Colorado hospitals were cited more than 80 times in the past
five years for infection control lapses when employees didn’t
take steps such as washing their hands, properly sterilizing
equipment or using protective gloves — mistakes that could spread
infections if they’re repeated during the current coronavirus
pandemic.
An emergency such as COVID-19 can cut both ways — it raises
awareness of infection control, but it also may overwhelm staff
members, who could forget a step, said Dr. Michelle Barron, medical
director for infection control and prevention at University of
Colorado Hospital. University of Colorado Hospital was cited for
infection control lapses on four occasions in the last five years.
None of the reported lapses involved harm to a patient.
Infection control specialists have been training staff on how to
properly use all protective equipment, because while employees may
have used a face shield or a respirator before, they typically
don’t need to use so many protective layers as they do now,
Barron said. Staff providing care also are keeping an eye on each
other and pointing out if someone forgets a step, she said.
“It happens that sometimes when you’re preoccupied, you miss
things, so we’re encouraging those types of interactions,” she
said.
A laboratory operator wearing protective gears runs tests on sample
possibly infected with Covid-19 at the Henri Mondor Hospital in
Creteil, near Paris, on March 6, 2020. Following infection control
procedures, including wearing gloves and a mask, is important to
keep the virus from spreading.
The 2003 SARS outbreak showed how infections can spread in
health facilities. A study in the Center for Disease Control and
Prevention’s Emerging Infectious Diseases journal estimated that
about 72% of
cases in Toronto were transmitted in hospitals, and 44% of
those infected were people working in health care. When health care
workers become sick, as they did during the SARS epidemic,
hospitals are less able to care for a surge of patients — a
scenario some experts worry could happen with COVID-19.
State and federal officials do routine inspections of most
health care facilities every three to six years, as well as
investigating complaints about poor care. Their findings are only a
snapshot of any particular facility, but they do show how common
mistakes in infection control can be.
Since 2015, 37 Colorado hospitals have been cited 87 times for
lapses such as staff forgetting to wash their hands, using masks
improperly, or not following the correct procedures to disinfect
equipment. Typically, hospitals don’t face a penalty if they show
they’re implementing a plan to prevent future mistakes., such as
forgetting to wipe down surfaces a patient touched, while another
could have only been cited once even if it exposed dozens of
patients to diseases by failing to clean surgical instruments or
scopes.
Only one incident involved harm to patients — though it’s
possible other infections were never reported.
Dozens of patients sued Porter Adventist Hospital over
infections linked to poor disinfection practices, which left
blood and hair on surgical instruments. Dr. Stephen Cobb, chief
medical officer for Centura Health’s Denver-area hospitals,
including Porter, said the problems have been corrected, and that
the previous problems with complex disinfecting procedures aren’t
relevant to a respiratory virus.
Mackenzie, 7, rests with her mother Rebecca Brown after Rebecca
returned from a trip to the emergency room in Castle Rock on June
7. Rebecca is one of 67 patients filing suit against Porter
Adventist in Denver.
“We’re very confident of the procedures at Porter,” he
said. “That’s like comparing not an apple and an orange, but an
apple and a house.”
Cobb said Centura’s hospitals have procedures in place,
including intercepting patients on their way in the door, routing
them through low-traffic areas of the hospital and deep-cleaning
the isolation rooms they stay in. They also are assigning certain
staff to COVID-19 patients and others to everyone else, to minimize
the number of people potentially exposed, he said.
“More than any other time in my time in health care, people
are acutely aware of” infection control, he said. “I think the
overall environment is making sure we have good adherence.”
State health officials say the greatest risk of infection is to
people who spend 10 minutes or longer within 6 feet of an infected
person, which would likely include those providing medical care for
him or her. A study suggests
the virus can live on hard surfaces for up to three days,
meaning if it might be able to pass from one patient to the next if
furniture and equipment aren’t properly disinfected.
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The processes to avoid spreading the new virus are relatively
simple. Staff need to put on their full protective equipment and
quickly move the patient to an isolation room, then decide if the
patient needs to be tested, stay in the hospital or go home, said
Dr. Darlene Tad-y, vice president of clinical affairs for the
Colorado Hospital Association. Some hospitals are considering
changing how they use their space and staff, if the number of cases
continues to grow, she said.
“If we have a huge outbreak or a prolonged outbreak, we’re
thinking about a dedicated wing or dedicated staff,” she
said.
Some of the responsibility for preventing the spread of COVID-19
will fall on individuals, who should call ahead if they think they
might be infected and need medical care, Tad-y said.
“Certainly we wouldn’t want to expose other people in the
waiting room,” she said.
Examples of infection control lapses, 2015-2020
University of Colorado Hospital: three hand
hygiene mistakes, three equipment sterilization, two personal
protective equipment (didn’t use or used incorrectly)
Longmont United Hospital: one hand hygiene,
three equipment sterilization, one personal protective
equipment
St. Mary’s Medical Center: one hand hygiene,
three equipment sterilization, one personal protective
equipment
Sterling Regional Medical Center: one hand
hygiene, three equipment sterilization, one personal protective
equipment
Porter Adventist Hospital: one hand hygiene,
two equipment sterilization, one personal protective equipment
Sources: Colorado Department of Public Health and Environment
and Centers for Medicare and Medicaid Services inspection
documents
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