Infection Control Deficiencies: Hand Hygiene, IV Line, and Enteral Feeding Tube Practices
Penalty
Summary
The facility failed to maintain appropriate infection prevention and control practices for three residents. For one resident on contact precautions due to a multidrug-resistant organism (MDRO) in a foot wound, the alcohol-based hand sanitizer dispenser in the room was not functional, with the pump lever falling off when used. Staff interviews confirmed the importance of having a working hand sanitizer dispenser in the room for infection control, and facility policy required hand hygiene products to be readily accessible. Another resident, also on contact isolation for MRSA of the left leg and receiving IV antibiotics, was observed with an uncapped IV tubing port hanging from the IV pole and touching the bedside curtain. The nurse acknowledged the absence of a protective cap and stated she could not find one. Facility policy required all administration set connections to be secured, but this was not followed in this instance. A third resident with a gastrostomy tube (GT) for enteral feeding was observed with the GT administration set disconnected from the resident and hanging on an IV pole, with the tube port uncapped and exposed. The nurse responsible stated she did not cap the port, despite being responsible for preventing contamination. The Director of Nursing confirmed that all licensed nurses are required to follow infection prevention protocols, including proper handling and covering of feeding tube ports when not in use.