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JEWISH HOSPITAL & ST MARY'S HEALTHCARE 200 ABRAHAM FLEXNER WAY LOUISVILLE, KY 40202 Oct. 2, 2013
VIOLATION: INFECTION CONTROL OFFICER RESPONSIBILITIES Tag No: A0749
Based on interview, record review and review of the hospital's policy, it was determined the hospital failed to report a probable case of communicable disease to the appropriate Local and State Agencies. One (1) of three sampled patients, Patient #1, was identified as having probable Tuberculosis prior to discharge from the hospital and it was not reported to the Local or State Health Departments.

The findings include:

Review of the hospital's policy regarding Communicable Disease Reporting, dated 03/2013, revealed in accordance with the Kentucky State Department of Health Regulation, communicable diseases and occurrences must be reported to the Louisville Metro Department for Public Health and Wellness, Local Health Department, or Department for Public Health within specified time periods. The following diseases shall be reported to the Louisville Metro Health Department for Public Health and Wellness, Local Health Department, or Department for Public Health within one (1) business day of diagnosis: Tuberculosis and others.

Review of the record for Patient #1 revealed the hospital admitted the patient on 09/05/13 with complaints of weakness, cough, congestion and weight loss. Review of the record also revealed Patient #1 had a positive PPD (purified protein derivative test for Tuberculosis) during that admission with a subsequent bronchoscopy (procedure to look into the lungs and obtain bronchial washings) and the washings were sent to the laboratory for culture for Tuberculosis. Review of the nursing notes for Patient #1 revealed he/she was placed in respiratory isolation at onset of admission due to presenting with clinical signs and symptoms of Tuberculosis. Review of Patient #1's progress notes dated 09/08/13 revealed the PPD test was read as being ten (10) millimeters in induration indicating a positive test for Tuberculosis. The Director of the Infectious Disease Physician's Department was consulted during Patient #1's admission and that physician wrote the discharge prescriptions for four (4) Tuberculosis drugs for Patient #1. Further review of the discharge summary revealed Patient #1 was to follow-up with the the Public Health Department and was to wear a mask for at least a couple of weeks.

Interview with Physician #1, on 10/01/13 at 11:00 AM, revealed he did consult on Patient #1 and he knew the patient had clinical signs and symptoms of active Tuberculosis, had a positive PPD, and a chest x-ray and chest CAT scan which were indicative of active Tuberculosis. He stated a definitive diagnosis of Tuberculosis could not be made until sputum/bronchial washing cultures were completed in six weeks. He indicated it was the practice of the facility to report cases of Tuberculosis which were confirmed by culture. He further stated it could be decided by clinical judgement to place a patient on anti-Tuberculosis medications based on patient symptoms until the culture for Tuberculosis was complete. He further indicated he had placed Patient #1 on the anti-Tuberculosis medications and in fact had written the discharge prescriptions.

Interview with the Infection Control/Surveillance Nurse #2, on 10/01/13 at 2:19 PM, revealed she would report a case of Tuberculosis to the Public Health Department when it was confirmed by laboratory culture. She indicated there had not been any active cases of Tuberculosis at the hospital since January 2013. She stated she had not known about the probable Tuberculosis diagnosis for Patient #1 as she had not received any positive culture reports. She further stated she would report to the Public Health Department when she was aware of a positive culture for Tuberculosis in a patient.

Interview with the Director of Quality and Accreditation, on 10/02/13 at 3:00 PM, revealed it was the practice of the hospital to report communicable diseases which had been confirmed by culture to the local Public Health Department. She stated the hospital had revised it's communicable disease reporting policy to report any probable cases of Tuberculosis and the hospital would discuss patients in a daily rounds meeting who might have a communicable disease to ensure timely reporting.