Failure to Sanitize Blood Pressure Monitor Between Residents
Penalty
Summary
The facility failed to maintain proper infection prevention and control practices when a licensed vocational nurse (LVN) did not sanitize a blood pressure monitor between use on two residents. During observation, the LVN measured the blood pressure of one resident and then immediately used the same device on another resident without cleaning it in between. The LVN only sanitized the equipment after the surveyor brought the issue to her attention. Both residents involved had a diagnosis of hypertension and were cognitively intact, as indicated by their BIMS scores. Interviews revealed that the LVN was aware of the importance of sanitizing medical equipment between residents but stated she forgot due to being in a rush. The facility administrator confirmed that the facility's infection control protocol requires all medical equipment, including blood pressure cuffs, to be sanitized after each use. However, review of in-service training records showed there had been no specific training on sanitizing medical equipment between residents during the relevant period. The facility's infection control policy also indicated that non-invasive resident care equipment should be cleaned daily or as needed between use.