The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

MARY WASHINGTON HOSPITAL, INC 1001 SAM PERRY BOULEVARD FREDERICKSBURG, VA 22401 Jan. 9, 2014
VIOLATION: INFECTION CONTROL OFFICER(S) Tag No: A0748
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on observations, interview, and document review the offsite emergency room failed to provide a sanitary environment.

The findings included:

1. Three gallon cleaning solution bottles were observed in the dirty utility room stored under the sink in the off site emergency room on [DATE]. Beneath the sink there was no enclosure. Two additional thirty two (32) fluid ounce spray bottles of Pre-Klenz were stored to the right of the sink when facing the sink. These two bottles were found on top of red containers. Staff #7 indicated all the cleaning solutions were used for pre wash for dirty instruments prior to being sent to central supply. Staff #5 and Staff #7 were present during the review and findings.

2. The code cart check list was reviewed on January 8, 2014 at approximately 11:15 am . Documentation on the checklist dated October 2013 showed the Illinois Sternal/Illiac Aspiration Needles/ Monoject Syringe (used for bone marrow aspiration) expired 08/2013. Documentation on the checklist indicated the Illinois Sternal/Illiac Aspiration Needle/Monoject Syringe was replaced on 10/04/2013. Staff #7 was present during the review and the findings.