Failure to Follow Hand Hygiene and Respiratory Etiquette During Resident Care and Dining
Penalty
Summary
The deficiency involves failures in the facility’s infection prevention and control program, specifically related to hand hygiene, handling of potentially contaminated items, and respiratory hygiene/cough etiquette. On one occasion, a CNA (V7) was observed providing direct care to a resident (R1) by repositioning and fixing an underpad without performing hand hygiene or donning gloves. During the same interaction, V7 removed a soiled napkin from R1’s bed and then exited the room. V7 then entered another resident’s (R5’s) room and placed the soiled napkin from R1’s room on R5’s dresser. Without performing hand hygiene, V7 donned gloves and assisted R5 to the restroom, then removed the gloves, picked up the same soiled napkin, and walked to the dining area. V7 placed the soiled napkin in a basket and then used the shared unit ice machine to place ice in a cup, again without performing hand hygiene. On another observation, a second CNA (V8) was seen donning gloves without performing hand hygiene before entering R1’s room to assist V7 in pulling R1 up in bed. V8 later acknowledged not sanitizing hands before putting on gloves and stated that hand hygiene should have been performed. V7 also acknowledged that she should have sanitized her hands and donned gloves before caring for R1, stating she was moving too fast and that she does not like to sanitize her hands before donning gloves because it makes her hands sticky. V7 further stated that she should sanitize her hands between residents but that it is very busy and she moves fast. The MDS Coordinator (V19) stated that hand hygiene is important to prevent the spread of infection, should be done before entering and leaving a resident’s room and between tasks, and that dirty linen should not be taken from one resident’s room to another. V19 also stated that the unit’s ice machine is for all residents and that if hand hygiene is not performed after resident care and then the ice machine is used, the ice machine is considered contaminated. A separate deficiency was observed during dining involving respiratory hygiene and hand hygiene while feeding a resident (R27). During a 1:1 feeding of an ice cream sandwich, V7 sat next to R27 and was observed coughing into her scrub shirt by turning her head and bringing the neck of the scrub shirt near her mouth with her right hand. V7 did not perform hand hygiene and began feeding R27 with a spoon. After feeding two bites, V7 sneezed into her right elbow while sitting next to R27 and again did not perform hand hygiene before continuing to feed three more bites. When a piece of the ice cream sandwich fell off the spoon onto the plate, V7 used her bare left hand to touch the ice cream sandwich piece and place it back onto the spoon, then fed it to R27. V19 later stated that staff should step away from residents if they have to cough or sneeze, perform cough etiquette, and then perform hand hygiene, and that staff feeding a resident 1:1 should not touch the resident’s food with bare hands. Facility policies on Infection Control, Hand Hygiene, and Respiratory Hygiene and Cough Etiquette require staff to perform hand hygiene before and after resident contact, after coughing or sneezing, and after contact with respiratory secretions, and to adhere to proper respiratory hygiene and cough etiquette to prevent the spread of infection.
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