Thursday, March 15, 2001

Hospital cited for troubles in ICUs

Infection control, records involved

By Tim Bonfield
The Cincinnati Enquirer

        University Hospital has been cited by the Ohio Department of Health after inspectors saw doctors and nurses touch patients in intensive care without washing their hands.

        Two other citations criticize record keeping at one of Cincinnati's largest and busiest hospitals.

        University Hospital will respond in writing to the state's findings, said Elliot Cohen, senior vice president of the Health Alliance of Greater Cincinnati and top administrator for University Hospital.

        Meanwhile, the hospital is notifying supervisors, counseling staff members involved, and reinforcing infection control and record keeping policies for all staff.

        “All these findings are taken very seriously,” Mr. Cohen said.

        The violations involve several doctors, nurses and other staff members who did not wash their hands after touching patients, others who did not properly document use of patient restraints, and others who did not properly record treatment for a patient who allegedly developed bed sores during a hospital stay.

        The Ohio Department of Health issued the citations March 6 after inspecting the hospital's medical intensive care and surgical intensive care units on Feb. 26, 27 and 28. The inspections were in response to two complaints, sent Oct. 6 and Jan. 3. A third complaint was made Feb. 27 while inspectors were touring the facility.

        Hand washing is considered a vital part of infection control, especially in intensive care units where very sick people are more vulnerable to infection.

        “(The citations) are certainly concerning,” said Randy Hertzer, spokesman for the Ohio Health Department. “You'd be surprised how some of the most common-sense things can get overlooked.”

Heart transplants on hold
        The health department action comes at a rough time for University Hospital, which temporarily suspended its high-profile heart transplant program Feb. 23 after announcing that Aspergillus fungus had contaminated transplant patient rooms.

        Here is what the state health inspectors found:

        • On Feb. 28, an inspector observed a nurse and a respiratory therapist in the medical intensive care unit who did not wear gloves or wash their hands after contact with a patient with a staph infection. In addition, five resident physicians on rounds (a routine part of medical education) entered the room, touched the bed and other objects and left without washing their hands.

        Ten minutes later, in the next room, the inspector saw a resident physician touch another patient, including helping the patient stand, without washing her hands.

        • On Feb. 27, two resident physicians were observed going in and out of a patient's room in the surgical intensive care unit without washing their hands or changing their paper protection gowns.

        • On Feb. 26 two staff members were working with a patient in the surgical intensive care unit when one staff member with visibly soiled gloves left the room to get supplies. The state inspector saw the person take clean supplies from two areas without removing the soiled gloves or washing hands.

        • The inspectors also noted that four rooms in medical intensive care listed as ready for occupancy were not well cleaned.

        “All four rooms had over-the-bed tables with dried substances on them and items such as sugar packets, sanitary napkins, papers and tissues,” the report states.

        The bathroom toilets in those rooms also were soiled and the bathroom floors were soiled and sticky.

        All these factors contributed to the infection control citation.

        Dr. Amy Beth Kressel, director of infection control at University Hospital, said there is no indication that patients were harmed.

        Even so, infection control training for all staff will be reinforced, she said.

        Inspectors also issued two record-keeping citations:

        • The hospital failed to keep detailed records in connection with an otherwise unsubstantiated allegation that staff neglect allowed a patient to develop bed sores in September.

        Records indicate the patient's back had skin tears and that the wounds were treated with a cream. However, the records did not document how the wounds responded to treatment, nor what steps were taken to prevent further skin breakdown.

        • The hospital also was cited for poor record keeping involving a patient who was held down with wrist and waist restraints during a 12-day stay in February.

        The report does not comment on whether the restraints were appropriate for that patient. But the hospital failed to document how the restraints were used.

        A doctor's order to use restraints did not specify the type of restraint to be used, nor when they should be used. And nurses did not follow hospital rules for documenting restraint use, the report states.

        In response, Mr. Cohen said proper medical care was provided to both patients. The only violation was that the care was not properly documented, he said.

        “We have reinforced with our staff that proper documentation has to be provided,” Mr. Cohen said.

        State inspectors cleared the hospital on several other allegations made in the three complaints. Those included a claim that the hospital “dumped” a patient by transferring a medically unstable person to a nursing home; and that hospital staff harvested a heart for organ transplantation without consent.

        The state health department provided little information Wednesday to put University Hospital's violations in perspective.

Inspection unusual
        It is unusual for the state to conduct a surprise inspection of a hospital, Mr. Hertzer said. It is common to find at least something wrong when an inspection occurs.

        Unlike nursing homes, which get annual inspections, the state health department inspects hospitals only after receiving complaints. The health department does not get many complaints about hospitals, Mr. Hertzer said.

        However, he said he could not provide specifics about how many hospital complaints the department receives, how many inspections the department conducts, or how many citations it issues.

        Mr. Cohen has until March 18 to respond to the report. He said Wednesday he plans to detail how the hospital will correct the violations. There will be no penalty if University corrects the problems.

        Mr. Hertzer said hospital patients can help enforce hand-washing policies by insisting that staff wash their hands before touching them.

        Meanwhile, anyone with a complaint about the quality of care provided at Ohio hospitals or nursing homes can call the Ohio Department of Health complaint hot line: 1-800-342-0553.


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