Failure to Perform Required Hand Hygiene During Incontinence and Wound Care
Penalty
Summary
The deficiency involves failures in staff adherence to the facility’s hand hygiene policy during incontinence care and wound care. For one resident with COPD, dementia, aphasia, atrial fibrillation, hypertension, and total dependence for personal hygiene and dressing, a CNA was observed providing incontinence care using prepackaged wipes and changing a soiled brief. After removing the soiled brief, cleansing the perineal area, and applying a clean brief, the CNA removed gloves and immediately donned new gloves without performing hand hygiene. The CNA then applied lotion to the resident’s chest, again removed gloves, and donned new gloves without hand hygiene before assisting the resident with dressing. The CNA later confirmed awareness that hand hygiene should have been performed after glove removal and before donning clean gloves. A second deficiency was observed during wound care for another resident with senile brain degeneration, COPD, chronic bronchitis, unspecified psychosis, dementia, hypertension, and a stage 3 pressure ulcer on the coccyx. The resident had an order for daily dressing changes that included cleansing the wound, patting it dry, applying alginate to the wound bed, and covering it with a dry clean dressing. During an observed dressing change, an LPN removed the resident’s brief and old dressing, cleansed the wound with water and gauze, applied calcium alginate to the wound dressing, placed the dressing on the resident, applied a clean brief, and repositioned the resident, all without changing gloves or performing hand hygiene between steps. The LPN only removed gloves and washed hands after completing the entire procedure and exiting the room, and acknowledged that she should have removed gloves and washed hands after cleaning the wound and before applying the new dressing. The facility’s hand hygiene policy required hand hygiene before clean tasks, after contact with bodily fluids or contaminated surfaces, before moving from a soiled to a clean body site on the same resident, and immediately after glove removal.
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