Failure to Disinfect Reusable Equipment and Perform Hand Hygiene
Penalty
Summary
Facility staff failed to follow appropriate disinfection practices for reusable medical equipment, including vital sign equipment and community-use glucometers. On multiple occasions, a CNA was observed moving a rolling vitals cart with reusable equipment from one resident room to another without cleaning the equipment between uses. When questioned, the CNA used personal care wipes instead of the required EPA-approved disinfectant wipes, stating that CNAs no longer had access to the proper wipes. The Director of Nursing Services confirmed that only EPA-approved Super Sani-Cloth wipes were acceptable for disinfecting reusable equipment, and personal care wipes did not contain the necessary germicide. Additionally, an LPN was observed using a community-use glucometer on one resident and then preparing to use it on another without cleaning it in between, only disinfecting it after intervention by a surveyor. The LPN acknowledged forgetting to clean the glucometer, and the DNS reiterated the expectation to use EPA-approved wipes and observe the required dwell time between uses. During meal service, a nursing assistant was observed delivering food trays to multiple resident rooms and to a family member without performing hand hygiene between rooms. The staff member admitted to not performing hand hygiene after leaving resident rooms during meal service. The LPN Resident Care Manager confirmed that staff were expected to perform hand hygiene after leaving each resident room during meal service. These failures were observed on one of four halls reviewed for infection control and meal service, and involved at least one sampled resident during medication pass.