HospitalInspections.org

Based on observations, interviews and document review, it was determined hospital staff failed to follow infection control methods to prevent and control the transmission of infection within the hospital by a) failing to wear goggles or a face shield in an acute care area, b) failing to wear a surgical mask correctly and c) failing to post signage relate to cough etiquette and infection control at the hospital entrance.

The findings include:

a) On 8/21/20 at 10:45 AM, while making observations of patient care on the "Med surg 1 short hall" the surveyor noted a group of five individuals who appeared to be making "rounds". The hospital is a teaching hospital and SM #2 confirmed for the surveyor the role of the individuals. Included in the group were a physician, a student, two resident physicians and a pharmacist. The individuals were observed entering and exiting more than one patient room. Closer observation found that three (3) of the five (5) individuals were not wearing the hospital's required eye protection. Staff Member (SM) #2 who was accompanying the surveyor addressed this with the individuals at the time of discovery.

On 8/7/20, the corporate emergency operations center issued a message to all team members as follows: "Effective today, (corporate name) has implemented universal eye protection for all patient encounters in its acute care facilities, as well as universal use of N95 respirators for all aerosol-generating procedures (AGPs). For universal eye protection, team members may wear the covering of their choice whether face shields or wraparound glasses."

b) On 8/21/20 at 12:00 PM during patient care observations in the ICU (intensive care unit) the surveyor observed Staff Member (SM) #25 providing care in room 957. The surveyor noted SM #25 had on a surgical mask which rested below the nose. The surveyor continued to observe SM #2 who entered room 959 to provide care with the surgical mask still worn below the nose. In an interview with SM #25 the surveyor determined SM #25 was knowledgeable of the policy related to the use of PPE (personal protective equipment). Review of training records for SM #25 found training on "Hand Hygiene and PPE" completed on 9/13/19.

Surveyor review of a message from the corporate emergency operations center to all team members dated 7/13/20 found the following in part: "Your mask should cover your nose and mask at all times"' SM #25 confirmed the mask should cover both the nose and mouth.

c) On 8/20/20 at 1:39 PM, the surveyor had opportunity to make observations at the hospital entrance. The entrance is the only point of access to the hospital serving both patients who are presenting to the emergency room for care, and visitors to the hospital. Upon entering the hospital, individuals (patients and visitors) present to a table/desk manned by two employees. Persons presenting to the table have their temperature taken and are asked a series of questions related to symptoms of Covid-19 and travel. Patients wait to be escorted to the emergency room and visitors receive an arm band that signifies they have been screened at the entrance. Signs related to visitation and mask wearing were noted to be present but no signage related to cough etiquette were noted. During the surveyors observation of at least eight (8) individuals who presented to the desk, there was no instruction given to the individuals by staff members related to respiratory/cough etiquette.

Review of hospital policy # IC-600-007-BH "Standard Precautions" effective date June 8, 2018 found the following in part: "V. F. Respiratory Hygiene/Cough Etiquette 1. Signage shall be posted at the first point of encounter with instruction to patients and accompanying family members to take appropriate control measures: a. Covering the mouth/nose with a tissue when coughing/sneezing, b. Prompt disposal of used tissues in trash receptacle, c. Hand hygiene after contact with respiratory secretions, d. Use of surgical masks on the coughing person when tolerated, e. Separating themselves at least (3) feet from the person next to them".

Review of the CDC's (Centers for Disease Control) "Comprehensive Hospital Preparedness Checklist for Coronavirus Disease 2019 (COVID-19)" found the following in part: under "Identification and Management of Ill Patients: Plans to post visual alerts (signs, posters) at entrances and in strategic places providing instruction on hand hygiene, respiratory hygiene, and cough etiquette that is language, format (i. e., prepared for individuals with visual, hearing or other disabilities) and reading-level appropriate". https://www.cdc.gov/coronavirus/2019-ncov/downloads/HCW_Checklist_508.pdf retrieved 8/26/20.

The above issues were discussed with SM #2 at the time of discovery and with the management team at the end of day meeting on 8/21/20. No further information was provided to the surveyor.