If electric beds are necessary, power cords should be shortened and securely fastened.
-When reviewing beds make sure it is not possible to create an anchor point by standing the bed on its end or side, or by looping a lanyard over the top or back of the bed to hang. With some beds it is necessary to bolt them to the floor to avoid them being used as an anchor point. Securing the bed to the floor also eliminates the beds being moved and used to barricade the door or stacked one on top of another to reach the ceiling;
- Prevent tables and chairs from being moved or overturned. This may be accomplished in several ways. They can be physically secured or too heavy to move;
-Furniture should be heavy and difficult to pick up and move; it should be made of wood or study plastic; knobs and pulls should be designed to not support weight. Furniture should be low profile type so that it cannot be used by the patient to reach the ceiling; and
- Emergency call cords, if used, shortened and/or permanently attached to beds. Cords should be made out of plastic bead type materials or breakaway type (15 lbs. max weight). Cords must be segmented in such a way as to break into segments that are no longer than 12 inches. If cords are present, they should be 12 inches or less. Cords of any length are not recommended for seclusion rooms.

2. Observations on the Senior Lifestyles Unit showed the following potential looping and/or hanging hazards:

-On 07/19/11 at 1:37 PM, patient room number 103 had the following:
- a sink with faucet handles (approximately 3 inches long) and a high goose neck faucet
(approximately 11 inches above sink);
- two electric hospital beds with upper side rails on each side of the bed, a bar at the foot
of the bed, electric cords 118 inches long and alarm cords 116 inches long;
- exposed toilet plumbing approximately 16 inches from the floor;
- the shower water control knob protruded approximately 1 ½ inches from the wall and
approximately 4 feet off the floor;
- metal toilet paper holder brackets protruding from and firmly attached to the wall
approximately three feet from the floor resisted a push down test;
- the patient's bathroom door had three hinges which left gaps between the hinges;
- unsecured lightweight furniture in the patient's room moved easily including two chairs and two
bedside stands. There is a potential the patient(s) can move/position the furniture under a
looping and hanging hazard to aid the patient in reaching a hanging position.

-On 07/19/11 at 1:45 PM, patient room number 104 had the following:
- sink faucet handles (approximately 3 inches long) and a high goose neck faucet
(approximately 11 inches above sink);
- two electric hospital beds with upper side rails on each side of the bed, a bar at the foot
of the bed, electric cords 118 inches long and alarm cords 116 inches long;
- hospital bed #2 had oxygen tubing 158 inches long attached to the wall;
- the shower water control knob was missing with metal plumbing protruding approximately
1 ½ inches from the wall and approximately 4 feet off the floor;
- the patient's bathroom door had three hinges which left gaps between the hinges; and
- unsecured furniture in the patient's room moved easily including two chairs and two
geriatric chairs (reclining chairs). There is a potential the patient(s) can move/position the furniture under a looping and hanging hazard to aid the patient in reaching a hanging position.


- On 07/19/11 at 2:15 PM, patient room number 106 had the following:
- sink faucet handles (approximately 3 inches long) and a high goose neck faucet
(approximately 11 inches above sink);
- two electric hospital beds with upper side rails on each side of the bed, a bar at the foot
of the bed, electric cords 118 inches long and alarm cords 116 inches long;
- exposed toilet plumbing approximately 16 inches from the floor;
- the shower water control knob protruded approximately 1 ½ inches from the wall and
approximately 4 feet off the floor;
- metal toilet paper holder brackets protruding from and firmly attached to the wall
approximately three feet from the floor resisted a push down test;
- the patient's bathroom door had three hinges which left gaps between the hinges (which provided an area for looping); and
- unsecured lightweight furniture in the patient's room moved easily including two chairs and two
bedside stands. There is a potential the patient(s) can move/position the furniture under a looping and hanging hazard to aid the patient in reaching a hanging position.


- On 07/19/11 at 2:45 PM, patient room number 101 had the following:
- sink faucet handles (approximately 3 inches long) and a high goose neck faucet
(approximately 11 inches above sink);
- one electric hospital bed with upper side rails on each side of the bed, a bar at the foot of
the bed, an electric cord 118 inches long and an alarm cord 116 inches long;
- exposed toilet plumbing approximately 16 inches from the floor;
- the shower water control knob protruded approximately 1 ½ inches from the wall and
approximately 4 feet off the floor;
- the patient's bathroom door had three hinges which left gaps between the hinges (which provided an area for looping); and
- unsecured lightweight furniture in the patient's room moved easily including one chair and one
bedside stand. There is a potential the patient(s) can move/position the furniture under a
looping and hanging hazard to aid the patient in reaching a hanging position.


-On 07/19/11 at 3:00 PM, patient room 102 had the following:
- sink faucet handles (approximately 3 inches long) and a high goose neck faucet
(approximately 11 inches above sink);
- two electric hospital beds with upper side rails on each side of the bed, a bar at the foot
of the bed, electric cords 118 inches long and alarm cords 116 inches long;
- exposed toilet plumbing approximately 16 inches from the floor;
- the shower water control knob protruded approximately 1 ½ inches from the wall and
approximately 4 feet off the floor;
- the patient's bathroom door had three hinges which left gaps between the hinges (which provided an area for looping); and
- unsecured lightweight furniture in the patient's room moved easily including two chairs and two
bedside stands. There is a potential the patient(s) can move/position the furniture under a looping and hanging hazard to aid the patient in reaching a hanging position.


-On 07/19/11 at 3:04 PM, patient room number 100 had the following:
- sink faucet handles (approximately 3 inches long) and a high goose neck faucet
(approximately 11 inches above sink);
- one electric hospital bed with upper side rails on each side of the bed, a bar at the foot of
the bed, an electric cord 118 inches long and an alarm cord 116 inches long;
- exposed toilet plumbing approximately 16 inches from the floor;
- the shower water control knob protruded approximately 1 ½ inches from the wall and
approximately 4 feet off the floor;
- the patient's bathroom door had three hinges which left gaps between the hinges (which provided an area for looping); and
- unsecured lightweight furniture in the patient's room moved easily including one chair and one
bedside stand. There is a potential the patient(s) can move/position the furniture under a
looping and hanging hazard to aid the patient in reaching a hanging position.


-On 07/19/11 at 3:05 PM, patient room number 105 had the following:
- sink faucet handles (approximately 3 inches long) and a high goose neck faucet
(approximately 11 inches above sink);
- two electric hospital beds with upper side rails on each side of the bed, a bar at the foot of
the bed, electric cords 118 inches long and alarm cords 116 inches long;
- exposed toilet plumbing approximately 16 inches from the floor;
- the patient's bathroom door had three hinges which left gaps between the hinges (which provided an area for looping); and
- unsecured lightweight furniture in the patient's room moved easily including two chairs and two bedside stands. There is a potential the patient(s) can move/position the furniture under a looping and hanging hazard to aid the patient in reaching a hanging position.


3. Record review of the Senior Lifestyles "Pro-Active Risk Assessment Form" dated 01/18/11 completed by Staff O, Nurse Manager Senior Lifestyles, identified the following risks for patients on the unit: Cords greater than 18 inches long in patient rooms. The type of injury which could result if harm occurred is identified as "strangulation". The assigned risk level is identified as "moderate" for likelihood of injury occurring and "moderate" severity of harm if injury does occur. (Cords greater than 18 inches were observed. The facility failed to ensure it met its own internal Standards of Practice for a safe psychiatric environment when it failed to correct the long cord lengths identified on 01/18/11.)

4. Record review of the Psychiatric Unit 2010 Environmental/Physical Facilities Annual Risk Assessment completed by Staff O, Nurse Manager Senior Lifestyles, identified the following risks for patients on the unit:
a. Electric bed cords are secured or shortened to 18 inches is scored as "NO"; and,
b. Bathroom door has a continuous hinge or is open at the top is scored as "NO."
The facility failed to ensure it met its own internal Standards of Practice for a safe psychiatric environment when it failed to comply with the cord length requirements and failed to ensure psychiatric safe bathroom doors were in place. The facility failed to correct the long cord lengths and the bathroom door risks identified on the Psychiatric Unit 2010 Environmental/Physical Facilities Annual Risk Assessment.

5. During an interview on 07/20 /11 at approximately 1:30 PM, Staff O, Nurse Manager of the Senior Lifestyles Unit stated the following:
-the management of the unit was done through a contracted company;
-the contracted company conducted annual environmental safety assessments of the unit and had identified environmental issues that may contribute to risk for self harm for some of the patients admitted to the unit;
-the contract company provided a written report of the environmental safety problems to the facility addressed to the Vice President of Nursing services and the Nurse Manager of the psychiatry unit; and
-he/she felt the identified issues were not addressed by facility.

6. Review of Senior Lifestyles Observation Flow Sheet showed rounding on patients (observation of where the patients were and what the patients were doing at a specific time) have the rounding times pre-typed onto the form and the staff initialed next to the rounding times instead of documenting the actual rounding time for each patient.

During an interview on 07/19/11 at 3:31 PM, Staff A, Chief Nursing Officer confirmed the Senior Lifestyles Observation Flow Sheet does have the pre-typed times and the actual time of patient rounding is not documented. He/she also confirmed all patients are on a 15-minute watch and the actual time of the patient observation should be documented. Staff A stated the facility did not currently have any suicidal patients but had admitted suicidal patients in the past.

Based on interview and record review, facility staff failed to identify changes to provide a safe patient environment including prevention of self harm on the psychiatry unit. The facility census was 80.

Findings included:

1. During an interview on 07/20 /11 at approximately 1:30 PM, Staff O, Nurse Manager of the Senior Lifestyles Unit stated the following:
-The unit was a gero-psychiatry unit.
-The management of the unit was done through a contracted company.
-The contracted company conducted annual environmental safety assessments of the unit and had identified environmental issues that may contribute to risk for self harm for some of the patients admitted to the unit.
-The contract company provided a written report of the environmental safety problems to the facility addressed to the vice president for nursing services and the nurse manager of the psychiatry unit.
-He/she felt the identified issues were not addressed by facility.
-He/she was not a member of the Quality Council or the facility Safety Committee that reported to the Quality Council.

2. Record review of the most current documentation showing identification of environmental problems, dated 05/03/11, from the contract company staff to Staff A, Vice President for Nursing showed the following:
-high plumbing fixtures that presented a risk for self harm (hanging);
-hangers in patient closets that could be used for self harm (hanging);
-Velcro privacy curtains that should be tested for weight release when bunched up;
-cords and high outlets should be lowered to allow only twelve to eighteen inch cord due to hanging risk; and
-a risk assessment had been completed and sent to the facility Safety officer.

3. During an interview on 07/21/11 at 2:20 PM Staff Y, Safety Officer stated the following:
-He/she was not aware of the environmental safety issues on the psychiatry unit.;
-He/she did perform safety rounds in the facility.
-The Director of Senior Lifestyles Unit (geriatric psychiatric) was not currently on the Safety Committee.
-Maintenance and Bio-medical staff were members of the Safety Committee.
-Maintenance staff do perform safety rounds on the Senior Lifestyles Unit, however those staff may not have been aware of the environmental suicide risks.
-Information discussed in the Safety Committee may not be directed to the Quality Council.
-Reports of patient safety issues on the Senior Lifestyles unit can bypass the reporting mechanisms up to the Quality Council.

Based on observation, interview and policy review, the facility failed to ensure medications on the Intensive Care Unit (ICU), medical unit and Cancer Infusion Center are kept in a locked or secure area to prevent unauthorized access. This had the potential to affect all patients. The facility census was 80.

Findings included:

1. Record review of facility policy 017 "Medication Administration Procedure," revised 07/10, states that staff are to store and secure medications by keeping medications locked at all times except when being administered in order to prevent unauthorized individuals from obtaining medications.

2. Observation in the ICU on 07/19/11 at 9:10 AM showed a half full bottle of Propofol (an intravenous, IV, medication used for anesthesia, deep sedation) discarded in a trash can on the suture cart in a common hallway.

During an interview on 07/19/11 at 09:10 AM, Staff AA, Nurse Manager ICU, stated that medication should not be disposed of in that manner.

During an interview on 07/20/11 at 1:30 PM, Staff X, Pharmacy Director, stated that he/she heard about the Propofol storage. Staff X stated that this is a problem and that pharmacy will put measures into place to secure medications that are being discarded.

2. Observation in the Cancer and Infusion Center on 07/21/11 at 9:10 AM showed four, 50 ml (milliliter) bottles of Lidocaine 2% (a medication used to numb skin) and two 20 ml containers of Formalin (a solution used to preserve specimens) in an unlocked closet in a common area of the infusion center.

During an interview on 07/21/11 at 9:15 AM, Staff BB, Director of Operations of Cancer and Infusion Center, stated that the closet and medications should be locked, it normally is locked.


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3. Observation on the medical unit on 07/19/11 at 1:00 PM showed an unlocked urology cart in the patient/ visitor hallway. The urology cart contained:
- two bottles of 0.9% Normal Saline for medication dilution
- a bottle of Lidocaine
- and numerous Saline irrigation bags, used to flush patients bladder (body structure that collects and stores urine) which can be tampered with and risk contamination by unauthorized persons.

During an interview on 07/19/11 at 2:00 PM, Staff Q, Director of Laundry and Central Sterile stated that the cart is not locked when sent to the nursing units. Staff Q stated that the cart contains medication and should be locked.

Based on observation and interview, the facility failed to maintain walls, ceilings and door assemblies in good repair and easily cleanable in the geriatric psychiatric unit of the facility. This had the potential to affect nine of nine patients on the psychiatric unit. The facility census was 80.

Findings included:

Observation during a tour of the geriatric psychiatric unit on 07/21/11, showed the following:

- A section of ceiling covering, approximately four square inches, was cracked and bubbling away from the ceiling in the bathroom of patient room 100.
- A section of the wooden door, approximately four inches long and one half inch wide, was cracked and splintered to patient room 100.
- A section of wall, approximately four inches long and one inch wide, was cracked and chipping away in the seclusion room.
- The paint was chipped and peeling away from the door frames to all seven patient rooms exposing the metal frame.

Staff F Director of Plant Operations confirmed these observations at that time.

Based on observation, interview and record review the facility staff failed:
-to clean and maintain dietary department equipment;
-to provide a safe environment for all patients by ensuring staff maintain usable supplies with current dates; and
-to remove expired supplies from stock have the potential to expose patients to unsterile, unstable supplies which could cause infection.

The facility census was 80.

Findings included:

1. Observation on 07/20/11 at 10:44 AM, showed Dietary staff failed to clean and maintain a table mounted can opener with metal can shavings imbedded in sticky black accumulated food debris along the gears behind the blade.

During an interview on 07/20/11 at 10:44 AM, Staff S examined the table mounted can opener and stated it needed cleaning.


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2. Record review of the facility's policy titled, "Central Service" with an effective date of August 30, 2001, showed direction for facility staff:

- Latex free and urology carts should be completely stocked and checked regularly to ensure integrity and condition of supplies
- Central Service personnel will inspect the returned cart(s), do a complete inventory, and check the supplies returned against the supplies used to further ensure accuracy and integrity of procedure.

3. Observation on 07/19/11 at 1:00 PM, showed a urology cart, in the hallway of the medical floor, contained the following expired supplies:
- 1000 ml (milliliter)of 0.9% Normal Saline(salt solution) irrigation solution with an expiration date of May 2011;
- Two 10 ml bottles of 0.9% Normal Saline with an expiration date of 07/01/11;
- Three packages of Wet Pruf (brand name) Abdominal Pads with an expiration date of 08/2010;
- Two packages of Wet Pruf Abdominal Pads with an expiration date of 02/2010;
- 0.9% Normal Saline 3000 ml irrigation solution with an expiration date of 03/11;
- Two bottles of 0.9% Normal Saline 3000 ml irrigation solution with an expiration date of 02/11;
- One Drainage bag with an expiration date of 04/2011; and
- One Drainage bag with an expiration date of 05/2011.

During an interview on 07/19/11 at 1:30 PM, Staff P, Central Supply Technician, stated that the cart is checked when it comes back to the department. Staff P stated the cart is not checked when it goes out of the department. Staff P stated the cart wasn't checked properly.

During an interview on 07/19/11 at 1:40 PM Staff Q, Director of Laundry and Central Supply, stated that he/she could not understand the outdated supplies. Staff Q stated that the carts are supposed to be checked for outdates.

Based on observation, interview and record review, the Infection Control Officer and Dietary management failed to develop and maintain a system for the identification and control of poor food handling measures that would contribute to cross contamination and growth of food borne illness causing bacteria.

Dietary staff failed to wash hands at appropriate intervals; store foods to protect against deterioration and cross contamination; wear effective hair restraints; assure dishes and utensils were consistently sanitized; and failed to serve foods at appropriate temperatures.

Staff failed to follow facility standard of practice for isolation precautions for one patient (#4) of one patient observed on isolation precautions during medication administration.

The facility census was 80.

Findings included:

1. Record review of the facility policy titled Food Service Staff Dress Code, policy #506, effective date 04/03/96 showed the following:
-Food service staff will dress according to set guidelines that comply with approved infection control procedures.
-All food service staff were required to wear approved hair restraints which cover all the employee's hair.
-Approved hair restraints include surgical bonnets, white paper hats and approved hair nets.
-Bandanas, baseball caps and other hats were not approved for use as hair restraints.
-Staff were not allowed to wear dangling earrings due to potential for getting caught in conveyor belts or other moving machinery.

Record review of the U. S. Department of Health and Human Services (USDA), Public Health Service (PHS), Food and Drug Administration (FDA), 2005 Food Code showed the following:
-Chapter 2-301.11 Food employees shall keep their hands and exposed portions of their arms clean.
-Chapter 2-301.14 Food employees shall clean their hands before working with exposed food, after touching bare human body parts, as often as necessary to remove soil and contamination and to prevent cross contamination when changing tasks, before donning gloves for working with food and after engaging in other activities that contaminate the hands.
-Chapter 3-305.11 Food shall be protected from contamination by storing the food in a clean, dry location not exposed to splash, dust, or other contamination.
-Chapter 3-304.12 Dispensing utensils shall be stored with their handles above the top of the food within containers or equipment that can be closed, such as bins of sugar or flour.
-Chapter 3-304.14 Cloths in-use for wiping counters and other surfaces shall be held between uses in a chemical sanitizer solution at a specified concentration and containers of chemical sanitizing solutions shall be stored off the floor and used in a manner that prevents contamination of food, equipment and utensils.
-Chapter 3-305.11 Food shall be protected from contamination by storing the food in a clean, dry location not exposed to splash, dust, or other contamination.
-Chapter 4-501.112 Mechanical ware washing equipment, hot
water temperatures for sanitizing rinse may not be less than 180 degrees Fahrenheit.

2. Observation on 07/20/11 at 10:20 AM, in the dietary department dry food storeroom showed staff stored two opened twenty ounce containers of caramel dessert sauce with sticky exterior surfaces, unrefrigerated on a shelf.

Review of the labels on the containers showed manufacturer's directives to refrigerate the containers after opening.

During an interview on 07/20/11 at 10:20 AM, Staff S, Director of Dietary stated the dessert sauces should not be stored unrefrigerated in the dry food storeroom and the sauces, last used in 06/11, should have been refrigerated.

3. Observation on 07/20/11 at 10:30 AM, in the Dietary department walk-in freezer showed staff stored a case of frozen fish on a shelf with case opened to air and the fish fillets exposed to air and cross contaminants.

During an interview on 07/20/11 at 10:30 AM, Staff S stated the case of fish was opened (plastic bag liner was opened to air) exposing the fish fillets to air and contaminants (Staff S failed to immediately cover the exposed foods).

4. Observation on 07/20/11 at 10:40 AM, showed Dietary staff stored food wiping cloths out on a counter in the cold food preparation area of the kitchen.

During an interview on 07/20/11 at 10:40 AM, Staff S, Director of Dietary stated dietary staff used a solution in a spray bottle to clean counter tops with food wiping cloths and staff did not immerse the used cloths in a sanitizing solution.

5. Observation on 07/20/11 at 10:44 AM, in the Dietary department showed staff stored rice in a bulk food container heavily spattered with dried food debris.

6. Observation on 07/20/11 at 10:44 AM, in the Dietary department showed staff stored a scoop with the handle of the scoop resting on the surface of rice in a bulk food container (potentially cross contaminating from scoop handle to the food).

7. Observation on 07/20/11 at 10:52 AM, showed Staff W, Diet Aide wearing a fabric scarf on the head and hoop style earrings (greater than two inch diameter).

8. Observation on 07/20/11 at 11:40 AM during patient tray assembly showed Staff CC, Diet Aide, place a gloved hand on his/her hair restraint then failed to remove soiled gloves, wash hands, re-glove before continuing with tray assembly.

9. Observation on 07/20/11 at 11:52 AM, during patient tray assembly showed Staff W (tray accuracy checker) removed soiled gloves, handled an ink pen and scrap paper, re-gloved without hand washing then continued to touch dishes and utensils on each patient meal tray.

Record review of the USDA, PHS, FDA, 2005 Food Code, Chapter 2-301.14 directed the following; Food employees shall clean their hands before working with exposed food, after touching bare human body parts, as often as necessary to remove soil and contamination and to prevent cross contamination when changing tasks, before donning gloves for working with food and after engaging in other activities that contaminate the hands.

10. Record review of the Dietary department dish washing machine temperature log showed staff intermittently recorded temperatures of 176 degrees Fahrenheit (six times in June, 2011 and once to date in July, 2011).

During an interview on 07/20/11 at 11:01 AM Staff V, Diet Aide stated he/she thought the final temperature should be 180 degrees Fahrenheit but was unsure and he/she would report the lowered temperatures to the Director of Dietary.

During an interview on 07/20/11 at 11:01 AM Staff S stated he/she was not aware dish washing staff had recorded temperatures below the required 180 degrees Fahrenheit.

11. During an interview on 07/22/11 at 1:05 PM Staff Y, Infection Control Officer stated the following:
-All facility departments were included in the hand washing surveillance program.
-Departments have staff who watch each other (secret shoppers).
-Dietary staff required on-going in-service training on infection control topics taught by an infection control professional.
-He/she had been going to each departmental staff meeting for education and training however, he/she had not been to a Dietary department meeting in a while.


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12. Record review of the facility's policy titled, "Isolation Precautions" with a revised date of June 2011, showed the following direction:
- Patients with known or suspected communicable disease, colonization, or infection will be placed in isolation precautions appropriate for the communicable disease, colonization, or infection immediately upon the discovery or suspicion of the communicable disease, colonization, or infection, until the patient is found to be clear of the communicable disease, colonization, or infection.
- Contact Precautions will be used for specified patients known or suspected to be infected or colonized with epidemiologically important microorganisms that can be transmitted by direct contact with the patient (hand or skin-to-skin contact that occurs when performing patient-care activities that require touching the patient's dry skin) or indirect contact (touching) with environmental surfaces or patient care items in the patient's environment.
-Patient-Care Equipment - When possible, dedicate the use of noncritical patient-care equipment to a single patient (or cohort of patients infected or colonized with the pathogen requiring precautions) to avoid sharing between patients. If use of common equipment or items is unavoidable, then adequately clean and disinfect them before use for another patient.

13. Observation on 07/19/11 at 9:05 AM, showed Staff I, Licensed Practical Nurse (LPN), administered medication to Patient #4. Patient #4 was on contact precaution isolation. Staff I touched Patient #4 and Patient #4's environment. Staff I removed a pen and scissors from his/her uniform to use during administration of Patient #4's medication. Staff I failed to clean and disinfect the scissors and pen before placing them in his/her pocket and leaving the patient's room.

During an interview on 07/19/11 at 2:15 PM, Staff I stated that he/she needed to keep himself/herself and the equipment free from contamination when working with patients with isolation needs.