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Based on Missouri State Statute review, personnel record review and interview the facility failed to ensure individuals listed on the Employee Disqualification List (EDL, a listing of persons who had abused or neglected patients under their care) were not employed by the facility. Record review of one (Staff G) of six licensed temporary facility staff revealed the facility failed to compare the names of staff against the EDL. The facility census was 27 patients.

Findings included:

1. Review of the Missouri State Statute RSMO 2003 Section 660.315 directed facilities licensed under Chapter 197 (hospitals) complete not only pre-employment EDL checks but also periodic checks of all existing staff against the quarterly updated EDL to ensure no current staff had been recently added to the EDL (The quarterly updated EDLs are available on the Missouri Department of Health and Senior Services web site).

2. Record review of Registered Nurse (RN), Staff F's personnel file revealed RN, Staff F had been provided orientation to work in the facility on 08/26/10, staff checked the EDL on 09/03/10 and had not had verification that he/she was not on the EDL prior to hiring RN, Staff F.

3. During an interview on 09/03/10 at 11:38 a.m. the Director of Quality Management, Staff A stated Human Resources (HR) failed to obtain an EDL check for Staff F.

Based on observation, interview and record review facility staff failed to ensure bedside commodes for two (Patient #7 and #8) patients were cleaned after use and failed to ensure bed linen were clean and safe for use. The facility census was 27 patients.

Findings included:

1. Record review of the facility infection Control policy titled Cleaning of Non Critical Patient Care Equipment, #IC-118, dated 03/08 directed, in part, the following:
-Bedside commodes should be cleaned with a hospital approved disinfectant.
-Bedside commodes should be emptied after use and cleaned as needed.

2. Observation on 09/02/10 at 11:52 a.m. revealed Patient #7 had a bedside commode within three feet of his/her bed and the bedside commode had an approximate two inch by one had inch brown smudge on the surface of the lid.

During an interview on 09/02/10 at 11:52 a.m., Patient #7 stated he/she felt that staff do clean the bedside commode and occasionally had to call staff to clean the bedside commode.

3. Observation on 09/02/10 at 12:00 Noon revealed a bedside commode with at least one inch of urine in it and within three feet of the patient (the patient was eating lunch).

During an interview on 09/02/10 at approximately 12:00 Noon, Patient #8 stated he/she used a bedside commode and staff "never" clean it on a regular basis. Patient #8 further stated the urine currently in the bedside commode had "been there a while".


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4. Observation on 9/2/10 at 11:34 a.m. revealed Registered Nurse (RN) E and RN D preparing to give Patient #15 a bed bath and change his bed linens. The stack of clean linens including sheets, pillow cases, towels, gown and wash cloths were on the lid of the dirty laundry. RN D proceeded to perform peri care on the patient who was incontinent of stool (inability to control the bowels). RN D reached into the stack of clean linen wearing the dirty gloves

-An interview on 9/2/10 at 12:00 p.m. Chief Clinical Officer B confirmed the clean linen was placed on the lid of the dirty linen cart and the RN had reached into the clean linen with the gloves he/she was wearing when performing peri care (the cleansing of the urinary and rectal orifices) on Patient #15.

Based on observation, interview and record review the facility failed to ensure the staff follow the policy on infection control when the staff did not cleanse their hands when leaving a patient's room or when they did not cleanse their hands between glove changes. The facility census was 27.

Findings included:

-Record review of the facility policy titled Infection Control IC 108 March 2008 in part stated the following information:

PURPOSE
To reduce the risk of exposure of healthcare workers to potentially infectious materials

POLICY

Standard Precautions will apply to all of the following possible exposures:
? All body fluids, secretions, and excretions, except sweat, regardless of whether they contain visible blood

PROCEDURES

Hand Hygiene
Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. Wash hands immediately after gloves are removed . . .

Gloves
Wear gloves (clean, non-sterile gloves are adequate) when touching blood, body fluids, secretions, excretions, and contaminated items. Change gloves between tasks and procedures on the same patient after contact with material that may contain a high concentration of microorganisms.
Remove gloves promptly after use, before touching non-contaminated items and environmental surfaces . . .

-Record review of the facility policy Hand Hygiene IC 109 March 2008 in part revealed the following information:

PURPOSE
Clean hands are the single most important factor in preventing the spread of pathogens and antibiotic resistance in healthcare settings.

POLICY
All employees, healthcare workers (HCW) and volunteers will follow these hand hygiene guidelines.

C. Hand hygiene is indicated:
? Before donning gloves.
? After contact with body fluids or excretion.
? After contact with non- intact skin or wound drainage.
? After removing gloves.

1. On 9/2/10 at 11:34 a.m. Registered Nurse (RN) D and RN E were preparing Patient #15 for a bed bath. RN D placed the basin of water on the bedside tray and removed his/her non sterile gloves. He/she then donned non sterile gloves. No hand cleansing was observed between glove changes. RN D picked up the suction cannula (a plastic tube connected to suction which removes extra secretions from the mouth) from the bed and placed it on the IV pole, assisted in rolling the patient to the left side and RN E provided peri care. RN D assisted RN E in repositioning the patient to the right side where RN D provided peri care. The patient was then repositioned up in the bed. RN D proceeded to pick up the cardiac monitor and placed it back on the bed. He/she then picked up the indwelling foley catheter bag (a thin flexible drainage tube that drains urine from the bladder and is collected in a bag) and hung it on the side of the bed. The gloves were not changed and no hand cleansing was done between providing peri care (cleansing of the urinary and rectal orifices) for the fecally (waste products) incontinent patient and the handling of equipment.

An interview on 9/2/10 at 12:00 p.m. Chief Clinical Officer B stated she was not aware of RN D not cleansing his/her hands between glove changes

2. On 9/2/10 at 2:00 p.m. Housekeeping H was observed to leave a patients room, remove his/her gloves and proceed to push the housekeeping cart. No hand cleansing was observed until the CCO intervened.