Improper PPE Removal and Facemask Use During Outbreak
Penalty
Summary
Surveyors identified that two Certified Nurse Aides (CNAs) failed to properly remove personal protective equipment (PPE) after caring for residents on transmission-based precautions for influenza and COVID-19. In both cases, the CNAs donned appropriate PPE before entering the residents' rooms but removed and discarded their gowns and face shields in the hallway outside the rooms, rather than inside the rooms as required by CDC guidance and the facility's own policy. Both CNAs stated they removed PPE in the hallway because the designated PPE trash bins were located there, and signage at the residents' doors clearly indicated the correct procedures for donning and doffing PPE. The residents involved had significant medical histories, including influenza, asthma, cancer, multiple sclerosis, and major depressive disorder, and were under physician orders for contact and droplet precautions. Additionally, a nurse was observed wearing a surgical mask improperly, with her nose exposed, while administering medications and providing care to a resident during a facility-wide outbreak. The nurse, who was an agency staff member, acknowledged she was aware of the mask requirement but stated she always wore her mask below her nose due to discomfort. Facility signage throughout the building instructed staff on proper mask usage, specifically stating not to wear masks under the nose or mouth. The DON confirmed that all staff were required to wear masks covering both the nose and mouth and that alternative mask styles were available to accommodate different needs. The facility was under outbreak protocols, as indicated by posted signage and the DON's statements, with source control measures implemented per CDC and local health department recommendations. Despite these measures and clear policies, staff did not consistently follow proper infection prevention and control procedures, specifically regarding the removal of PPE and the correct wearing of facemasks while providing resident care.