Failure to Follow Infection Control Protocol During Wound 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 deficiency occurred when an LPN performed a dressing change for a resident with a coccyx pressure ulcer and failed to follow infection prevention and control protocols. The LPN removed the soiled dressing and continued to cleanse the wound without removing gloves or performing hand hygiene, contrary to the facility's policy which requires removal of soiled gloves and handwashing after removing the dressing. This was confirmed during an interview with the LPN, who acknowledged not changing gloves or completing hand hygiene as indicated. The resident involved had a history of fractured right femur, heart failure, dementia, and high blood pressure, and had a physician's order for wound care to the coccyx.