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Based on the manner and degree of the standard level deficiency referenced to the Condition, it was determined the Condition for Participation §482.41 PHYSICAL ENVIRONMENT, was out of compliance.

A0701 §482.41 (a) BUILDINGS. The condition of the physical plant and the overall hospital environment must be developed and maintained in such a manner that the safety and well-being of patients are assured. Based on document review and interviews, the facility failed to implement adequate corrective measures to ensure the well-being of the patients. Specifically, the water temperature of the washing machines used to launder patient clothing in the patient care units did not meet guidelines for parasite control.

Based on document review and interviews, the facility failed to implement adequate corrective measures to ensure the well-being of the patients. Specifically, the water temperature of the washing machines used to launder patient clothing in the patient care units did not meet guidelines for parasite control.

Findings include:

Facility policies:

The Parasite Control - Lice (Pediculosis) policy read, its purpose was to prevent and control parasitic infestations. Humans are the only natural reservoirs of lice. Infestation among human hosts are associated with poor hygiene, overcrowding, and inadequate facilities for personal hygiene or cleaning clothing. Contributing factors for the spread of human lice include increased sexual promiscuity, communal living, and widespread travel. Human lice feed on blood obtained by biting a person's skin. Bites can be hemorrhagic due to anticoagulants introduced into the skin and thereby allow the mite to access the bloodstream. These bites cause intense itching, a red rash, and occasionally may lead to fever. Due to scratching by the human host, the bites can become excoriated and infected with bacteria leading to secondary infections. The procedure read, the Mental Health Clinician (MHC) is to wash clothes and linens that the patient has used within 48 hours before treatment. Machine wash at relatively high temperature (140 Fahrenheit (F) for ten minutes) then dry in clothes dryer for length of normal cycle. Place other non-washable items into a sealed leak-proof plastic bag as follows: head lice for 10-14 days, body lice for 30 days, and pubic lice for seven days.

The Cleaning and Disinfection of Unit Washers and Dryers policy read, its purpose is to ensure a standardized process to prevent the spread of infectious agents within the facility through proper cleaning and disinfection. The Centers for Disease Control (CDC) Guidelines note that hot water provides an effective means of destroying microorganisms, and a temperature of at least 160 F for a minimum of 25 minutes is commonly recommended for hot-water washing.

References:

The Lice Tip Sheet read, lice is spread by direct contact with clothing (such as hats, scarves, coats) and personal items (such as combs, brushes, or towels) used by an infected person.

CDC guidelines found at https://www.cdc.gov/lice/treatment/index.html read, follow these steps to help avoid re-infestation by lice that have recently fallen off the hair or crawled onto clothing or furniture. Machine wash and dry clothes, beddings, and items used by the infested person in the two days before treatment. Use hot water (130 F) and high heat drying. If you can't wash or dry clean items, seal them in a plastic bag for two weeks. Soak combs and brushes in hot water (at least 130 F) for five to ten minutes.

The instructions for use (IFU) for permethrin lice treatment creme rinse read, after using creme rinse, it is very important to clean personal items and your home to prevent the spread of lice. All personal head gear (hats, etc.), scarves, coats, towels and bed linens should be washed in hot water (above 130 F), then dried in the dryer using the hottest cycle for at least 20 minutes.

The instructions for use (IFU) for ivermectin lotion for lice treatment read, machine wash any bedding and clothing used by anyone having lice. Machine wash at high temperatures (150 F) and tumble in a hot dryer for 20 minutes.

1. The facility failed to implement corrective measures to ensure the water temperature of the washing machines used to launder patient clothing in the patient care units was hot enough to meet guidelines for lice control.

A. Document Review

i. Patient #2's medical record was reviewed and revealed on 10/6/24 at 8:30 a.m., staff noticed Patient #2 itching during a routine safety check and observed lice on the bed pillow. Staff reported this observation to the nursing staff. Patient #2 was examined by a doctor who ordered Permethrin (a topical medication used to treat lice). Patient #2 was treated a second time seven days later with Permethrin as indicated by the IFU. Patient #2 continued to have lice several days later and was treated a third time. The third treatment for lice was with ivermectin (a stronger topical medication used to treat lice).

ii. A review of the preventative maintenance log on 10/8/24 at 12:21 p.m. revealed the check for proper temperature setting had been documented as 110 F. The facility water temperature which supplied the patient washing machines was 20 degrees or more too low to mitigate a lice infestation.

The review of the log was in contrast with facility policies and guidelines which instructed washing clothing and linens of patients with lice in temperatures ranging from 130 F to 160 F.

B. Interviews

i. On 11/18/24 at 2:54 p.m., an interview was conducted with registered nurse (RN) #1. RN #1 stated the patient admission procedure was to remove the patient's clothing and give them facility scrubs. RN #1 stated the patient's clothing was washed in the unit washer and dryer by the mental health clinician (MHC) and then returned to the patient.

ii. On 11/20/24 at 11:02 a.m., an interview was conducted with MHC #2. MHC #2 stated patients were allowed to wash their laundry on the unit at least once each week. MHC #2 stated the washer and dryer settings would have been set by the patient with help from an MHC if needed. MHC #2 stated in August the moment lice were discovered on Patient #1, all of Patient #1's clothing had been removed from their room and placed in a plastic hazardous material bag and sealed according to the Lice Control policy. Also, MHC #2 stated some of Patient #1's clothing had been washed in the unit's washer and dryer.

iii. On 11/20/24 at 11:40 a.m., an interview was conducted with RN #3. RN #3 stated they had administered the medication treatments of permethrin and ivermectin to Patient #2. RN#3 stated they had worked with medical staff and the certified infection control nurse (CIC) #4 to manage a lice infestation in October 2024. RN #3 stated the patient's clothing was washed in the unit washer and dryer. RN #3 stated CIC #4 had directed staff to wash affected clothing in hot water two times to mitigate the spread of lice. RN #3 stated two additional patients on the unit had gotten lice during the infestation.

iv. On 11/20/24 at 3:19 p.m., an interview was conducted with CIC #4. CIC #4 stated during the lice infestation on Team 1 (a civil high acuity unit) in August 2024 and Team 4 (a forensic high acuity unit) in October 2024, they had helped bag the affected patient's belongings and get them washed. CIC #4 stated the patient's clothing had been laundered in-house and the linens and towels had been put into a red biohazard bag and laundered by the linen services company. Also, CIC #4 stated scrubs worn by the patients go to the linen services company to be laundered. Additionally, CIC #4 stated patients' personal items, including socks, underwear, and hoodies would have been washed in the unit washer and dryer.

Further, CIC #4 stated they provided guidance to the staff on how to run the washer and dryer at high-temperature settings. CIC #4 stated one area that had been a concern for a long time had been the water temperature of the washing machines. CIC #4 stated the washer temperatures had been set at 110 F for patient safety. CIC #4 further stated to mitigate the lice infestation, staff had been directed to wash and dry the clothing two times.

Upon request, there was no evidence provided to support that washing and drying clothing twice at a water temperature of 110 F would have mitigated a lice infestation.