Improper Linen Handling and Storage Breaching Infection Control Practices
Penalty
Summary
The deficiency involves the facility’s failure to handle and store clean linen in accordance with its infection prevention and control policies and its in-service training on proper linen handling. An anonymous complaint was received alleging insufficient linen and blankets. During review of an in-service titled “Proper handling of Linen,” the facility’s guidance stated that clean linen should be stored in a designated clean area or cart, kept covered when transported to a patient room, and that only the amount of linen needed for each resident should be brought to the room. The sign-in sheet for this in-service did not include the name of CNA 1. The facility’s Laundry and Linen policy required separation of soiled and clean linen at all times and protection of clean linen from environmental contamination by covering clean linen carts. During observation and interview in a resident room, surveyors noted a large, open plastic bag filled with multiple bed pads, gowns, towels, and sheets placed on the nightstand next to the bed of a female resident with multiple diagnoses including hemiplegia and hemiparesis following cerebral infarction, DM, metabolic encephalopathy, CKD stage 4, dementia, muscle weakness, and polyneuropathies. This resident’s MDS showed impaired cognition and total dependence on staff for toileting, showering, bathing, and transfers. CNA 1 stated that the resident had already received a bed bath and explained that she gathered all linen for all of her residents in the morning, placed it in one bag, brought that bag into this resident’s room, and then used that bag as a source of linen for other residents by transferring items into separate plastic bags. CNA 1 stated this was common practice. Another CNA reported gathering linen for each resident separately and placing each bag in the respective resident’s closet for infection control. An LVN stated CNAs were educated to gather linens in a plastic bag and place them inside each resident’s room so each resident would have their own separate bag, and acknowledged that having all linen for every resident in one room could lead to cross contamination because once linen is taken into a room it is considered dirty. Additionally, on a separate floor, two linen carts were observed with their covers flipped up, leaving clean linen exposed, contrary to the facility’s policy to keep clean linen hygienically clean and protected from environmental contamination.
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