Failure to Follow Hand Hygiene and Glove Protocols During Wound Care
Penalty
Summary
Surveyors identified a deficiency in the facility’s infection prevention and control program related to hand hygiene and glove use during wound care. The facility’s policy required alcohol-based hand rub as the preferred method of hand hygiene when hands are not visibly soiled, and specified hand hygiene before donning gloves, before handling clean or soiled dressings, after handling used dressings or contaminated equipment, and after removing gloves. The enhanced barrier precautions protocol required staff to wear gloves and a gown for high-contact resident activities such as wound care and to perform hand hygiene before and after leaving the resident’s room. During wound care for a resident on enhanced barrier precautions for wounds and an indwelling urinary catheter, the Assistant Director of Nursing (ADON) donned a gown and gloves before entering the room and placed a clean towel as a barrier on the bedside table, then placed clean supplies on it. She removed a soiled dressing from the resident’s right foot and placed it on the clean barrier next to unused supplies, did not remove gloves or perform hand hygiene before cleaning the wound, and then opened and applied collagen and a bordered dressing without changing gloves or performing hand hygiene. She then removed a soiled sacral dressing, placed it on the bedside barrier, cleaned the sacral wound, and again opened and applied collagen and a bordered dressing without changing gloves or performing hand hygiene between handling soiled items and clean supplies. In a separate observation of wound care for another resident on enhanced barrier precautions for a wound, the ADON donned a gown and gloves without performing hand hygiene before entering the room. She placed a clean towel and clean wound care supplies on the bedside table, repositioned the resident, removed a soiled sacral dressing and left it on the bed, then cleaned the wound and placed used gauze on the towel next to clean supplies. Without removing gloves or performing hand hygiene, she opened collagen with silver, applied it to the wound, and applied a silicone-bordered dressing. She removed her gloves without performing hand hygiene, exited the room wearing the gown, retrieved tape from the wound cart in the hallway, reentered the room without hand hygiene, and donned clean gloves. She then removed a soiled dressing from the resident’s right foot, left it on the bed, and wrapped the foot with a dry dressing without changing gloves or performing hand hygiene between soiled and clean tasks. After completing wound care, she discarded used dressings and the towel, removed her gown and gloves, and washed her hands. These observations showed failure to follow the facility’s infection control policies for hand hygiene, glove changes, and handling of soiled dressings and clean supplies during wound care under enhanced barrier precautions.
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