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Based on observation, interview and record review (three of eight medical records) the facility infection control staff failed to follow their infection control policy to prevent and control the spread of infection to both patients and visitors by allowing personnel into positive pressure rooms without appropriate apparel, i.e. three facility staff, one nursing student, and one nursing instructor were observed providing care to 3 patients who were on contact isolation without wearing isolation gowns. (Staff #S 17, 18 and 21, nursing student 1 and nursing instructor 2 and Patient #S 3, 6, and 7).

Findings include:

During observation tour of Intensive care Unit (ICU) on 3/30/11 at 11:45 am, a registered nurse (#17) was observed suctioning patient #3 (in line trach). Patient #3 was in a private room, on ventilator-trach and on contact isolation per the sign next to his door (with the title " Contact Precautions " ) ' and there was an isolation cart at the entrance of his room (content include isolation gowns, gloves, and masks). Staff #17 had her scrub on and was not wearing an isolation gown. At 11:50 am, staff #17 completed suctioning patient #3 and called another staff (Respiratory Therapist) #18 to assist her in repositioning patient #3 in bed, both staff #S 17 and 18 repositioned patient #3 without wearing isolation gown. Interview with the CCO (Chief Clinical officer) at this time revealed that patient # 3 had in line suction tube and added " regardless they both should have worn isolation gowns " . Review of patient # 3 ' s medical record revealed he had diagnoses of multiple wounds with Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterial infection that is highly resistant to some antibiotics and Pseudomosis, this patient was on multiple intravenous antibiotics.

During rounds on medical surgical floor on 3/31/11 at 9:00 am, surveyor observed staff #21 providing care to resident #6 without wearing an isolation gown, patient # 6 had contact isolation and an isolation sign posted on the front of his room and isolation cart mounted on the front his door. Interview with staff # 21 at this time revealed " I could not find any isolation gown on the cart ' . Observation of the cart mounted on patient #6 ' s front door at this time revealed there were two isolation gowns on the cart. Review of patient #6 ' s medical record revealed he had diagnoses of MRSA of the nares, Clostridium Difficile (bacteria in the intestines) in the stool and VRE (Vancomycin Resistant Enteroccoci) in urine; these organisms are usually resistant to more than one antibiotic. VRE can also be spread from person to person. Patient #6 was receiving 4 different intravenous antibiotics. At 9:20 am on 3/31/11, two individuals wearing white and blue scrubs were observed in patient #7 ' s room doing skin assessment, they were not wearing isolation gowns. Patient #7 was on contact isolation, an isolation sign was posted in front of her door and isolation cart mounted on the front door. Interview with these two individuals identified themselves as nursing student/nursing instructor and interview with them at this time revealed " I thought you wear gowns only when you provide bath and dressing changes to patients " , and added " we were just checking her skin " . Review of patient #7 ' s medical record revealed he had diagnosis of " Sepsis with Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterial infection that is highly resistant to some antibiotics, this patient was on multiple intravenous antibiotics.

Interview with the facility Chief Executive Officer (CEO) on 3/30/11 at 1:30 PM and 3/31/11 at 11:15 am revealed that facility had identified that infection control area " required close monitoring and I had to make administrative changes to help take care of the problem " . Review of personnel files for staff #16, 17 and 21 revealed they all received infection control training during orientation, signed that they received and read infection control policy and had documented annual competency skills check lists. Interview with the Licensed Vocational Nurse instructor on 3/31/11 at 10: 30 am revealed she gave orientation on infection control to all her students prior to clinical rotation.

Review of isolation signs posted on patients ' #S 2, 6, and 7 doors revealed the following: " Contact Precautions) Visitors -report to nursing stations before entering room:
4. Wear a gown if you anticipate that your clothes will have substantial contact with the patient, environmental surfaces, or items in the patient ' s room " .

Review of facility Policy and Procedure for Infection Control, titled ISOLATION PRECAUTIONS revised 4/12/2010 #1C-106, subtitle 6: Gowns and Protective Apparel revealed " Various types of gowns and protective apparel will be worn to provide barrier protection and to reduce opportunities for transmission of microorganisms. " " Gowns will be worn to prevent contamination of clothing and to protect the skin of personnel from blood and body fluids " . " Gowns will also be worn by personnel during the care of the of patients infected with epidemiologically important microorganisms to reduce the opportunity for transmission of pathogens from patients or items in their environment to other patients or environments; when gowns are worn for this purpose, they will be removed before leaving the patient ' s environment. "