Inadequate Hand Hygiene During Resident Feeding
Penalty
Summary
The facility failed to ensure proper hand hygiene practices were followed by staff during resident dining services, which could potentially lead to the spread of infectious microorganisms. Observations revealed that a Certified Nursing Assistant (CNA), identified as V13, did not perform hand hygiene after touching a resident's meal tray and before feeding another resident. Similarly, another CNA, V11, was observed not sanitizing hands between feeding different residents and after touching personal body parts, such as the face and ears, while feeding a resident. The report highlights specific instances involving residents R28, R43, and R77, who were affected by these lapses in infection control. R43, with a diagnosis of severe protein-calorie malnutrition and moderate cognitive impairment, required partial assistance with eating. R77, with severe cognitive impairment and a dependency on staff for feeding, was also at risk. R28, with severe cognitive impairment and requiring substantial assistance with eating, was observed being fed by V11, who did not perform hand hygiene at various points during the feeding process. The Director of Nursing (DON), identified as V2, acknowledged the importance of hand hygiene in preventing infection transmission and stated that staff are expected to perform hand hygiene before and after resident contact, especially when feeding residents. The facility's policies on infection control and hand hygiene were not adhered to, as evidenced by the observations of CNAs not washing or sanitizing their hands between resident interactions and after touching potentially contaminated surfaces or their own body parts.