HospitalInspections.org

36543

Based on observation, interview and record review, the hospital failed to have an effective, active and a systemic surveillance program to provide a sanitary environment and minimize the sources of infections as evidenced by the hospital's failure to:

1. Ensure housekeeping staff followed manufacturer's guidelines for cleaning a Clostridium difficile (C. diff, is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon) isolation patient's room. (Refer to A-0749)

2. Ensure housekeeping staff followed the manufacturer's guidelines for cleaning and disinfecting surfaces and dwell time (amount of time required for contact of a chemical agent with a surface to kill or reduce the number of infectious agents). (Refer to A-0749)

3. Ensure housekeeping staff followed the hospital's policy and procedure for cleaning the Operating Room (OR). (Refer to A-0749)

4. Ensure housekeeping uniforms were not visibly soiled. (Refer to A-0749)

The cumulative effects of these systemic failures resulted in the hospital's inability to ensure a sanitary environment which placed all patients, staff, and visitors at risk of being exposed to infectious and communicable diseases.

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Based on observation, interview, and review of the hospital's policy and procedure and the manufacture's manual, the hospital failed to:

1. Ensure housekeeping staff followed manufacturer's guidelines for cleaning a Clostridium difficile (C. diff, is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon) isolation patient's room.

2. Ensure housekeeping staff followed the manufacturer's guidelines for cleaning and disinfecting surfaces and dwell time (amount of time required for contact of a chemical agent with a surface to kill or reduce the number of infectious agents).

3. Ensure housekeeping staff followed the hospital's policy and procedure for cleaning the Operating Room (OR).

4. Ensure housekeeping uniforms were not visibly soiled.

These failures had the potential to spread infectious diseases to all patients, staff, and visitors.

Findings:

1. During an observation with the Quality Resource Registered Nurse and Infection Control Coordinator (ICC), on 8/1/16, at 1:25 PM, on the Medical-Surgical unit (2 center), Environmental Staff (EVS) 1 was in Room 2217. The sign on the door indicated "CONTACT ISOLATION."

During an interview with EVS 1, on 8/1/16, at 1:25 PM, she stated the patient (47) in the room was on C-diff isolation and staff were required to wear a gown and gloves, and were to clean the room with a bleach solution.

During a concurrent observation and interview with EVS 1 and the ICC, on 8/1/16, at 1:42 PM, EVS 1 was observed pouring a small amount of Clorox Healthcare Bleach Germicidal Cleaner directly into a pre-filled bucket of water and multiple mop heads. She then took one of the mop heads, wrung out excess water, placed it on a mop and proceeded to mop the floor. EVS 1 stated she had received in-service (training) on the the disinfection of an isolation room using the Bleach Germicidal Cleaner. EVS 1 stated, "I just put a little amount in the bucket. Maybe a cap full of bleach. I don't like the smell. It's too strong." The ICC confirmed the observation, and stated the bottle of Bleach Germicidal Cleaner is "ready to use," it does not need to be mixed with water. The ICC stated "They (EVS) should not be mixing the solution with anything. When they do, they are diluting the solution."

During an interview with the Housekeeping Manager (HM) and Director of Environmental Services (DEVS), on 8/2/16, at 9:05 AM, they both stated the Clorox bleach used for mopping was premixed and does not require additional water. The HM stated adding additional water will dilute the bleach and make it less effective (decreases the disinfection properties). The HM stated "Housekeeping should not have mixed the chemical."

The manufacture guidelines for "Clorox Healthcare Bleach Germicidal Cleaners" indicated "Clorox Healthcare Bleach Germicidal Cleaners are premixed, ready to use..."



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2. During an interview with Patient Services Associate (PSA) 6, on 8/1/16, at 9:48 AM, OR 4 had just been wet mopped. PSA 6 stated "I was told the floor needed to remain wet for ten minutes...difficult to monitor when he is the only one working...does not have time to stand at the door and monitor the floor."

During a concurrent interview and observation of OR 4 with PSA 5, on 8/1/16, at 9:50 AM, Surgical Technician (ST) 1 entered the OR through the sterile core (storage area for sterile supplies) door. The floor was visibly wet. PSA 5 informed ST 1 it was not time to come into the room. PSA 5 stated "She (ST) should know better." PSA 5 stated the floor cleaner was HDQL (disinfectant, cleaner, and deodorizer for floors, walls...) and had a ten minute dwell time.

During an interview with ST 1, on 8/2/16, at 3:20 PM, she stated she was aware the floor needed to dry for ten minutes before entering the room but a PSA told her it was "OK" to enter the room.

During an observation and concurrent interview with the Interim Director of Perioperative Services (DPS), on 8/1/16, at 9:54 AM, the floor in OR 4 was dry, six minutes after the mopping was completed. The DPS stated there was no process in place to ensure the floor remained wet for the full ten minutes.

During a subsequent observation and concurrent interview with the Quality Staff Nurse (QRN), on 8/2/16, at 9:37 AM, PSA 5 began mopping the floor in OR 5 from the center of the room out. At 9:41 AM, PSA 5 completed mopping the floor. At 9:46 AM, the floor in OR 5 was dry. The QRN confirmed the observation and stated "it looks like it dried in about five minutes." The staff did not monitor the dwell time or re-mop the OR floor to ensure it remained wet for the full ten minutes.

The manufacturer's label for the HDQL floor cleaner indicated "Allow the surface to remain wet for ten minutes."

The Association of Perioperative Registered Nurses (AORN) publication, "Guidelines for Perioperative Practice," dated 2016, indicated "Disinfectants should be applied and the reap-plied [sic] as needed, per manufacturers' instructions, for the dwell time required to kill..."

3. During a concurrent observation and interview with the QRN, on 8/2/16, at 9:29 AM, in OR 5, PSA 5 pre-cleaned the area near the OR table, and was observed to push the kick bucket (a wheeled trash can) to the side with the mop. The kick bucket and wheels were not disinfected. At 9:37 AM, PSA 5 began mopping the floor in OR 5 starting from the center of the room out. At 9:41 AM, PSA 5 completed mopping the floor. The wheels and casters of the OR table were not disinfected.

During an interview with PSA 5, on 8/3/16, at 9:35 AM, she stated the kick bucket is wiped if heavily soiled and that she is "not sure about cleaning the wheels" of the equipment. PSA 5 stated if visible debris or blood was seen on the wheels (of the kick bucket), then the wheels would be run over the wet mop pads.

During an interview with PSA 2, on 8/3/16, at 10:10 AM she stated "I eyeball the kick buckets, they are cleaned if there is visible debris. The wheels and casters are cleaned by wiping them down or rolled on a mop pad."

During an interview with the ICC, on 8/3/16, at 8:22 AM, she stated "I am really surprised. It [the cleaning of the OR rooms] is different than what I observed." She also stated there is not a checklist (to ensure the OR is cleaned according to policy and procedure).

The hospital policy and procedure titled "Environmental Preparation and End of Case Clean-Up for the Operating Room and Procedure Rooms" effective date 11/2013, indicated "The wheels and casters of furniture are pushed through detergents used for floor cleaning. All receptacles (kick buckets, pails) should be cleaned and disinfected. Wet mop perimeter of room ... Mop center of room and replace table in center of room under lights. Set and lock wheels. Wipe casters on equipment and table with damp cloth soaked in disinfecting solution."

4. During an observation and concurrent interview with the QRN, on 8/2/16, at 9:37 AM, in OR 5, PSA 2's scrub pants were too long and she was walking on the excess length. As she walked around on the mopped floor, the bottom of the pants legs became soiled and wet. The QRN confirmed the observation.

AORN document titled "Recommended Practices for Surgical Attire" dated 1/2012, indicated "Surgical attire should ...not be worn if it becomes wet or contaminated."

The Centers for Disease Control and Prevention (CDC) document titled "Guideline for Prevention of Surgical Site Infection" dated 1999, indicated "Change scrub suits that are visibly soiled, contaminated..."