Failure to Follow Infection Control Protocols for Hand Hygiene and IV Equipment Removal
Penalty
Summary
A Registered Nurse Supervisor (RNS) failed to perform hand hygiene after conducting a blood glucose check on a resident. After using a lancet to obtain a blood sample and removing his gloves, the RNS proceeded to document in the Medication Administration Record and then prepared medications for another resident without using hand sanitizer or washing his hands. The RNS acknowledged during an interview that he forgot to perform hand hygiene and was aware of the requirement to do so after glove removal and before preparing medications. The facility's Infection Preventionist and Assistant Director of Nursing confirmed that staff are expected to perform hand hygiene after removing gloves and after using a glucometer, as outlined in the facility's hand hygiene policy. Additionally, two empty intravenous (IV) medication bags with attached tubing were found at a resident's bedside more than 30 days after their use. The bags were labeled with medication and expiration dates, and the Director of Nursing confirmed that the bags should have been removed immediately after administration was completed. The facility's policy on infection control and universal precautions requires staff to comply with guidelines during all IV therapy procedures, which was not followed in this instance.