HospitalInspections.org

Based on a review of medical record and documentation, it was determined that the governing body was not responsible for services provided in the hospital, as evidence by the fact that staff failed to follow established facility policy and procedure in the documentation a patient discharge against medical advice. The facility also failed to follow established requirements set forth in 25 TAC 133.41 (f)(4)(B).

Findings were:

A review of medical records for 2 patients (Patient # 1 and 2) discharged against medical advice revealed a " Release from Responsibility for Discharge " form for Patient #2. Patient #1 did not have a " Release from Responsibility for Discharge " form or documentation of refusal to sign the form in the medical record.

Facility policy and procedure entitled, " AMA Discharge (Against Medical Advice) " stated in part,
" Once the patient expresses the desire to leave AMA, the nurse shall:..
3. Complete and have the patient or responsible other sign the Release from Responsibility for Discharge form ...
5. In the event that the patient/responsible other refuses to sign the form, this fact shall be documented in the chart. "

The expectation of nursing staff to obtain a " Release from Responsibility for Discharge " form or documentation of the refusal to sign the form are to be included in the medical records of patients that are discharged against medical advice was confirmed in an interview with staff member # 3 on 02/26/13.

Based on observation and interview, it was determined that the facility did not ensure a sanitary environment for staff and patients.

Findings were:

A brief tour of the facility on 02/26/13 revealed the following infection control issues:

? In patient room 310 it was observed that several horizontal surfaces were visibly dirty and dust could be observed on the wall air conditioning unit ' s air griddle. Inspection of the restroom area found the sink to be soiled with an unknown yellow substance.

? In patient room 210 it was observed that all horizontal surfaces were dusty and the air conditioner vent had accumulated dust as well. Inspection of the restroom area found hair on the shower handle in the shower stall. Rust was found on plumbing adjacent to the hand washing sink. A loose faucet was also observed as well as unclean area behind the faucet.

? In patient room 236 it was observed that all horizontal surfaces were dusty and the air conditioner vent had accumulated visible dust as well.

? In the Rehab Area the following observations were made: Inspection of the gym (Rehab area) revealed the following issue: it was observed that the treatment table mattress, where patients lay to exercise had loose upholstery and visible tears were observed on its perimeter, indicting the mattress could not be properly cleaned or disinfected.

These observations indicated ineffective cleaning of these rooms with a risk of cross contamination from dust particles and an increased risk for infection.

The Centers for Disease Control and Prevention (CDC) article, Guidelines for Environmental Infection Control in Health-Care Facilities (2003), by Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R, Fields B, McNeil MM, Whitney C, Wong S, Juranek D, Cleveland J., the Healthcare Infection Control Practices Advisory Committee (HICPAC); and the Chicago IL American Society for Healthcare Engineering/American Hospital Association, found at: , states on page 75 that, " Horizontal surfaces with infrequent hand contact (e.g., window sills and hard-surface flooring) in routine patient-care areas require cleaning on a regular basis, when soiling or spills occur, and when a patient is discharged from the facility.6 Regular cleaning of surfaces and decontamination, as needed, is also advocated to protect potentially exposed workers. "
Staff members # 1 and 2 accompanied the surveyors during the room inspections and verbally confirmed that the rooms were not cleaned appropriately as most horizontal surfaces in all three rooms had visible accumulated dust. They also verbally confirmed that the air conditioning units ' vents were visibly dusty. Staff member #2 agreed that dust could be an infection control problem for her patient population.

Facility policy and procedure entitled, " Environmental Services Department General Guidelines " stated in part, " Proper cleaning of the environment is an essential component of the entire spectrum of preventing and controlling infections. All places of work, passageways, storage rooms and service rooms will be kept clean, ordered, and in sanitary condition ...
2. The Housekeeping Director/supervisor will implement procedures and schedules for daily cleaning in all patient areas in order to reduce bacterial load ...
CLEANING GUIDELINES ...
3 Thoroughly clean patient treatment areas, bathroom fixtures, hand washing facilities, and service sinks with a detergent/disinfectant solution daily.
4 Cleaning of horizontal surfaces in patient care areas- ...
1. Housekeeping is responsible for keeping equipment as bacteria and dust-free as possible.
CLEANING SCHEDULES: ...
1. Daily schedules are established for the cleaning of patient rooms ...
3. Surfaces soiled with moist body substances shall be cleaned in accordance with the established procedures for cleaning spills/splashes of blood/body fluids. "