Improper Disinfection of Glucometer and Storage of Nebulizer Equipment
Penalty
Summary
Surveyors identified a deficiency in the facility’s infection prevention and control program related to improper disinfection of a shared glucometer and improper storage of nebulizer equipment. The facility’s Communicable Disease Management Policy stated that infection prevention and control guidelines would be established to prevent transmission of infections and that employees would utilize barriers and implement isolation barriers beyond standard precautions per CDC guidelines. However, the facility lacked specific policies detailing best practices for cleaning and storing glucometers and nebulizer masks, as confirmed by the corporate nurse. For three residents with diabetes, staff used non-medical-grade, lemon-scented disinfecting wipes to clean a multi-use glucometer between blood glucose checks. One resident with moderately impaired cognition and diabetes had a physician’s order for Novolog insulin via sliding scale, and an LPN was observed cleaning the glucometer with a lemon-scented wipe and placing it on a barrier on the medication cart before and after performing the blood sugar test. The same glucometer was then used on two cognitively intact residents with diabetes, one with an order for insulin lispro via sliding scale and another with orders for blood glucose monitoring and physician notification for out-of-range values. In each instance, the LPN cleaned the glucometer only with the lemon-scented disinfecting wipe and placed it back on the barrier on the medication cart. The DON, administrator, and corporate nurse later stated that staff should not use lemon-scented wipes on multi-use medical equipment and that the facility did not purchase such wipes for that purpose, indicating that purple-top Sani Wipes with germicidal content were the expected product for cleaning medical equipment. For a resident with dysphagia following stroke, chronic systolic heart failure, muscle weakness, moderate depression, and COPD exacerbation, the facility failed to ensure proper storage of nebulizer equipment. The resident had orders for budesonide and arformoterol nebulizer treatments for COPD exacerbation. During observation, the resident was in bed with the head of bed elevated and a nebulizer mask lying across the lap while the nebulizer machine was turned on. On a subsequent observation period, soiled clothing was seen on top of the nebulizer tubing, machine, and mask, which were balled up on a chair. An LPN described that the CMT or nurse should remove the nebulizer mask from a protective pad, place medication in the cup, apply the mask, turn on the machine, and remain nearby to observe for nosebleeds or excessive coughing, with no formal monitoring required. The DON stated she expected the nebulizer to be stored on a clean surface with the mask and tubing in a dated plastic bag changed weekly, but this practice was not followed for the observed resident.
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