Inadequate Infection Control in Respiratory Equipment Storage and Medication Handling
Penalty
Summary
The deficiency involves failures in infection prevention and control related to respiratory equipment storage and medication administration practices. One resident with COPD who required oxygen and used two spirometers and a nebulizer had this respiratory equipment stored improperly. During observation, one nebulizer and one spirometer were found lying on the resident’s bed and another spirometer was on a windowsill, with none of the items stored in secure bags to maintain cleanliness. A registered nurse confirmed that the equipment was not stored appropriately and stated that the respiratory equipment should be stored in bags, and the infection preventionist later stated that such equipment should be labeled, dated, and stored in a bag to maintain cleanliness. A second deficiency was observed during medication administration for another resident when an RN prepared a glucosamine 500 mg oral tablet and, upon removing it from the bubble packaging, the pill missed the medication cup and landed on top of the medication cart. The RN then picked up the pill without gloves and placed it into the medication cup with other medications. In a subsequent interview, the RN stated that protocol required discarding any pill that landed on the medication cart and obtaining a new pill from the bubble package, and she was unsure whether she had picked up and used the dropped medication. The DON stated that, regarding infection control, staff are expected to perform hand hygiene between residents, not use the same cups and supplies for multiple residents, and to dispose of any pill that lands on top of the medication cart and replace it with a new one.
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