DMC Harper University Hospital cited for infection-control problems
Regulators have notified Detroit Medical Center's Harper University Hospital of at least 22 incidents of deficient infection-control standards found during a surprise inspection in October.
Deficiencies included bugs flying around intensive care unit patient areas, dirty kitchen and food handling areas, and a surgical instrument tray opened potentially too early for the operation and improperly covered with blue towels that violated infection-control rules, according to a letter sent to the hospital Nov. 7 by the federal Centers for Medicaid and Medicare Services.
The inspections, which were conducted by inspectors from the Michigan Department of Licensing and Regulatory Affairs Oct. 16-18, were prompted by physician and staff complaints about dirty surgical instruments and other problems in the downtown hospital system's sterile processing department.
In a Nov. 21 response, DMC Harper Hospital officials proposed in a 13-page letter to CMS a variety of actions to fix the problems. A spokesperson for DMC did not immediately respond to a request for comment.
Crain's reported the infection control and instrument cleaning allegations in an Oct. 7 article on problems with DMC's cardiology program.
The letter to DMC Harper Hospital from CMS said the hospital failed to comply with three infection-control standards that included nearly two dozen separate incidents. DMC Harper is owned by Tenet Healthcare Corp., a Dallas-based investor-owned hospital chain.
"The deficiencies cited are significant and limit your hospital's capacity to render adequate care and to ensure the health and safety of your patients," according to the letter from CMS to Harper officials.
A CMS spokesman said DMC Detroit Receiving Hospital also has been cited for failing to comply with the federal government's hospital Medicare conditions of participation. That report was not available Monday evening.
"Should CMS decide to impose termination (from Medicare), at that time, you will receive official notification of our decision and have the right to request a hearing before an administrative law judge of the United States Department of Health and Human Services' departmental appeals board," the CMS letter said.
A CMS spokesman said Harper and Receiving will be re-inspected in an unannounced visit in the coming days or weeks.
According to CMS, it found the following deficiencies at Harper:
- Failure to provide a sanitary environment to avoid sources and transmission of infections and communicable diseases. CMS said Harper did not have an active program in place.
- Failure to follow policy and procedure for reducing infection risk, failure to ensure a catheter bag used to collect patient urine was kept free from exposure to contaminates, failure to ensure cleanliness of facility areas and failure to ensure items were clean and stored in designated areas.
- Failure to ensure infection control is integrated into quality assessment and performance improvement program.
- Cardiologists were found donning and wearing skull caps without the use of a bouffant protective covering.
- Insects were found flying around in an intensive care unit. Nurses said the problem was ongoing for at least three months.
- An ICU patient had a urine collection device, a catheter bag, hanging from the side of the bed frame that was improperly touching the floor.
- The kitchen floor was found to have multiple spills, dirt and debris. The grill area was found to have black film substance on it, as was a floor drain.
- A walk-in cooler had wrapped food but no date of preparation displayed. Other food was unwrapped.
- In a third-floor operating room, a table was found to have a surgical tray on it with blue towels draped over. The nurse manager said OR staff was preparing for a delivery. However, infection-control rules call for surgical fields and trays not be covered.
They include the following:
- Quality officers, directors and managers have revised policies that include proper surgical attire, use of Foley catheters, environment of care education of infection control and restrictions on beverages allowed in work areas.
- Improvements were made in dietary, facilities and environmental services that range from use of disposable skull caps, which must be covered with hospital-provided disposable bouffant head covering, to hiring a pest-control company to address bugs.
- More training and education of staff that includes proper sterile techniques and opening of sterile equipment.
- All hair must be covered prior to entering sterile environment.
- Nothing must be stored on top of a functioning heating system.
- Routine schedules have been established to clean and maintain food carts. Floors will be deep cleaned and walls washed to remove splatter.
- Noncompliance with corrective action by hospital staff will result in immediate remediation and appropriate disciplinary action according to work rules.
Previous Crain's stories on DMC's sterile processing department cited two examples where surgeons were preparing for adult surgeries found dirty and bloody instruments in surgical trays. In all the examples, sources said, the dirty and contaminated instruments were discovered before operations.
Each day, DMC's sterile processing department cleans and assembles thousands of instruments into surgical sets, or trays, for the hospitals of the DMC's downtown campus, which includes Receiving, Harper, Hutzel Women's and DMC Cardiovascular Center.
"DMC Harper University Hospital cited for infection-control problems" originally appeared in Crain's Detroit Business.
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