HospitalInspections.org

Based on observation and staff interview, the facility failed to maintain the floor of the clean area of the central sterile in good repair.

Findings include:

During observation of the Central Sterile Unit on 09/30/2020 at 10:49 AM, a porting of the floor tiles in the clean area of the Central Sterile Unit was damaged (broken) and there was an accumulation of dusts and dirt in the space under the broken surface; this makes it impossible to adequately clean and disinfect the floor.

During a concurrent interview with Staff D, Infection Prevention Nurse on 9/30/2020 at 10:52 AM, she acknowledged the finding and reported that a work order was submitted for general repair of the entire central sterile unit.

Based on observation, review of document and interview, the facility failed to ensure compliance with nationally recognized infection prevention and control guidelines. Specifically, the facility failed to ensure:

1) All staff and visitors are appropriately screened for signs and symptoms of COVID-19;
2) Employees wore facemask to cover mouth and nose for source control while they are in the healthcare facility;
3) Doors of rooms of patients admitted for COVID-19 and other respiratory infections are closed;
4) Hand hygiene is performed before and after patient contact;
5) Reusable Personal Protective Equipment are properly cleaned and maintained.

These failures may result in transmission of infections.

See A0772

Based on observation, review of document and interview, the facility failed to ensure compliance with nationally recognized infection prevention and control guidelines.

These failures may result in the transmission of infections.

Findings include:

1. As per interview on 9/25/20 at 10:11 am with Staff M (Assistant Vice President of Operations) and Staff N (Assistant Director of Regulatory Affairs), the facility implements the Center for Disease Control and Prevention (CDC) "Interim Infection Prevention and Control Recommendations for Healthcare Personnel for Coronavirus Disease 2019."

Review of the CDC "Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic" last revised 7/15/20 revealed facility's lack of adherence to the CDC guidance to mitigate the critical elements of transmission of COVID-19.

CDC guidance notes " ...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....."

Observations on 9/25/20, between 12:00 pm and 1:00 pm at the Children Hospital building noted 10 visitors that had gone past the building entrance and the screening station. During interviews with these visitors, they all reported that they have not been screened for signs and symptoms of COVID-19.

Similar findings regarding lack of appropriate screening for visitors for signs and symptoms of COVID 19 upon entering the facility were noted for four additional visitors on 9/28 and 9/29/20.

Observation of staff screening conducted at the facility 210 street main entrance on 9/25/20 and 9/29/20 between 12:21 pm and 1 pm revealed that staff members who do not have the COVID-19 screening app on their phones were made to fill out a form to answer the screening questions. The screening forms were then placed in a box. The forms filled out by staff were not reviewed upon submission or before the staff enters the facility.
On September 28, 2020, at 12:54 pm, during an interview with Staff M (AVP of Operations) she acknowledged findings and stated that screening forms are collected and reviewed afterwards.

Review of facility document revealed that Staff O, Physician Assistant returned to work on 09/17/20 after an international travel. Staff O worked at the facility on 09/17/20 and 09/18/20 even after complaining of not feeling well on both days. Staff O did not return to work on 9/19/20, he later tested positive for COVID-19.

Review of the data entry on the "COVID Employee Attestation Log" for Staff O revealed noncompliance with the screening process. As a result, Staff O exposed 16 staff members and 8 patients to COVID-19 virus.

On September 29, 2020, at approximately 1:00 pm, during an over the phone interview with Staff O (Physician Assistant), he acknowledged that he did not indicate in the screening app that he had traveled outside of the United States in the past 14 days.

2. The CDC guidance notes " ...HCP should wear a facemask at all times while they are in the healthcare facility, including breakrooms or other spaces where they might encounter co-workers ..."

Observation in the facility on 9/25, 9/29, and 9/30/20 revealed 22 out of 50 instances where employees were either not wearing a mask or wearing it below the nose and on the chin.

On 9/25/20 at approximately 1:00 pm, an employee wearing a lab coat was walking towards the elevator bank in the lobby with no mask on. The surveyor attempted to get the attention of the employee, but the staff quickened his steps and walked away.

On 9/29/20 at approximately 9:39 am, a transporter had a mask below the nose. During a concurrent interview with the transporter, she stated, "It falls down."

On 9/29/20 at 9:49 am, two employees were observed standing by the facility's pharmacy communicating in close proximity to each other. Both staff members wore their mask below the nose.

Observation conducted on 9/29/20 between 6:00 pm and 7:00 pm in the facility lobby noted a perioperative staff with a surgical mask under the chin, a greeter with a mask under the chin and a physician with a mask under the chin.

On 9/29/20 at 8:44 pm, in Foreman 6B, a Registered Nurse (RN) wore her surgical mask below her nose and was standing in close proximity to the unit secretary.

During tour of Klau-7 on 9/29/20 at approximately 8:35 pm, a housekeeping staff wore his mask under the chin in close proximity with a patient who was taking a walk in the hallway.

Observations of various areas conducted from 9/25 to 10/1/20 noted 19 additional instances where staff members failed to practice source control while in the facility.

Review of "Workplace Health and Safety Guidelines" (Published July 28, 2020) notes "... Face masks are the primary tool to prevent COVID - 19 transmission and must fully cover the mouth and nose at all times ...."

These observations were brought to the attention of Staff N (Assistant Director of Regulatory Affairs), and Staff T (RN, Clinical Director of Nursing) during an interview on 09/30/20 at 6:00 pm.

3. CDC guidance notes " ...For patients with COVID-19 or other respiratory infections, evaluate need for hospitalization ... If admitted, place a patient with suspected or confirmed SARS-CoV-2 infection in a single-person room with the door closed ..."

Review of facility's "Infection Prevention and Control Isolation Guidelines 2020" (Revised: 08/2020) for Special Pathogens also notes " ...if a negative pressure room is not immediately available, place the patient in a private room with door closed ..."

On September 25, 2020, at approximately 11:00 am, during the tour of Klau-4 Pavilion, a unit dedicated for the care of COVID-19 positive patients, it was observed that Patient #s 2 and 3 were in two separate rooms and their doors were wide opened.

On 9/25/20 at approximately 11:05 am, during an interview with Staff P (Nursing Assistant) who was at the doorway performing one to one observation on Patient #2, he reported that he was not aware that the door should be closed.

During interview with Staff Q (Nursing Assistant) who was performing one to one observation of Patient #3 in the doorway, she stated that she was not told that the door should remain closed.

During an interview with Staff K (Klau-4 Nurse Manager), he stated, "Being in the room, exposes staff to COVID-19 infection continuously; the door is open for safety."

On September 29, 2020, at 10:30 am, during the tour of Klau-6 (Medical Unit), it was observed that Patient #31 was vent-dependent and was on "Air Borne, and Contact Isolation." The door of the room was opened.

On 9/29/20 at 9:30 pm, the door of the room (F667) of a patient who was on air borne, contact, and droplet precautions was wide opened.

On 9/30/20, at approximately 8:40 pm, the door of the room (Klau-737) was opened. The patient who was on BIPAP (A non-invasive form of therapy for patients with sleep apnea) and had been placed on droplet, aerosol and contact isolation.

On 9/30/20 at 9:25 pm, a patient in room K622 was on droplet, aerosol and contact isolation as per signage posted at the patient's door. The door of the room was opened.

During a concurrent interview with Staff R, (RN) she confirmed that the door of patients on isolation should be closed.

4. Review of the policy "Standard Precautions" last revised 03/2020 notes, " ...elements of standard precaution ... Hand hygiene shall be performed "before and after patient contact and in between patients ..."

The CDC guidance notes " ...HCP who enter the room of a patient with suspected or confirmed SARS-CoV-2 infection should adhere to Standard Precautions and use a NIOSH-approved N95 or equivalent or higher-level respirator (or facemask if a respirator is not available), gown, gloves, and eye protection. HCP should perform hand hygiene before and after all patient contact, contact with potentially infectious material, and before putting on and after removing PPE, including gloves. Hand hygiene after removing PPE is particularly important to remove any pathogens that might have been transferred to bare hands during the removal process ..."

On 9/29/20 at approximately 9:00 pm in Foreman 6B unit, Staff U, RN walked out of a room for the patient who was under investigation for COVID-19. The staff wore an N95 mask under the nose, she removed her gloves, took off her gown and placed it in the garbage with her bare hands. The staff did not perform hand hygiene immediately after doffing PPE.

On 9/29/20 at 9:30 pm, Staff V, Surgeon was observed entering Room F699 to see a patient who was status post lung transplant and immunocompromised. The surgeon did not perform hand hygiene prior to entering the room.

During a concurrent interview with Staff V, he acknowledged the finding but reported that he performed hand hygiene at another inpatient unit prior to coming to Foreman 6B and entering the patient's room.

On September 30, 2020, at approximately 8:26 pm, during tour of an inpatient unit, Staff W and X, critical care physicians entered Room W709 to assess a patient; the two physicians left the room without performing hand hygiene.
These finding were brought to the attention of Staff W and X post observation and to the facility's administrative personnel during an exit conference on 10/9/20 at 11:50 am.

5. The CDC guidance notes " ...Any reusable PPE must be properly cleaned, decontaminated, and maintained after and between uses ..."

During observation on 9/30/20 at approximately 8:40 pm, multiple used face shields, Bouffant, masks and other used supplies were observed at the nursing stations opened to air and not contained.

During a concurrent interview Staff Y (Registered Nurse) she acknowledged findings.

These finding were brought to the attention of the facility's administrative personnel during an exit conference on 10/9/20 at 11:50 am.

6. On 09/30/2020 at approximately 10:15am, during observation of cleaning procedures in the Operating Room (OR), OR Housekeeper used a disposable paper towel to pick up a bleach wipe from the OR floor and then used it to clean a ring stand that houses a splash basin that is also used to open instrument set.

On 09/30/2020 at approximately 10:20 am, OR housekeeper cleaned the OR table with bleach solution, after four minutes, at approximately 10:24 am, Staff C dried the bleach solution on the OR table with a sterile towel.

OR housekeeper did not allow the bleach solution to be in contact with the OR table for 10 minutes as per the facility's instruction for appropriate cleaning and disinfection of items using bleach solution.

On 09/30/2020 at 10:25 am, Staff D (Associate Director) acknowledged these findings.