Failure to Perform Hand Hygiene During Infectious Disease Outbreak
Penalty
Summary
A deficiency was identified when a Certified Nursing Assistant (CNA) failed to follow proper infection prevention and control practices during an infectious disease outbreak. Specifically, the CNA was observed exiting a resident's room, removing gloves outside the room, and touching the linen cart in the hallway without performing hand hygiene. The CNA then re-entered the resident's room without using hand sanitizer or washing hands. This lapse in protocol was acknowledged by the CNA during a concurrent interview, where she admitted she should have used hand sanitizer to prevent the spread of germs. Further interviews with other staff, including another CNA, the Infection Prevention Nurse, and the Director of Nursing, confirmed that facility policy and standard precautions require hand hygiene before and after entering a resident's room and after contact with potentially contaminated surfaces. A review of the facility's infection prevention and control policy, as well as CDC guidelines, reinforced the importance of hand hygiene in preventing the spread of infection. The failure to adhere to these procedures was observed during an unannounced visit investigating an infectious disease outbreak.