HospitalInspections.org

Based on observation, staff interviews, and review of facility policy and procedure, it was determined that the facility failed to ensure that acceptable standards of practice for transmission based precautions, are implemented.

Findings include:

Reference: Facility policy, "Standard and Transmission Based Precautions state, "... Contact Precautions... Healthcare workers caring for patients in Contact Precautions must... 1. Put on gloves and gown prior to entering the patient's room. ... ."

1. During a tour of the 4th floor on 12/10/20 at 11:20 AM, the following was observed:

a. Signage posted outside of Room #424 states, "Stop... Contact Precautions... To prevent the spread of infection, ANYONE ENTERING THIS ROOM MUST... [pictures present depicting the following: Hand Hygiene, Gloves, and a Gown]." Staff #8 was observed exiting Room #424 wearing gloves and a surgical mask.

(i) Upon interview at 11:20 AM, Staff #6 confirmed that the patient in Room #424 was on contact isolation precautions.

b. Upon interview at 11:22 AM, Staff #8 confirmed that he/she entered Room #424 without donning a gown, as indicated in the facility's policy for transmission-based precautions.

2. Staff #1, Staff #3, and Staff #6 confirmed the above finding on 12/10/20 at 11:25 AM.