HospitalInspections.org

Based on observation, interview, and record review, the facility failed to provide a sanitary environment to avoid sources and transmission of infections in that:

1) One of one personnel (Personnel #9) used Vinyl gloves for re-processing contaminiated endoscopes.

2) One of one endoscope re-processing room did not have a handwashing sink.

Findings included:

1) During a tour of the endoscopic re-processing room on 05/12/15 at 9:00 AM boxes of vinyl gloves were observed. Personnel #9 was asked by the surveyor if she used the gloves for cleaning the contaminated endoscopes. Personnel #9 said she did. Personnel #9 was asked why she used the gloves instead of nitrile gloves and she said because she didn't have any sensitivities to the vinyl gloves.

During a telephone interview with Personnel #7 on 05/15/15 at 8:05 AM she said nurses used the vinyl gloves unless they had sensitivity to vinyl. They used the nitrile gloves if they had sensitivity to vinyl or if they used harsh chemicals. The surveyor informed Personnel #7 that the recommendations listed on the manufacturer's website (maker of the vinyl gloves) stated the vinyl gloves shouldn't be used when there is moderate to high risk of exposure to blood or body fluids or when using harsh chemicals. She said there are nitrile gloves available in those situations. The surveyor informed her that when staff were asked when they would use vinyl or nitrile gloves they said their use depended on whether or not they had a sensitivity to vinyl or not. There wasn't mention of the exposure to blood or body fluids. Personnel #7 said she didn't think their policies indicated that nitrile gloves must be used. The surveyor told Personnel #7 that vinyl gloves were used in the endoscopic reprocessing room where harsh chemicals were used and contaminated endoscopes were cleaned. The surveyor asked if AORN recommendations were followed by the hospital. Personnel #7 stated that AORN recommendations were followed in some of the procedures conducted at the hospital.

The hospital's Endoscope Reprocessing policy dated 02/2013 indicated "AORN- Perioperative Standards and Recommendations-Cleaning and Processing Endoscopes-page 499-2012 Edition" was utilized in the endoscopic high level disinfectant cleaning process. " ...Prepare endoscope for high level disinfecting. Don the appropriate PPE, impervious gown, nitrile gloves, and protective eyewear ..."

CDC's (Center for Disease Control and Prevention) 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.
" ...I.E.1. Gloves For contact with blood and body fluids during non-surgical patient care, a single pair of gloves generally provides adequate barrier protection... However, there is considerable variability among gloves; both the quality of the manufacturing process and type of material influence their barrier effectiveness... While there is little difference in the barrier properties of unused intact gloves ... studies have shown repeatedly that vinyl gloves have higher failure rates than latex or nitrile gloves when tested under simulated and actual clinical conditions... For this reason either latex or nitrile gloves are preferable for clinical procedures that require manual dexterity and/or will involve more than brief patient contact ...

AORN (Association of periOperative Registered Nurses) 2014 Recommendation XII, XII.a page 536 reflected, " ...personal protective equipment (PPE) helps to protect the employee from exposure to bloodborne pathogens and other potentially infectious materials ... The appropriate PPE for these types of exposures include, but is not limited to ... disposable chemical resistant glove ..."

At the website http://cardinalhealth.com/us/en/providers/products/gloves/pdfs/2GLV0062-01_ESN_VinylNeu-Thera.pdf documentation indicated vinyl gloves were not recommended when there was a moderate to high risk of exposure to blood or body fluids; and when handling chemicals or other caustic agents.

2) During the tour of the endoscopic re-processing room Personnel #9 was asked by the surveyor where she washed her hands since there was only one sink used to clean contaminated endoscopes. She said she cleaned the sink after cleaning the endoscopes and then washed her hands in the sink.

AORN (Association of periOperative Registered Nurses) 2014 Recommendation XI.a, IX.c pages 535-536 reflected, " ...Flexible endoscopes should be decontaminated in an area physically separated from locations where clean items are handled and patient care activities are performed ... This area should contain, but not limited to, sinks to manually clean flexible endoscopes, hand-washing facilities ... Sinks are required to manually clean or remove gross bioburden from flexible endoscopes before high-level disinfection via manual or automatic endoscope reprocessor methods. Hand washing facilities are required to decontaminate hands after removal of PPE [Personal Protective Equipment] ... XL.c. Flexible endoscopes and accessories should not be decontaminated in scrub or hand sinks. Cleaning soiled instruments in a scrub or hand sink can contaminate the sink and faucet, which also may be used for clean activities (eg, hand washing, surgical hand antisepsis) ..."