Failure to Perform Hand Hygiene and Proper PPE Disposal After Resident Care
Penalty
Summary
Staff failed to perform appropriate hand hygiene and proper disposal of personal protective equipment (PPE) after providing care to residents. In one instance, a certified nursing aide (CNA) provided incontinence care to a resident with multiple diagnoses, including Alzheimer's disease and a colostomy, who was on enhanced barrier precautions. After completing care, the CNA, still wearing soiled gloves and gown, opened the resident's drawer, handled a candy bar, and gave it to the resident without removing the PPE or performing hand hygiene. In a separate observation, the same CNA assisted the resident with mobility, removed her gown and gloves, tucked them under her arm, and exited the room without washing her hands. She then entered another resident's room, touched the privacy curtain, and only used hand sanitizer after leaving the second room, still carrying the soiled PPE. Another incident involved a different CNA providing catheter care to a resident with Alzheimer's disease and Parkinson's disease. After completing the care, the CNA touched the bed controller, sheets, and the resident's head to adjust the pillow while still wearing the gloves used during catheter care. The CNA confirmed she did not remove her gloves or perform hand hygiene before touching clean areas in the resident's environment. Facility policy required hand hygiene before and after resident contact, after contact with contaminated surfaces, and immediately after glove removal, but these procedures were not followed.