Improper Hand Hygiene and Glove Use During Wound Care
Penalty
Summary
The deficiency involves the facility’s failure to ensure proper hand hygiene and glove use during wound care, resulting in potential cross-contamination between wounds. For one resident with congestive heart failure, diabetes, peripheral vascular disease, and multiple venous ulcers, staff did not change gloves appropriately between wounds or perform hand hygiene between glove changes. This resident was cognitively intact but dependent on staff for most ADLs and had open venous ulcer wounds on both lower legs, as well as a left heel condition and a skin tear on the left shin, all requiring specific wound care orders including cleansing with Vashe Wound Cleanser, application of Triad paste, silver dressings, and Betadine. During an observed wound care session for this resident, an RN and an LPN initially washed their hands, gowned, and gloved, and a clean field was set up. The RN removed dressings from the right and then the left leg without changing gloves between legs, despite the right leg dressing having a large amount of bloody drainage and both legs having open wounds. After removing dressings from both legs, the RN changed gloves without performing hand hygiene, while the LPN removed gloves, washed hands, and re-gloved. The RN then cleansed the right leg wounds and later removed gloves, obtained Triad paste, re-gloved without hand hygiene, and applied Triad paste with gloved fingers. After both nurses removed gloves, washed hands, and re-gloved, the RN applied dressings to the right leg. When the medication cup with Triad paste was dropped on the floor, the RN picked it up, removed one glove, obtained more Triad paste, re-gloved again without hand hygiene, and applied Triad paste to the left leg, followed by Betadine to the left heel and additional dressing applications, again changing gloves without performing hand hygiene. For a second resident with diabetes, morbid obesity, MASD, and open wounds under an abdominal fold, the RN also failed to perform hand hygiene between glove changes. This resident was cognitively intact, dependent for most ADLs, and had an open MASD wound on the right iliac crest with orders for Triad paste and Interdry to abdominal folds. During observation, the RN placed Triad paste in a medication cup, washed hands, and gloved, then exposed the abdominal area and used a wet washcloth with a small amount of hand soap to wipe two open wounds on both sides of the abdominal fold, followed by drying with a hand towel. The RN then removed gloves and donned a new pair without performing hand hygiene between glove changes and applied Triad cream to both open wounds with the same fingers. Interviews with the RN, another RN, an LPN, the Infection Preventionist, and the DON confirmed that facility expectations and policy required hand hygiene between glove changes and glove changes between wounds to prevent cross-contamination, and the hand hygiene policy specified hand hygiene before handling clean or soiled dressings, after contact with blood or body fluids, after handling used dressings, and after removing gloves.
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