Failure to Perform Proper Hand Hygiene During Incontinent Care
Penalty
Summary
A deficiency was identified when a certified nursing assistant (CNA) failed to follow proper hand hygiene protocols while providing incontinent care to a resident. The CNA did not wash her hands upon entering the resident's room and coughed into her left hand before donning gloves without performing hand hygiene. During the care, the CNA used her gloved hands to handle wipes and assist with resident positioning, resulting in potential contamination of both the wipes and the resident's skin. Hand hygiene was only performed after glove removal at the end of the care episode, rather than at the required intervals. The resident involved was an elderly female with multiple diagnoses, including dementia, schizoaffective disorder, diabetes, atrial fibrillation, COPD, and muscle weakness. She required substantial assistance with toileting hygiene. The CNA acknowledged during interview that her actions led to contamination and that she had received hand hygiene training, though she could not recall when. The facility's policy and the Director of Nursing's expectations both required hand hygiene before resident contact, after contamination, and when moving from dirty to clean care tasks, which were not followed in this instance.