Failure to Follow Infection Control Practices During Enteral Feeding, IV Therapy, and Wound Care
Penalty
Summary
Staff failed to follow infection control standards during enteral feeding, wound care, and intravenous therapy for two residents. In one instance, an LPN administered medication via a gastric tube to a resident and placed the used flush syringe, which contained visible white residue, back into a clear bag without rinsing it. The LPN acknowledged not flushing the syringe and stated that typically a new syringe would be used. Facility policy required the syringe to be cleaned with warm water after use. In another case, an RN entered a resident's room with enhanced barrier precautions signage without performing hand hygiene or donning a gown, only putting on gloves. The RN handled the IV pole, connected IV tubing, and started the IV pump without changing gloves or performing hand hygiene. The RN later admitted that hand hygiene and gown use should have been performed, as required by facility policy and the resident's physician orders for enhanced barrier precautions. Additionally, during wound care for the same resident, another RN used bandage scissors stored in his pants pocket to cut dressings and did not clean the scissors before use. The RN also failed to remove gloves and perform hand hygiene between removing soiled dressings and applying prescribed cleanser to multiple wounds. The RN believed it was unnecessary to change gloves or perform hand hygiene between these steps, contrary to facility policy and competency requirements, which specify glove changes and hand hygiene at key points during wound care and prohibit storing scissors in personal pockets.