Failure to Follow Hand Hygiene and Infection Control During Medication Pass
Penalty
Summary
Facility staff failed to perform proper hand hygiene and adhere to infection control guidelines during medication administration for four observed residents. Specifically, a Licensed Practical Nurse (LPN) did not perform hand hygiene before applying gloves, handled insulin and medication packaging with gloved hands, and touched various surfaces, including the computer screen and medication drawer, without changing gloves or performing hand hygiene between tasks. The LPN also picked up a dropped medication from the top of the medication cart with a gloved hand, without prior hand hygiene, and placed it into a medication cup for administration. Additionally, a Registered Nurse (RN) used a visibly soiled pill cutter without cleaning it, handled medications and equipment without performing hand hygiene before or after glove use, and failed to clean or disinfect a resident's inhaler after use, returning it to the medication cart without wiping it down. These actions were inconsistent with the facility's policies on administering medications and hand hygiene, which require hand hygiene before and after handling medications, before applying gloves, and after removing gloves. Interviews confirmed that staff were expected to follow infection control measures at all times.