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Based on observation, interview and record review, the facility failed to ensure that respiratory services were provided according to facility policy and professional standards of practice for 1 of 12 current sampled inpatients ( Patient ID # 12):

Respiratory Therapist (RT ) # 6 failed to maintain sterility of suction catheter during suctioning of Patient # 12 tracheostomy; failed to sanitize her hands between glove changes; contaminated supplies on top of nightstand; and failed to assess Patient # 12's breath sounds before or after suctioning.

In addition, during facility tour: a contaminated oral suction device was not properly stored, and various previously used items related to patient care were observed discarded onto the floor in several patient rooms.

Findings include:

TX # 00205987

Record review of complaint intake # TX 00205987 revealed concerns related to staff throwing trash on the floor and not using the trash cans, as well as improper storage of used suction devices. The complaint intake also contained an allegation related to staff competency related to tracheostomy (trach) suctioning.

Suctioning and Tracheostomy Care: Patient # 12:

Record review of Patient # 12's medical record revealed she was an 89 year old female admitted to the facility on 11-08-14 with a diagnosis of Respiratory Failure.

Observation on 12-19-14 at 11:15 a.m. revealed RT # 6 performed endotracheal suctioning and trach care on Patient # 12. RT # 6 removed bloody gauze from around Patient # 12's trach . RT # 6 failed to remove the contaminated exam gloves and sanitize her hands. RT # 6 donned a pair of sterile gloves on top of the contaminated exam gloves and proceeded to perform suctioning procedure.

RT # 6 held the sterile suction catheter in her right hand and used her left hand to manipulate the ambubag. After 2 suctioning attempts, RT # 6 contaminated the sterile suction catheter with her left hand; and proceeded to use it for a third suctioning attempt.

After the suctioning, RT # 6 performed trach care. RT # 6 cleansed around Patient 12's trach and placed a clean drain sponge around the trach site. While wearing contaminated exam gloves, RT # 6 went to a box of supplies on top of the patient's nightstand and touched several packages prior to locating the supplies she needed.

RT # 6 changed gloves several times during the suctioning and trach care procedures. She failed to sanitize her hands between any of the glove changes. In addition, RT # 6 did not auscultate Patient # 12's breath sounds before or after suctioning.

Interview with RT # 6 immediately after the procedures she said she could not think of anything she did wrong during the trach care and suctioning. She said she intended to wash her hands before she cared for the next patient.

Interview on 12-19-14 at 2:45 p.m.with Chief Clinical Officer (CCO) she stated she expected staff to sanitize hands between glove changes and to assess breath sounds before and after patient suctioning.

Review of facility policy titled: "Tracheostomy and Endotracheal Tube Open Suctioning," dated 02/2012, read: "Policy: ...3. Suctioning will be performed using sterile technique...Procedure: ...11. Protect the sterility of the suction catheter if several passes are to be made during the procedure. If at any time catheter is contaminated, discard the catheter and gloves and start over... Document: ..5. Description of patient's breath sounds pre and post suctioning..."

Review of facility policy titled "Hand Hygiene,"dated 08/2012, read:"...Policy:....Hand Hygiene will be performed as follows:...J. Before donning and after removal of gloves..."

Environment:

Observation on 12-19-14 at 9:15 a.m. during a tour of the Intensive Care Unit (ICU) on 12-19-14 at 9:30 a.m. revealed several plastic syringe and IV fluid caps, papers, and opened alcohol prep pads observed on the floors by the trash cans and near the beds in several patient rooms ( ICU # 3, 5, 7, 8 ). These same observations were made during the facility tour in rooms 206 and 207.

An opened , uncovered hard plastic oral suction device was observed located directly on top of a mechanical ventilator in ICU # 5 on 12-19-14 at 9:30 a.m.

Interview at the time of observation with Director of Quality Management (DQM) # 3 she stated the facility rarely used the hard plastic suction devices but needed them for those patients who bit down during suctioning. She went on to say this type of suction device should be stored covered.