Health Department Raises Alarm about RI Hospital Infection Controls after Measles Incident

Serious deficiencies in infection control policy and procedures at Rhode Island Hospital has prompted the state Department of Health to order the hospital take immediate corrective action including the retraining of staff, stating that without intervention, the hospital's current procedures "have the potential to harm the public."

The action, outlined in a March 21 consent order that was released to the media on Wednesday, ordered the hospital to develop a corrective plan of action signed by the hospital's CEO by March 28 and provide the health department with a root-cause analysis no later than May 1.

The order stems from a March 4 inspection at the hospital by health department officials. That inspection revealed the hospital was in violation of several licensing rules and its implementation of infection control policies and procedures "have the potential to cause harm to the public."

Additionally, Rhode Island Department of Health Director Michael Fine said without intervention, the health safety and welfare of patients that go to the hospital for emergency services "may be in jeopardy."

Along with reporting back to the health department, the consent order requires the hospital to develop and implement an immediate staff reeducation and re-training "regarding the care and treatment, including emergency room assignments and required precautions, for patients presenting with contagious or potentially contagious conditions."

According to the inspection report (see attached .PDF), workers at the hospital's emergency department on Feb. 28 didn't take sufficient measures when a patient with measles symptoms was not isolated from other patients for more than two hours despite staff being aware of the patient's potentially highly contagious condition.

The report states that the patient came to the emergency room at 5:36 p.m. complaining of flu-like symptoms with fever. The patient also said he or she was seen in another emergency department three days earlier for chest pains.

At 5:46 p.m., the patient was seen by a physician assistant in the triage area and blood tests were ordered and sent at 5:55 p.m.

At 6:16 p.m., in another area of the emergency department, a second physician assistant got a call from a nurse practitioner at an outpatient clinic stating the patient had been to that clinic with fever, cough and rash and "had not had MMR (measles, mumps, rubella) vaccine" and that nurse practitioner "was concerned for possible measles."

Despite that information, staff at Rhode Island Hospital did not bring the patient to a private room until 8:31 p.m., the report states. 

In three interviews with staff on March 4, health department officials learned that the second physician assistant went to the triage area after the call and told staff about the possible measles case. At the time, the patient was in a public waiting area and records show the patient sat there for two hours after staff learned about the possible contagious condition.

Though the patient did wear a mask while in the emergency department, it was removed when speaking to the triage nurse but put back on when he started to cough and was supplied with another mask, which was worn for the rest of the time at the ED.

Though the patient reportedly wore the mask at all times, which is in accordance with hospital policy regarding flu-like cases, "the hospital failed to move this patient with a suspected contagious condition from the public waiting area to a private room in accordance with the hospital policies," the inspection report states.

The hospital's policy clearly states that measles conditions must prompt an immediate transfer of a patient to a private room, which the hospital failed to do, the report states. It also failed to provide adequate care in accordance with hospital standards because airborne precautions were not activated as soon as the alert to staff about the contagious condition occurred.

Hospital officials responded with a statement that said the patient did not end up having measles, according to tests, but acknowledged that the patient should have been placed in a private room as its infection control policies dictate.

"Rhode Island Hospital takes the safety of its patients and staff seriously and has in place comprehensive infection control policies and procedures," the statement read. 

As a result of the incident, the hospital said it will be As a result, the hospital is "reeducating emergency department staff on the appropriate policies and procedures that must be followed when treating patients presenting with symptoms that are consistent with rare communicable diseases," the statement read.

The consent order follows a warning issued by the health department in early March about a possible measles outbreak. In the warning, it was reported that a man was treated at Roger Williams Medical Center on Feb. 25, then at a Minute Clinic at a North Attleboro CVS and eventually ended up at Rhode Island Hospital on March 1. 

This story was updated at 7:20 p.m. and 9:09 p.m.