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F0880
D

Infection Control Breach During Pericare

Lomira, Wisconsin Survey Completed on 05-01-2025

Penalty

No penalty information released
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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 a Certified Nursing Assistant (CNA) failed to follow standard infection control practices during pericare for a resident. The CNA set up a wash basin with water and two wash cloths, used one wash cloth to perform frontal pericare, and then placed the contaminated wash cloth back into the basin. The CNA then used the second wash cloth to rinse the resident, placed it into the same basin, and proceeded to dry the resident. Without removing gloves or performing hand hygiene, the CNA touched the bedside cabinet drawer, removed a bottle of powder, applied it to the resident's groin, and returned the powder to the drawer, all while wearing the same contaminated gloves. During interviews, both the CNA and the Director of Nursing (DON) acknowledged that the wash cloths and gloves were contaminated after pericare and should not have been handled in the manner observed. The facility's policy on standard precautions requires hand hygiene before and after resident contact, after touching contaminated items, and after glove removal, which was not followed in this instance. The actions observed were in direct violation of the facility's infection prevention and control program, as outlined in their policy.

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