Medical personnel discuss patients who had been admitted for coronavirus testing at Central Maine Medical Center in Lewiston on March 13. Credit: Robert F. Bukaty / AP

A handful of Maine hospitals didn’t follow all federal rules meant to limit the coronavirus’ spread over the summer, with employees at some not wearing face coverings and eye protection, according to regulators who visited the hospitals between June and September. In other cases, inspectors found, hospitals weren’t fully screening workers and visitors for COVID-19 symptoms.

Now, as the number of Mainers hospitalized with the coronavirus keeps climbing amid a record-breaking surge of infections across the whole state, those hospitals’ slip-ups and the experiences of other institutions that have had outbreaks highlight the risk that the virus could still breach their walls.

At least seven hospitals have been cited for the violations, most of them in more populated sections of the state where COVID-19’s prevalence has been greatest throughout the pandemic. One of them, Central Maine Medical Center in Lewiston, was actively trying to contain an outbreak among its own staff and patients when inspectors visited in late July and found lapses in symptom screening.

In general, there has been no clear evidence that the coronavirus is circulating in Maine’s hospitals, especially after they stocked up on protective equipment and adopted precautions that the federal government has required during the pandemic.

But at least two other facilities with limited screening procedures, the Maplecrest Rehabilitation and Living Center nursing home in Madison and the York County Jail in Alfred, suffered large outbreaks after infected people came to work. The jail also didn’t require that workers wear face masks.

Two other hospitals, Calais Regional Hospital and Waldo County General Hospital in Belfast, have had to contain their own recent outbreaks among employees, although it’s possible those workers caught the virus in their communities, where the virus is now circulating, and not at work.

The most common type of violation at the seven hospitals cited by the state inspectors were for inadequate screening of visitors, such as not taking their temperatures or, when they did, using a benchmark of 100.4 degrees to classify someone as having a fever. The federal government has lowered that guideline to 100 degrees.

A few of them were found to be poorly enforcing requirements that workers wear face masks, and some had not yet implemented a new requirement that frontline medical staff in areas with a higher prevalence of COVID-19 regularly wear goggles or face shields, according to records the BDN obtained from the Maine Department of Health and Human Services, which inspects health care facilities for the federal government.

At Central Maine Medical Center in Lewiston, 14 workers and 2 patients eventually tested positive for COVID-19 after the resident of a nearby nursing home that was having an outbreak was taken to the intensive care unit in July. That resident initially tested negative for the virus before entering the hospital, but then retested as positive.

After the state learned of the outbreak, inspectors who went there observed numerous visitors being asked about potential COVID-19 symptoms but not having their temperatures taken before they were allowed in. They also saw that some staff entering the hospital were not being screened for symptoms.

At one point, an employee was seen entering the emergency room without wearing a face mask, and inspectors found that dirt and some debris had accumulated in the hospital’s intensive care unit where the patients infected with COVID-19 were being treated.

In response, the hospital boosted its symptom screening, limited its entry points to make it easier to keep track of who was entering the building and improved its sanitation practices, among other measures, according to Dr. John Alexander, chief medical officer for parent organization Central Maine Healthcare.

The Lewiston hospital usually relied on medical workers to clean the units for COVID-19 patients, Alexander said, but many of those workers had to quarantine during the outbreak. He said the hospital also wasn’t able to determine whether the employees caught the virus in the hospital or outside work.

“We try to take a very safety-first approach,” Alexander said. “That’s why we’ve taken this matter so seriously, really since it first was brought to our attention back in July, and we’ve really continued to keep it at the forefront, checking and making sure every single day we’re doing the right things around screening and hand hygiene and cleaning.”

In late June, a state inspector who visited another Lewiston hospital, St. Mary’s Regional Medical Center, observed an emergency department nurse who wasn’t wearing a face mask and another who had a mask pulled under her chin. The two were sitting just inches apart from each other, according to the inspector’s report, despite the risk that the virus can pass between people who are close together.

Stephen Costello, a St. Mary’s spokesperson, said that staff have worn face masks when seeing patients throughout the pandemic, but that the hospital has provided more education about the need to wear them even when they’re not near patients, to cover both their mouths and noses with the masks, and to use social distancing.

He said the hospital now does “daily audits” of mask-wearing, which have found better than 99 percent compliance.

Four other Maine hospitals that have been cited for infection control violations all belong to the state’s largest hospital chain, MaineHealth: Maine Medical Center in Portland, Southern Maine Health Care in Biddeford, Mid Coast Hospital in Brunswick and Spring Harbor Hospital, a psychiatric facility in Westbrook.

Inspectors who visited all four facilities in July and August found that they did not take visitors’ temperatures.

They also found that the two visited in July, Maine Medical Center and Mid Coast Hospital, had not yet begun requiring frontline staff to wear eye protection such as face shields or goggles when seeing patients, which had recently become a federal requirement for hospitals in communities with “moderate to sustained” transmission of the virus. Until then, the MaineHealth facilities only took that precaution when providers saw patients who were at risk of having the coronavirus.

John Porter, a MaineHealth spokesperson, said that the facilities immediately adopted the eye protection policy once it “was made explicit” and that its leaders had “a dialogue with regulators about the effectiveness of temperature checks.”

“These regulatory findings represent a positive and helpful dialogue between MaineHealth clinicians and state and federal officials, all of whom have worked closely together to identify and implement best practices, and in no way should be interpreted as a deficiency in policies or procedures at MaineHealth,” Porter said.

In mid-September, an inspector who visited Penobscot Valley Hospital in Lincoln found that workers were not screened as they entered the facility, but rather were required to complete self-screening assessments before and after they arrived at work. The inspector also found that chairs in the hospital’s waiting area were not adequately spaced apart and that the facility did not have enough signs promoting precautions such as mask-wearing.

CEO Crystal Landry said the hospital has rearranged the waiting area to provide at least six feet between chairs, increased the number of signs and improved the entry process for employees arriving to work.

“We welcome the survey team’s evaluation of our processes, which were put in place to ensure patient and staff safety,” Landry said. “We were found to be in compliance with all other aspects of the CDC guidelines. We will continue to provide the very best care to our community and to comply with all guidelines for safe care during the COVID-19 pandemic.”

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