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Based on observation, interview, and record review, the facility failed to implement an effective program to prevent infections. The facility failed to ensure:

*A peripherally inserted central catheter (PICC) intravenous site was dated and sterile dressing change was performed per facility policy (Patient # 1).

* Linen was stored in a manner to prevent contamination.

* Expired indwelling urinary catheter was not available for patient use.

Findings include:

TX 00218019

PICC Line:

Observation on 07-21-15 at 10:00 a.m. revealed Patient # 1 laying in bed. He had a PICC intravenous (IV) line inserted to his right inner upper arm. Further observation revealed no date noted on the insertion site.

Interview at time of observation with RN # 6, she stated the site should be dated. She went on to say the PICC line dressings were changed 24 hours after initial insertion and then weekly thereafter.

Record review of Patient # 1's clinical record revealed the PICC line was inserted on 07-18-15. RN # 6 was unable to locate documentation the dressing had been changed on 07-19-15.

Review of facility "PICC Midline Care" guidelines, undated, read: "...4. Sterile dressing change on date of insertion...dressing to be changed 24 hours after insertion date...and weekly dressing change thereafter...or change as needed for soiled, wet, non-occlusive dressing..."

Linen Storage:

Observation on 07-21-15 at 10:15 a.m. revealed a large linen storage closet by administration. Multiple stacks of "clean" linen were stored uncovered on several wire shelves. Linen was stored in a manner that it directly touched the walls with no barrier to prevent contamination. In addition, the bottom shelf was an open wire rack, which exposed the linen to potential contamination during routine mopping of the floor.

Interview at the time of observation with Chief Clinical Officer (CCO) # 3 she stated she was unaware of the potential contamination issues and they would be corrected.

Indwelling urinary catheter:

Observation on 07-21-15 at 10:00 a.m. revealed a crash cart in the Intensive Care Unit (ICU). Further observation revealed a Foley catheter labled with an expiration date of March 2015. CCO # 3 stated staff must have missed this during their crash cart checks.