Failure to Follow Hand Hygiene and Food Handling Protocols During Meal Service
Penalty
Summary
Facility staff failed to follow proper hand hygiene and gloving procedures during meal service, as observed during continuous monitoring in the assisted dining room and Evergreen Hall. Specifically, a nurse aide (NA-K) was seen delivering meal trays to multiple resident rooms without removing gloves or performing hand hygiene between rooms, contrary to facility policy. NA-K also handled a tray of sliced cinnamon apples, some of which were uncovered, and carried the entire tray into resident rooms, increasing the risk of potential contamination. These actions were confirmed by NA-K during an interview, acknowledging the failure to doff gloves and perform hand hygiene as required. Record review of the facility's policy on meal tray delivery and infection control outlined the necessity for staff to apply hand sanitizer after each tray delivery and to repeat handwashing procedures upon returning to the kitchen. Despite these policies, the observed practices did not align with the established protocols. The Clinical Care Coordinator confirmed that 44 residents received food from the affected tray cart during the period in question. The facility census at the time was 103 residents.