HospitalInspections.org

Based on observation, document review, and interview the facility failed to properly prevent the transmission of COVID-19 and follow Centers for Disease Control and Prevention (CDC) Guidelines and Recommendations regarding screening of all staff and Health Care Providers upon entering the facility.

This deficient practice had the likelihood to cause serious harm, injury, and possibly subsequent death. Failure to adhere to the CDC's recommendations and guidelines placed all patients, staff, and Health Care Providers at a higher risk for contracting and transmitting COVID-19.


Findings Include:

An observation tour was conducted on 10/15/2020 after 10:00 AM with Staff #2 and Staff #7. The following was observed.

Main Entrance

Construction is noted at the main entrance of the facility. Through the first set of double doors is an employee time clock and a thermometer mounted to the wall for staff and Health Care Provider temperature screenings. Staff #2 confirmed patients and visitors also enter through this door and they are stopped at the registration desk for a temperature check and COVID-19 screening. During observation, it was noted one physician and two staff members did not stop at the registration desk for screenings before being allowed into the facility.

Staff #2 and #7 confirmed staff and Health Care Providers are not stopped for COVID-19 screening.

An interview conducted with Staff #2 and Staff #7 was conducted on 10/15/2020 after 10:00 AM. Staff #2 was asked what National Guidelines the facility used for the control of COVID-19. Staff #2 replied, "We follow the Centers for Disease Control and Prevention (CDC) Guidelines. Staff #2 was asked if staff or Health Care Providers are screened for COVID-19 symptoms or exposure according to CDC Guidelines. Staff #2 stated, "No employee or Health Care Provider was screened for COVID-19 symptoms except for a temperature check. The employees are told to check their temperatures using the mounted themometers when entering the building."

Staff #7 was asked how many employee entrances were available for staff. Staff #7 stated, "We have two entrances at this time and that is the Emergency Room (ER) and the Main entrance. Employees can enter at either place." Staff #7 was asked if the ER also provided a thermometer for staff and Health Care Providers to use before entering the facility. Staff #7 replied, "Yes." Staff #2 was asked if screening questions were asked to staff or Health Care Providers regarding COVID-19 symptoms or exposure before entry into the facility was allowed. Staff #2 replied, "No we do not stop staff or Health Care Providers that enter the facility for COVID-19 screening questions only patients and visitors." Staff #2 was asked how the facility ensured all staff and Health Care Providers stopped to check their temperature before entry into the facility. Staff #2 replied, "We base it on an honor system. There is no way for us to know if the employees stopped to check their temperature or not." Staff #2 was then asked if there was an alert or alarm that notified anyone if someone entered the facility without a temperature screening. Staff #2 stated, "No there is no way to know."

An interview was conducted with Staff #4 on 10/15/2020 after 10:00 AM. Staff #4 was asked if there was a way to ensure that all staff and Health Care Providers were properly screened for COVID-19 prior to entering the facility. Staff #4 confirmed there was no documentation ensuring staff or Health Care Providers were screened prior to entering the facility.


Emergency Room

A thermometer was noted to be mounted on the wall next to the time clock at the ER entrance. Inside the doors was a registration desk. The registration clerk screened all patients and visitors entering the facility. An interview was conducted on 10/15/2020 at 10:00 AM with Staff #6. Staff #6 was asked if she was screened for any symptoms or exposure of COVID-19 before she was allowed in the facility. Staff #6 confirmed she was not screened for symptoms or exposure of COVID-19. Staff #6 also confirmed staff was not stopped at the registration desk for screening. Staff #6 was asked how they identified patients or visitors of a potential COVID-19 Diagnosis. Staff #6 stated, "All patients and visitors are screened for symptoms, exposure, and temperatures when they arrive at the facility. If there was a patient that exhibited symptoms of COVID-19 the ER team was notified by the ER Registration clerk."


A review of the document titled, "COVID-19 DAILY DIGEST" dated March 26, 2020 was as follows:

" ...To: ****** (THRW) Caregivers, Leaders, and Medical Staff


Screening Update: Caregivers and Physicians

Hospital Access

Just a reminder that as of Thursday, March 26 all caregivers and physicians are required to enter the front lobby doors for screening prior to beginning their shift. At NRER the Charge Nurse will be screening all caregivers as they arrive. Screening will include any symptoms and temperature checks..."


Staff #13 confirmed the facility was not currently screening any staff or Health Care Providers for symptoms of COVID-19 prior to entering the facility.

Staff #13 was asked when did the COVID-19 screening for staff and Health Care Providers cease. Staff #13 replied, "The week ending August 15th. We placed thermometers at the Main and ER entrances so employees screened themselves for a fever prior to entering the facility." Staff #13 was asked if the facility has had any COVID-19 positive employees. Staff #13 confirmed 27 of 561 employees have tested positive for COVID-19. Staff #13 was asked if she could ensure all staff and Health Care Providers currently screened themselves prior to entering the facility. Staff #13 said, "No."



A review of the CDC Guidelines and Recommendations was as follows:

" ...Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic

Infection Control Guidance
Updated July 15, 2020

Background

This interim guidance has been updated based on currently available information about COVID-19 and the current situation in the United States. As healthcare facilities begin to relax restrictions on healthcare services provided to patients (e.g., restarting elective procedures), in accordance with guidance from local and state officials, there are precautions that should remain in place as a part of the ongoing response to the COVID-19 pandemic. Most recommendations in this updated guidance are not new (except as noted in the summary of changes above); they have been reorganized into the following sections:

Recommended infection prevention and control (IPC) practices for routine healthcare delivery during the pandemic

Recommended IPC practices when caring for a patient with suspected or confirmed SARS-CoV-2 infection

This guidance is applicable to all U.S. healthcare settings

Screen and Triage Everyone Entering a Healthcare Facility for Signs and Symptoms of COVID-19
Although screening for symptoms will not identify asymptomatic or pre-symptomatic individuals with SARS-CoV-2 infection, symptom screening remains an important strategy to identify those who could have COVID-19 so appropriate precautions can be implemented.

Take steps to ensure that everyone adheres to source control measures and hand hygiene practices while in a healthcare facility

Post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide instructions (in appropriate languages) about wearing a cloth face covering or facemask for source control and how and when to perform hand hygiene.

Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand sanitizer (ABHS) with 60-95% alcohol, tissues, and no-touch receptacles for disposal, at healthcare facility entrances, waiting rooms, and patient check-ins.

Limit and monitor points of entry to the facility.

Consider establishing screening stations outside the facility to screen individuals before they enter.

Screen everyone (patients, HCP, visitors) entering the healthcare facility for symptoms consistent with COVID-19 or exposure to others with SARS-CoV-2 infection and ensure they are practicing source control.

Actively take their temperature and document absence of symptoms consistent with COVID-19. Fever is either measured temperature ?100.0°F or subjective fever.

Ask them if they have been advised to self-quarantine because of exposure to someone with SARS-CoV-2 infection.


People with COVID-19 have had a wide range of symptoms reported - ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea

This list does not include all possible symptoms. CDC will continue to update this list as we learn more about COVID-19 ..."

During interviews with Staff #4 and #13 on 10/15/2020, Staff #13 confirmed the facility did not currently have a process in place to screen staff or Health Care Providers for COVID-19 before entering the facility. Staff #13 presented a plan at this time. The plan detailed a screening process that would be implemented for staff and Health Care Providers prior to entering the facility. Staff #13 confirmed the new plan would follow all current CDC Guidelines to ensure the containment and prevention of COVID-19. Staff #4 confirmed.

Staff #2, #4, and #13 confirmed the above findings.