Failure to Follow Infection Control Practices During Wound Care
Penalty
Summary
The deficiency involves a failure to follow infection prevention and control practices during wound care for Resident #80. The resident’s MDS assessment showed severely impaired cognitive skills for daily decision making. Hospice orders for the resident’s left knee wound directed staff to cleanse the wounds with wound cleanser, apply triple antibiotic ointment, cover with a non-adhesive dressing, and wrap with cotton gauze twice daily and as needed. During an observation of wound care to an abrasion on the resident’s left knee, the LPN (Staff E) removed the dressing and cleansed the wounds but did not remove her gloves or wash her hands after cleansing. She then used her gloved index finger to apply triple antibiotic ointment directly from the tube to four areas on the left knee, three of which had open skin, without using a different finger or an applicator for each area. Other nursing staff and leadership described wound care procedures that differed from what was observed. One RN stated that gloves should be changed after removal of a soiled dressing and that hands should be washed, and that a sterile applicator should be used for each wound area when applying ointment. Another RN explained that after setting up supplies and cleaning the wound, gloves should be removed, hands washed, and ointment applied with gloves on, changing gloves with each area unless treating the same area, followed by glove removal, handwashing, and application of a clean dressing. The facility wound nurse (an LPN) reported she observed Staff E put ointment on her gloved finger and said she would have expected use of an applicator and hand hygiene between cleansing and ointment application. The DON stated staff should wash hands and change gloves between cleansing the wound and applying ointment. The facility’s wound care policy directed staff to remove gloves and wash and dry hands thoroughly after dressing removal, to use a no-touch technique, and to use sterile tongue blades and applicators to remove ointments and creams from their containers.
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