HospitalInspections.org

Based on observations, record reviews, and interviews, the hospital failed to employ methods for preventing and controlling the transmission of COVID-19. This deficient practice was evidenced by:

1. Failure to place an Airborne/Contact/Droplet Precaution Isolation signage on a patient's door with suspected Covid-19 for 1 out of 1 (Patient #R3) suspected Covid-19 patient.
2. Failure of staff (S6RN, S8NT, S10MD) to perform hand hygiene and wear gloves appropriately;
3. Failure of staff members (S7RN, S9CNA, S10MD) to wear a face mask when indicated and/or to wear a face mask properly.

Findings:

1. Failure to place an Airborne/Contact/Droplet Precaution Isolation signage on a patient's door with suspected Covid-19.

Review of the Airborne/Contact/Droplet Precaution signage revealed the signage should be place on the patient's door for indication or conditions (laboratory-confirmed, known, or suspected) for which airborne/contact/droplet precautions are indicated; (SARS) Severe Acute Respiratory Syndrome, (MERS) Middle East Respiratory syndrome, 2019 novel Coronavirus.

Review of Patient# R3's ED record revealed on 07/14/2020 at 2:24 p.m. the patient arrived in the ED. The patient was triaged at 2:33 p.m. Presenting complaint was documented as cough and chest discomfort for a week, seen by urgent care and sent to the ED after "bad" chest x-ray taken. Vital signs documented at 2:34 p.m. on 07/14/2020 revealed Patient# R3's temperature was 103.1 degrees Fahrenheit (F). The patient was in Bed 7 in the ED.

An observation was conducted on 07/14/2020 at 3:07 p.m. of bed 7. There was no signage on Patient# R3's door indicating he was on Airborne/Contact/Droplets Precautions.

An interview was conducted with S3RN, Nurse Manager ED on 07/14/2020 at 3:10 p.m. He reported there should have been signage on bed 7's door indicating he was in Airborne/Droplet/Contact Isolation.


2. Failure of staff to perform hand hygiene and wear gloves appropriately

Review of the hospital Hand Hygiene Policy, Policy Number OHS.IC.001, Review Date January 2014, January 2017 revealed, in part:
IV. Policy Statement. A. Hand hygiene is considered a necessary step to reduce transmission of pathogenic microorganisms to patients, personnel, and visitors in healthcare settings. It is the most important single procedure for preventing healthcare-associated infections (HAI).

An observation was conducted in the ED on 07/14/2020 at 10:45 a.m. of S8NT going into a room in the ED labeled "staff only" with a pair of gloves on, coming out the room and entering Patient# R1's room with the same pair of gloves on her hands. Once entering Patient #R1's ED room, S8NT was observed taking Patient #R1's blood pressure (with the same gloves on). S8NT then exited Patient# R1's room (with the same gloves on) and entered the nurse's station and proceeded to remove the gloves while in the nurses' station.

An observation was conducted in the ED on 07/14/2020 at 10:50 a.m. of S6RN leaving Patient # R1's ED room. When S6RN left Patient #R1's ED room she had on gloves and proceeded to grab the door handle, then she removed the gloves and went in the nurses' station. Hand hygiene was not performed.

An observation was conducted in the ED on 07/14/2020 at 10:58 a.m. of S8NT coming out of Patient #R2's ED room with gloves on and walking towards the nurse's station. Her gloves were not removed prior to leaving the patient's room.

An interview was conducted with S1CNO on 07/14/2020 at 11:00 a.m. She confirmed the staff should be removing their gloves and performing hand hygiene before leaving the patients' rooms.

An observation was conducted in the ED on 07/15/2020 at 9:08 a.m. of S10MD entering and leaving Patient #R4's ED room. S10MD did not perform hand hygiene during the observation and went into the nurse's station.

An interview was conducted on with S11Quality on 07/15/2020 at 10:02 a.m. She confirmed staff were expected to perform hand hygiene after each patient contact and when leaving patients rooms.

3. Failure to wear a face mask when indicated and/or wear a face mask properly.

Review of the hospital Personal Protective Equipment & Re-Use Guidelines for Ochsner Health Hospitals & Procedural Areas, Revised June 29, 2020 at 4:00 p.m., revealed, in part:
Employee and Provider PPE Guidance: All patient facing employees will be provided and are expected to wear one surgical or procedural mask during their time at work.

An observation was conducted on 07/14/2020 at 10:56 a.m. of S7RN at the ED nurse's station. S7RN had a mask on, but the mask was pulled down below her nose and her nose was not covered.

An interview was conducted with S3RN, ED Nurse Manager at 07/14/2020 at 11:00 a.m. He confirmed S7RN was incorrectly wearing her mask in the ED nurse's station.

An observation was conducted on 07/14/2020 at 12:39 p.m. of S9CNA at the Medical/Surgical unit nurses' station. S9CNA did not have a mask on.

An observation was conducted on 07/15/2020 at 9:11 a.m. of S10MD at an ED nurse's station computer station. S10MD had a mask on and pulled his face mask down below his nose and mouth. S10MD was noted to converse with ED staff that were within 6 feet.

An interview was conducted with S11Quality on 07/15/2020 at 10:02 a.m. She confirmed S9CNA and S10MD were incorrectly wearing their mask and that all staff were expected to wear either a surgical or procedural mask during their time at work.


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