Deficiencies in Infection Control: Staff Screening, Vaccination, and PPE Use
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by lapses in pre-employment screening and vaccination procedures for staff, as well as improper use of personal protective equipment (PPE) during resident care. Specifically, two certified nursing assistants (CNAs) were not screened for tuberculosis (TB) using the facility's baseline risk assessment form prior to hire, despite providing external TB testing documentation. Additionally, there was no documentation that three staff members, including two CNAs and one licensed vocational nurse (LVN), were offered the hepatitis B vaccination upon hire, as required by OSHA and CDC guidelines. Interviews with administrative staff revealed uncertainty and lack of awareness regarding these requirements, and the facility's onboarding checklist included these items but they were not consistently completed. Observations and record reviews also identified failures in the use of PPE during the care of residents on transmission-based precautions. One male resident with a urinary catheter and contact precautions in place was observed to have had his room entered by the Director of Nursing (DON) without the DON donning the required gown and gloves. The DON acknowledged this lapse and recognized the associated risk of infection transmission. Another female resident with a gastrostomy tube and on enhanced barrier precautions was observed during medication administration, where the DON failed to change gloves and perform hand hygiene between tasks, instead using the same gloves to access the medication cart and perform documentation before continuing care. Facility policies required staff and visitors to wear gloves and gowns upon entering rooms under contact precautions and to remove gloves promptly after use, with immediate handwashing. However, these protocols were not followed during the observed incidents. The CDC and OSHA guidelines referenced in the report further support the need for baseline TB screening, risk assessment, and hepatitis B vaccination offers for healthcare personnel, which were not consistently implemented for the staff reviewed.