Failure to Prevent Cross Contamination During Wound Dressing Change
Penalty
Summary
A deficiency was identified when a Registered Nurse (RN) failed to follow infection prevention and control protocols during a wound dressing change for a resident with diagnoses including high blood pressure, diabetes, and dementia, who required pressure ulcer care. The RN did not clean the surface used to hold wound care supplies before or after the dressing change, did not place a barrier under the resident's foot, and used scissors taken from a pocket without cleaning them prior to use. Additionally, after removing the soiled dressing, the RN placed the dirty dressing and empty packaging on the floor. These actions were observed during a dressing change and later confirmed by the RN in an interview. The facility's policy on wound care was not followed, resulting in a failure to prevent cross contamination during the procedure. The deficiency was cited under the relevant Pennsylvania Codes for resident care policies and nursing services.