cms_GU: 65
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 65 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2013-09-20 | 441 | E | 0 | 1 | JK1T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to establish and maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of disease and infections. Failure to prevent the development and transmission of disease and infections could potentially contribute to facility acquired infections for all residents and staff. Findings include: 1. Resident 5 was readmitted to the facility on June13, 2013 with a [DIAGNOSES REDACTED]. The facility placed the resident of Contact Isolation precautions. These precautions included, per policy and the sign on the door of the resident's room, that gloves and gown be worn when entering the room, as well as hand washing before entering and after exiting. An observation of a wound ulcer dressing change was made on (MONTH) 19, 2013 at approximately 11:50AM. The resident (Resident 5) had bilateral skin ulcers to both feet/lower extremity. LN 6 stated that the resident was on contact precautions due to the ulcer wounds being MRSA positive. LN 6 assembled the items necessary to do the dressing change, placed them in the room on a mayo stand, and then proceeded to wash his hands and don the appropriate protective equipment as stated in the facility policy. As LN 6 was preparing to remove the current wound dressing, he realized that he needed additional supplies, and left the room wearing his gloves and gown without removing them. He went to the medication cart to retrieve an ointment, and then returned to the room to resume the procedure. As LN 6 was trying to remove the current dressing by pulling away the tape securing to the area, he decided to use his personal scissors from a pocket in his uniform, and proceeded to cut away the current dressing covering the wounds with the scissors. As he was changing the dressings on the various ulcers wounds, LN 6 used the same glove to grasp the prescribed ointment to be applied to the new dressing, and then place it back on the mayo stand. At the completion of the dressing change, LN 6 used an alcohol wipe to clean the scissors, and then placed them back in his pocket. When asked whether or not if he knew if alcohol was an effective disinfectant to use on his scissors that were used on a resident with MRSA, he responded that he wasn ' t sure, I will have to look into that. LN 6 was observed putting the ointment container that he used on the patient ' s wounds back into the medication cart that contains and stores medication for residents throughout the facility that is accessed by all licensed staff. 2. Resident 4 was readmitted to the facility on (MONTH) 3, 2013 with a [DIAGNOSES REDACTED]. The resident had been placed on contact precautions, and there was a placard taped outside the room indicating such, and that visitors and staff need to wear gloves and gowns when in the room, and wash hands upon entry and exit of the room. During the initial tour of the facility (MONTH) 18, 2013 at approximately 9:10AM, LN 1 entered the room of the resident. A family member of the resident was sitting at the bedside playing cards, and was not observed to be wearing gloves. The family member was also observed throughout the remainder of the day to not be wearing gloves while in the resident room, nor washing hands when exiting. After the tour was completed, LN 1 was interviewed regarding what contact isolation was. He indicated that all staff and visitors need to at least wear gloves, regardless of what they do in the room. He added that if there was going to be close contact between the resident and staff or visitors, those individuals would also have to wear a gown. On a different observation on (MONTH) 19, 2013 at approximately 11:10AM the family member was observed to be arranging the blanket that was covering the patients torso and legs (upper extremities). Again, the family member was not wearing gloves. On (MONTH) 19, 2013 at approximately 1:50PM, the family member of the resident was interviewed and asked if he had been educated regarding the resident ' s condition, why they were on contact precautions, and what the interventions were (as posted on the placard taped near the doorway). The family member stated they didn't recall, but said they would start. 3. An observation of a dressing wound change of Resident 4 was observed at approximately 12:10PM on (MONTH) 19, 2013. Prior to the dressing change, the nurse pulled the privacy curtain around the bed of the resident to protect the privacy of the resident during the procedure. When the light blue drape made of disposable material was pulled around the patient, there were darkened spots on the drape where some fluid that was dark in color had splashed or spilled, and subsequently dried on the material. After the wound dressing was complete, LN 10 was interviewed at approximately 12:40PM. When asked about the dried substance, she stated she didn't know what it was or how long it had been there, but it looked gross . When asked how often the curtains are changed, she wasn't sure, but responded sometimes not often enough . 4. Resident 6 was admitted to the facility on (MONTH) 4, 2013 with a [DIAGNOSES REDACTED]. The resident was placed on contact precautions, and there was a placard taped outside the room indicating such, and that visitors and staff need to wear gloves and gowns when in the room, and wash hands upon entry and exit of the room. During the initial tour of the facility with LN 1, a family member was observed asleep in a chair at the bedside of the resident. The family member was observed to not be wearing gloves (or a gown). On (MONTH) 20, 2013 at approximately 10:05AM, a different family member was observed at the bedside of the resident. The family member was observed to not be wearing of the protective equipment that was stipulated on the placard for staff and visitors. The family member was then asked if they knew why the resident was on contact precautions. The family member responded saying that they thought was due to an infection in the urine of the resident, but not certain. When asked if they had been educated about the precautions, he responded 'not really' . The family member went on to say that sometimes staff wore gloves, sometimes they didn't. While interviewing the family member, an area of dried fluid appearing white in color was observed on the disposable drape window covering. The bottoms of the light-blue disposable curtain was also frayed, torn, and appeared dirty. That looks terrible the family member said. Can't they afford to change them (the disposable drapes)? 5. On (MONTH) 18, 2013 LN#14 was observed administering a gastric-tube feeding to Resident #1. The nurse stated the resident was on contact isolation precautions due to multidrug resistance and the presence of Methicillin-resistant Staphylococcus aureus. He used a gown, gloves and mask during the gastric tube feeding. On (MONTH) 20, 2013 at approximately 12:00PM Resident #1 was observed having several dressings changed by LN#7; aside from the gastric feeding tube the resident also has a tracheostomy and a pressure ulcer dressing. The nurse was using a gown, gloves and mask; gloves were changed several times during the dressing changes. The resident was log rolled during the dressing changes which may have loosed up some pulmonary secretions which necessitated tracheostomy suctioning. While waiting to suction the tracheostomy LN#7 was observed entering into and out of the room into the hall with the same gown and mask. The nursing supervisor (LN #2) was requested to provide the facility policy regarding contact precautions. LN#2 provided the policy addressing Expanded Precautions dated 12/2009. Under item #I of the Expanded Precautions the policy addressed Contact Precautions. Sub item f of the Contact Precautions indicates . Gloves, mask and gowns should not be worn outside the resident's room once care of the resident has been initiated. That same section of the Contact Precautions section was reviewed with the Nursing Supervisor and she affirmed she would have expected LN #7 to remove her gloves, mask and gown if she was exiting the resident's room. | 2018-07-01 |