HospitalInspections.org

Based on observation, review of documentation and interview it was determined that the facility failed to ensure that expired medical supplies were removed and not available for use.

Findings were:
Expired medical supplies were found which were available for use by staff and expired test strips used to determine whether the concentration of CIDEX disinfection solution is effective were found to have been used by staff.

During a tour of the hospital endoscope storage room on the morning of 7/30/2014, 15 each unopened sterile "Boston Scientific Medium 27, 2.8mm" disposable endoscope instruments were found in a wall mounted supply cabinet. Each of these individual instruments had a use by date of 2014-01 listed on the packaging. These expired instruments were potentially available for use by staff members during patient endoscopic procedures.

In the endoscope disinfection room, expired test strips were found in a wall mounted cabinet. Two bottles of expired "Cidex OPA Solution Test Strips" were found. One unopened bottle had an expiration date of 2013-10 on the labeling and the other opened bottle had an expiration date of 2013-08 on the labeling. No other bottles of test strips were found. "Cidex" is a high level disinfectant agent used to disinfect endoscopes. A review of the manufacturer's packaging labeling from the test strips bottle stated: "The CIDEX OPA Solution Test Strips are semi-quanatitive chemical indicators for use in determing whether the concentration of ortho-phthalaldehyde, the active ingredient in CIDEX OPA Solution, is above or below the minimum effective concentration (MEC) established for CIDEX OPA Solution." Also found on the same packaging insert were the comments: "M. Disposal Dispose of used or expired Test Strips and their bottle in a waste bin or per hospital policy." A review of a document entitled: "KIMBLE HOSPITAL GI PROCEDURES CIDEX OPA SOLUTION TEST RECORD" revealed that there were 17 instances (9-19-13, 10-3-13, 10-17-13, 11-7-13, 11-14-13, 12-5-13, 1-9-14, 1-30-14, 2-6-14, 3-6-14, 3-20-14, 4-3-14, 5-1-14, 5-15-14, 5-29-14, 5-29-14, 6-26-14, 7-24-14) where expired test strips had been used.

In an interview with the Assistant Administrator on 7/30/2014 it was confirmed that the 15 endoscopic instruments found by the surveyor were expired and it was also confirmed that the test strips which had been used to determine the effectiveness of the Cidex disinfection solution were expired.

Based on observation, review of documentation and interview it was determined that the facility failed to ensure that the kitchen was cleaned in accordance with hospital policy.

Findings were:
During a tour of the hospital kitchen on the morning of 7/30/2014, visible dust was observed on top of the ice machine and the top of the coffee maker. When the surveyor ran his hand over the top of the ice machine, visible dust was observed sticking to his hand and dust was also observed falling to the floor. Visible amounts of dust were also observed on the hand of the Assistant Administrator when he ran his hand along the horizontal top of the kitchen refrigerators.

Visible amounts of dust was also observed on the stainless steel utensil rack located over the food preparation area where a newly baked open top pan of wheat rolls was located.

Additionally what appeared to be dried food residue (whitish in color) , approximately the size of a fingernail was found inside a hanging pot located on the same utensil rack and a small piece (approximately the size of number two pencil lead) of what appeared to be dried greenish food matter was observed in another pot located on the same utensil rack.

Review of Kimble Hospital Dietary Policies and Procedure, # 3.043 stated under item #1. Equipment: "a. Equipment shall be kept clean and well- maintained." Under item #2. Work Area, the policy stated: "c. Work areas are to be kept clean and orderly." Review of Kimble Hospital Dietary Policy and Procedure,
3.040 stated: "4. All work surfaces, utensil, and equipment should be cleaned and sanitized after each use."

In an interview with the Assistant Administrator on the morning of 7/30/2014 it was confirmed that there was dust found on high horizontal surfaces in the kitchen and that there was what appeared to be dried food residue on the inside of the two hanging pots.