Las Vegas Sun

September 20, 2014

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health care:

Hospital must improve infection control

State inspectors say MountainView could be dropped by Medicare

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Steve Marcus

MountainView Hospital Chief Executive Will Wagnon says infection control problems have been corrected and that patients can trust care there.

With the largest hepatitis C outbreak in the country still fresh in Southern Nevada’s consciousness, hospitals should be taking exceptional precautions to protect patients from infections.

One Las Vegas hospital has been slapped for failing to do so.

The risk of contracting infections at MountainView Hospital has been so great that it is in jeopardy of being dropped as a Medicare and Medicaid participant, according to a recent report by state health inspectors.

Inspectors reported multiple infection control violations at MountainView, including blood on the floor of a lab, a physician assistant contaminating equipment with bloody gloves and no system in place to track whether patients had picked up an infection after undergoing an outpatient endoscopy or cardiac catheterization procedure.

The infection control problems led inspectors to declare that MountainView was failing to meet a condition required to participate in Medicare and Medicaid, the federal government’s insurance programs for disabled patients, people over age 65 and the poor.

Losing government reimbursements would put a hospital in critical condition financially.

MountainView turned in a lengthy corrective action plan to the state on Thursday, and Medicare officials said that an unannounced inspection in the coming months would determine whether the problems have been fixed.

If the follow-up visit shows the infection control problem has not been corrected, “then the hospital is subject to being terminated from the Medicare program,” said Rufus Arthur, director for hospital and community care operations for the Center for Medicare & Medicaid Services in San Francisco.

MountainView Chief Executive Will Wagnon said he is confident the hospital has taken the necessary actions to correct the problems revealed in the survey and that people can trust the care they receive at the hospital. “I really want to reinforce that the survey process is intended and designed to find opportunities to do better,” Wagnon said. “We feel the findings were isolated events. We’ve added additional checks and balances to make sure our practices are consistent.”

Every year an estimated 1.7 million Americans acquire an infection during a hospital stay, resulting in almost 100,000 deaths, according to a study in the journal Public Health Reports. Many of the infections are highly contagious, resistant to drugs and virtually impossible to treat. That’s why the federal government places such stringent requirements on infection control in hospitals.

Infection control failures became a community outrage this year after nurses in an endoscopy center reused syringes and single-use medical vials of anesthetics, requiring some 50,000 people to be tested for blood-borne diseases after a hepatitis C outbreak.

Infection control was not the only problem discovered at MountainView during the survey, which took place July 22-25. The inspectors from the Nevada Health Division’s Bureau of Licensure and Certification, which conducted the inspection on behalf of the federal government, detailed the deficiencies in a sweeping 32-page report.

Less severe shortcomings include stocking expired medications in the supply that would be used for patients, unsecured medical records, computer screens visible to the public that displayed patients’ names and diagnoses, illegible medical records and failures in the Quality Assurance and Performance Improvement program.

The survey’s findings stand in contrast to a recent report by the Joint Commission, the nonprofit organization that accredits hospitals nationwide. The Joint Commission surveyed MountainView on June 5 and gave the hospital its Gold Seal of Approval.

Joint Commission officials said policy forbids them from releasing their survey, though the hospital can if it chooses to, and that the Gold Seal does not mean there was no corrective action required after the June survey.

Wagnon told the Sun, “We are firmly committed to transparency in health care,” but when the Sun requested to see the Joint Commission survey findings, a hospital spokesman said, “That’s something we don’t make public.”

The infection control violations detailed by state inspectors included:

• Leaking bags of intravenous fluids and a failure to dispose of old intravenous fluid bags.

• A surgical technician whose gloves became bloody during an operation wore the same gloves as he left the operating room to get a bed to transport the patient. He opened the door with his soiled gloves, walked into the hallway and retrieved the bed, touching it with his contaminated hands. The employee told inspectors he should have removed his gloves before leaving the room, but “the physicians were always in a hurry.”

• Four small drops of blood in the cardiac catheterization lab before a procedure, at the end of the procedure table. Hospital employees said they always clean up after procedures.

• A medication nurse left the room of a patient who was in isolation because of a “multidrug resistant organism,” a highly contagious and difficult to treat condition. The nurse washed her hands when she left the room but did not follow hospital policy by wiping with antiseptic the cart she had taken into the room.

• A phlebotomist drew blood from a patient and kept on her gloves while typing on a keyboard, effectively contaminating it. The woman then removed her gloves and sanitized her hands, but then typed on the same keyboard, contaminating her hands. She then put on a new pair of gloves and proceeded to draw blood from the next patient.

• A review of records showed that in March 2007 a nurse was identified as a tuberculosis “converter,” meaning the nurse had been exposed to and contracted the disease, but did not exhibit any symptoms. Such TB carriers cannot pass on the airborne disease, but need treatment so they do not become sick and put others at risk, according to the Centers for Disease Control and Prevention. There was no evidence in MountainView’s records that the nurse had received therapy or was being monitored for signs of active tuberculosis. In a subsequent interview, the infection control nurse told inspectors she was aware of the nurse’s positive test result, and that the employee had not received any treatment.

A local physician who has worked in a performance improvement capacity in local hospitals called MountainView’s infection control breakdown severe. There are so many violations that it’s impossible to pass them off as bad sampling and the Bureau of Licensure and Certification has been conducting similar inspections at other facilities, the doctor said.

“Most of the other hospitals had those very same questions and scenarios posed to them and they passed with flying colors,” said the physician, who demanded anonymity because he feared retribution from hospital administrators.

The doctor said one of the most glaring problems is the failure to “look back” to make sure patients did not pick up infections at the hospital, which he says is astonishing considering the recent hepatitis C crisis.

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