Infection Control Deficiencies in PPE Use, Hand Hygiene, and Laundry Room Practices
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by several deficiencies observed during the survey. One significant issue involved the improper use of personal protective equipment (PPE) by CNAs while transferring a resident who was on Enhanced Barrier Precautions (EBP) due to an open draining wound. The CNAs did not wear PPE gowns during the transfer, and there was no signage or PPE supply cart outside the resident's room to indicate the need for EBP. This oversight was compounded by the fact that both the CNA and LVN were unaware of the resident's EBP status, which was confirmed by the Director of Nursing (DON) as necessary. Another deficiency was observed when an LVN failed to follow proper hand hygiene protocols after washing her hands in a resident's bathroom. The LVN used her bare hands to turn off the sink faucet, which could lead to contamination and increase the risk of infection. The LVN acknowledged the mistake and the DON confirmed the risk associated with not using a paper towel to turn off the faucet. Additionally, the facility did not enforce proper infection control practices in the laundry room. A laundry aide was observed eating and drinking in the laundry room, which could lead to cross-contamination of clean linens. The DON stated that staff should not eat or drink in the laundry room to prevent contamination of linens, which are meant to remain hygienically clean for resident use.