Failure to Maintain Infection Control During Medication Administration
Penalty
Summary
The facility failed to maintain proper infection control procedures during medication administration for two residents. For one resident with a history of cerebral infarction and chronic pain syndrome, an LPN did not perform hand hygiene before preparing medications, before donning gloves, after removing gloves, or before and after administering medications. The LPN handled the medication cart, computer, and administered medications without performing hand hygiene at any of the required steps. The LPN confirmed during interview that hand hygiene was not performed as required. For another resident with metabolic encephalopathy, an LPN washed hands before administering medications but failed to perform hand hygiene after completing medication administration. The LPN acknowledged forgetting to perform hand hygiene after the task. The Director of Nursing confirmed that facility policy requires hand hygiene before and after each resident interaction during medication administration, as well as before donning and after removing gloves. Facility policies reviewed emphasized the importance of hand hygiene as the primary means to prevent healthcare-associated infections and specified the required moments for hand hygiene.