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F0880
D

Failure to Follow Infection Control Protocols During Blood Glucose Monitoring

Akron, Ohio Survey Completed on 12-11-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A deficiency was identified when a Licensed Practical Nurse (LPN) failed to follow proper infection control procedures during blood glucose monitoring for a resident with type 2 diabetes mellitus, impaired cognition, and other diagnoses. The LPN placed a shared glucometer directly onto a visibly dirty over-bed tray without using a barrier or disinfecting the surface. The tray contained personal items such as an open bottle of pop, an opened bag of chips, and a tissue. After use, the LPN did not clean the glucometer before returning it to the medication cart, despite it being used for multiple residents requiring blood glucose monitoring. During interviews, the LPN admitted to not using a barrier or disinfecting the glucometer, stating she was unaware of the requirement and was in a hurry. The Director of Nursing confirmed that facility policy requires a barrier to be used and the glucometer to be cleaned before and after each use. Review of facility policy and the glucometer user manual also confirmed these procedures are necessary to prevent the transmission of blood-borne pathogens. The failure to follow these infection control practices was observed to affect one resident and had the potential to affect several others who also required blood glucose monitoring.

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