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F0695
D

Improper Storage of Nebulizer Mask Breaches Infection Control

Oak Creek, Wisconsin Survey Completed on 10-03-2025

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 resident with chronic obstructive pulmonary disease (COPD) was observed to have their nebulizer mask stored improperly. The resident, who was moderately cognitively impaired, had a physician's order for Ipratropium-Albuterol inhalation solution to be administered via nebulizer as needed for shortness of breath or cough. During two separate observations, the nebulizer mask was found lying uncovered on the bedside table, rather than being stored in a plastic or Ziploc bag as required by facility policy and infection control guidelines. Staff interviews confirmed that the mask should have been stored in a plastic bag when not in use. The registered nurse, unit manager, and infection preventionist all acknowledged that the observed storage method did not comply with the facility's policy, which specifically directs that nebulizer masks and mouthpieces be stored in a Ziploc bag. This failure to follow proper storage procedures for respiratory equipment constituted a breach of infection control practices.

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