Failure to Perform Hand Hygiene During Dining Service
Penalty
Summary
The deficiency involves staff failing to follow proper hand hygiene practices during meal service in the dining room, potentially affecting all 38 residents who ate there. During a continuous observation of a lunch meal service, an activities aide served a meal tray, readjusted a resident’s wheelchair, and cut the resident’s food, then returned to the kitchen to obtain additional trays without washing her hands after touching the resident’s equipment. She then served four more resident trays without performing hand hygiene. After all meals were served, the same aide carried residents’ empty cups from dining tables to the drink station and refilled nine drink cups without performing hand hygiene between handling and refilling the cups. In a separate continuous observation of another lunch meal service, an RN touched her ponytail and then served a tray with two meals to residents without washing her hands after touching her hair. During the same meal, two RNs and the activities aide moved three residents, who had already been served their meals, from one table to another by pushing their wheelchairs; none of them washed their hands afterward, and the two RNs then began assisting residents to eat while the aide served six more meals without hand hygiene. After all trays were served, the aide refilled two resident drinks by taking the cups from the table, refilling them at the drink station, and returning them to the residents without washing her hands before or after refilling. The regional dietician stated that staff should wash their hands anytime they touch their own clothing, body, or hair, and after touching a resident’s clothing or equipment, and that staff should wash their hands if they touch resident cups while refilling them. The executive director confirmed there was no dining-specific handwashing policy but stated the facility followed a general hand hygiene policy based on CDC standards.
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