HospitalInspections.org

28682


Based on observation and interview with the Critical Access Hospital (CAH) failed to ensure that unusable drugs and biologicals are not available for patient use in 1 of 1 fluid warming cabinet and 1 of 1 contrast media warming cabinet observed.

Findings included:

- Document review on 2/8/10 of the information sheet provided by the manufacturer of the Omnipaque (an intravenous dye) directed under storage "...may be stored in contrast media warmer at 37 degrees Celsius (98.6 degrees Fahrenheit) for up to 1 month...".

- Observation on 2/8/10 at 11:15am revealed a contrast media warming cabinet in the Cat Scan (CT) control room contained three 100mL vials of Omnipaque and two 50mL vials of Omnipaque. These solutions lacked a date when placed in the warmer or when to be removed from use.

Interview on 2/8/10 at 11:15am with staff E acknowledged the five vials of Omnipaque lacked the date when placed in the warmer and were unaware of the length of time Omnipaque remained stable in a warming cabinet.

- Document review on 2/8/10 of the information sheet provided by the manufacturer of the warmed intervenous fluids directed "...may be warmed not to exceed 104 degrees Fahrenheit for a period no longer than two weeks (14 days)...".

- Observation on 2/8/10 at 3:00pm revealed a fluid warming cabinet in the sub sterile area of the Operating Room Suite (OR). The temperature of the upper compartment of the warming cabinet registered 98 degrees Fahrenheit. The upper compartment of the warming cabinet contained the following:
1) Two 1000 cubic centimeters (cc) containers of normal saline IV solution;
2) Three 1000 cc containers of Lactated Ringer IV solution;
3) Two 1000 cc of Dextrose half normal Saline IV solution; and
4) Eight 50mL vials of Omnipaque.

The IV solutions and Omnipaque lacked a date when placed in the warmer or when to be removed from use.

Interview on 2/8/10 at 3:00pm with staff F acknowledged the IV solutions and Omnipaque lacked the date when placed in the warmer or when they needed to be removed from use.

Based on observation, staff interview and document review, the hospital's infection control officer failed to develop an active infection control system ensuring hospital personnel followed basic infection control practices during 9 of 21 random observations.

Findings included:

- Observation on 2/8/10 at 2:20pm in Operating Room Suite (OR) revealed one open Yankauer suction tip in OR room #1 with the sterile packaging partially opened. Observation on 2/8/10 at 2:25pm OR room #2 revealed two open Yankauer suction tips with the sterile packaging partially opened.

Staff F on 2/8/10 at 2:25pm acknowledged the open sterile packaging on the Yankauer suction tips.

- Observation on 2/9/10 at 10:10am in the Emergency Room (ER) revealed one open Yankauer suction tip in ER room #1 and room #2 with the sterile packaging partially opened.

Staff A on 2/9/10 at 10:05am acknowledged the open sterile packaging on the Yankauer suction tips.

- Observation on 2/9/10 at 9:20am during environmental tour revealed two gray plastic trash bags resting directly on the floor in the soiled utility room across the hall from the nurses station.

Staff D on 2/9/10 at 9:20am acknowledged the trash bags have the potential for contamination due to leakage and verified the bags should not be on the floor.

- Observation on 2/9/10 at 10:10am revealed staff G cleaning Emergency Room #2. Staff G, wearing gloves, cleaned the emergency room cart, instrument stand, sink and counter using Virex 256 cleaning solution. The emergency room cart and counter top remained wet for a contact time of two minutes. The instrument stand remained wet for a contact time of six minutes. Staff G cleaned the sink using Virex 256, applied Pledge polish to sink and immediately dry wiped the sink. Staff G at 10:19am wet mopped floor using Virex 256 cleaning solution which dried within six minutes, not the required 10 minutes for disinfection.



21996


- Observation on 2/8/10 at 11:25pm revealed staff G cleaning room #103. Staff G, wearing gloves, sprayed the sink in the patient room, the inside and outside of the toilet bowl and the sink in the bathroom with a solution of Virex 256. Staff G sprayed the inside of the toilet bowl with Lysol Disinfectant Toilet Bowl Cleaner. Staff G used a cloth taken from a container that held Virex 256 solution, ran water in the sinks and wiped the sinks out. The surfaces remained wet 2-5 minutes after the application of the Virex 256 solution. Staff G cleaned the inside of the toilet bowl with a toilet bowl mop, flushed the toilet, wiped the outside of the toilet with a cloth wet with the Virex 256 solution and sprayed the outside of the toilet bowl with Lysol Disinfectant Spray. The toilet bowl surfaces dried in 6 minutes after the application of the disinfectant products. Staff G mopped the floor with a Virex 256 solution which dried in 6-8 minutes of the initial contact time.

Staff G failed to allow the Virex 256 cleaning solution to remain on surfaces for 10 minutes in the patient room and bathroom to achieve the desired disinfection of the sinks, toilet bowl and floors and failed to follow the manufacturer's directions for the use of the Lysol Toilet Bowl Cleaner and Disinfectant Spray to achieve the desired disinfection.

Review on 2/10/10 of the directions on the Virex 256 (One-Step Disinfectant Cleaner and Deodorant) bottle, the Lysol Disinfectant Toilet Bowl Cleaner container and the Lysol Disinfectant Spray can, for disinfection all surfaces must remain wet for 10 minutes.

- Observation during the cleaning of a dismissed patient room #103 on 2/10/10 revealed staff G mopped the floor with a micro fiber mop wet with a Virex solution that dried in 7-8 minutes of the initial contact time.

Interview on 2/9/10 at 9:35am with staff G acknowledged the surfaces dried in less than 10 minutes. Staff G and lacked knowledge the surfaces must remain wet for 10 minutes to achieve disinfection as required by the manufacturers.

Interview on 2/9/10 at 3:30pm with staff B acknowledged the facility failed to monitor the contact time of the facility approved cleaning products.

- Observation on 2/8/10 at 1:07pm in patient room #103 and at 1:20pm in patient room
#108 revealed an air mattress pump and tubing resting directly on the floor.

Interview on 2/8/10 at 1:30pm with staff H acknowledged the pump and tubing resting on the floor .