Health inspection·February 13, 2020

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, policy review, personnel file review, review of Isolation guidelines from the Center for Disease Control (CDC), review of a self-learning orientation packet for volunteers, and interview, the facility failed to ensure isolation precautions were adhered to by a volunteer. This involved one (Resident #9) resident of two residents reviewed for respiratory care/infections. This had the potential to affect all 20 residents. Residents Affected - Many Findings include: Review of Resident #9's medical record revealed an admission date of 02/04/20. Diagnoses included acute respiratory failure with hypoxia and acute bronchiolitis (inflammation of the bronchioles caused by a viral infection) due to respiratory syncytial virus (RSV). Laboratory results from the hospital dated 01/30/20 revealed Resident #9 tested positive for RSV prior to her admission to the nursing facility. A safety assessment dated [DATE] indicated Resident #9 was placed on contact and droplet isolation precautions. On 02/10/20 at 9:15 A.M., personal protective equipment (PPE) was observed hanging from Resident #9's door to the hallway with signs on the door frame indicating droplet precautions and contact precautions. The signs indicated visitors were to wear gowns, gloves, and masks. The signs instructed visitors to wash hands before entering the room and to wash hands before leaving the room. At the time of the observation, Registered Nurse (RN) #40 reported Resident #9 was on isolation for RSV-A and people entering her room needed to wear gown, gloves and mask. On 02/10/20 at 11:47 A.M., State Tested Nursing Assistant (STNA) #52 was observed taking a tray from the meal cart to the doorway of Resident #9's room and asking if she could hand the tray to Volunteer #210 who was already in the room. Volunteer #210 was observed standing in the room handling objects in the room (especially on the overbed table sitting in front of Resident #9), picking the food tray up off the bed and placing it on the over bed table. Volunteer #210 was not wearing PPE and left the room without washing her hands or using hand sanitizer. On 02/10/20 at 11:52 A.M., during interview,Volunteer #210 (who was wearing a smock with a name tag identifying her as a volunteer) verified she did not wear PPE while in Resident #9's room and stated she had never been told anything about PPE use. Volunteer #210 acknowledged the lack of hand hygiene being performed. Volunteer #210 stated she delivered mail throughout the facility and adjoining hospital. On 02/10/20 at 11:55 A.M., during interview, RN #40 stated volunteers should use the same isolation precautions as other staff and she was uncertain what kind of training volunteers received. Page 1 of 2 366405 366405 02/13/2020 Wooster Community Hospital Snf 1761 Beall Avenue Wooster, OH 44691

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many On 02/10/20 at 11:58 A.M., during interview, STNA #52 verified she handed Resident #9's tray to Volunteer #210 who was in the room but stated she did not notice if Volunteer #210 was wearing PPE. On 02/10/20 at 12:00 P.M., during interview, RN #40 stated Volunteer #210 was in Resident #9's room as a friend at the time of the above observation. RN #40 stated sometimes there were visitors who refused to follow isolation precautions. Review of CDC Isolation Precautions Guidelines indicated: Provide job- or task-specific education and training on preventing transmission of infectious agents associated with healthcare during orientation to the healthcare facility; update information periodically during ongoing education programs. Target all healthcare personnel for education and training, including volunteers. Review of the policy Infection Control and Prevention: Standard and Transmission Based Precautions (revised 01/30/20) revealed for residents on contact precautions hand hygiene was to be performed upon room entry and before exit. Gowns and gloves were to be donned prior to entering a room and discarded with hand hygiene performed before leaving a room. Staff were to instruct visitors on Contact Precautions and the use of PPE to reduce the transmission of infectious organisms. Visitors should be encouraged to wear appropriate PPE. Visitors who were providing care to the resident was expected to wear appropriate PPE. For droplet precautions, hand hygiene was to be performed upon room entry and before exit. Surgical masks were to be worn on room entry and gloves were to be worn when handling items contaminated with respiratory secretions. PPE was to be removed and hand hygiene performed when leaving the resident's room. Staff were to instruct visitors on droplet precautions including cleaning hands on entering the room and when leaving the room. Visitors were to be encouraged to wear appropriate PPE. Visitors who were providing care to the resident were expected to wear appropriate PPE. The policy indicated for residents with RSV who were immunocompromised, standard and contact precautions were to be used for the duration of the illness. Masks were to be used in accordance with standard precautions. In immunocompromised residents, extent the duration of contact precautions due to prolonged shedding. On 02/11/20 at 1:03 P.M., RN #215 was interviewed regarding isolation policies. RN #215 stated volunteers receive training on infection control, including isolation. Nurses were responsible for educating family and visitors. When asked what the facility did in the case of visitors refusing to use PPE she stated education would be provided by nursing and she would also speak to the person. If the visitor continued to refuse to follow policies for isolation she was not sure what would happen. RN #215 verified if visitors refused to follow isolation precautions it could put other residents at risk. The facility had no policy/procedure and the infection control committee would probably have to meet to decide how to best handle the situation. RN #215 stated she had not noticed any patterns of infection. On 02/12/20 at 2:12 P.M., during interview,RN #215 stated volunteers received annual training on infection control and isolation. At 2:35 P.M., review of Volunteer #210's personnel file revealed she was absent for the 2019 training but received a refresher course in 2018. RN #215 stated the refresher course contained all the material provided to volunteers when they started and provided the packet of information. The packet was titled Self-Learning Orientation Packet for students, contracted staff, volunteers and patient safety observers. Pages 4 and 5 of the booklet addressed infection control. Page 5 instructed it was very important to read all precaution signs posted on the room door. It was the person's responsibility to follow the directions on the sign. 366405 Page 2 of 2