Failure to Perform Hand Hygiene During Incontinence Care
Penalty
No penalty information released
The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.
Summary
A Certified Nursing Assistant (CNA) failed to perform proper hand hygiene and did not change gloves after assisting a resident with bladder and bowel incontinence care. The resident, who had diagnoses including Alzheimer's Disease, narcolepsy, anemia, adult failure to thrive, dementia, and a history of falling, was transferred to the toilet, where he urinated and had a large bowel movement. After the resident used toilet paper to wipe himself, the CNA pulled up the resident's clean incontinence brief and pants without performing hand hygiene or washing hands. This action was observed and confirmed to be inconsistent with the facility's hand hygiene policy, which requires hand hygiene when moving from a soiled to a clean body site.