Failure to Ensure Hand Hygiene and Cleanliness Before Assisting Resident With Meal
Penalty
Summary
The deficiency involves the facility’s failure to maintain an effective infection prevention and control program when a resident with known behaviors and significant ADL dependence was assisted with eating while fecal matter remained on his hands. The resident was an older male with moderate cognitive impairment (BIMS score of 11) and active diagnoses including progressive neurological conditions, hypertension, viral hepatitis, diabetes mellitus, and non-Alzheimer’s dementia. His MDS and care plan documented that he required substantial/maximal assistance with eating and personal hygiene, had visual deficits including blindness in one eye, and needed maximum assistance for personal hygiene tasks. His care plan also included interventions to ensure he was clean, dry, and comfortable before mealtime and that he required substantial assistance for meal intake. On the evening in question, the resident’s family member arrived during dinner and, upon approaching the dining room table, smelled a foul odor like bowel movement and observed fecal matter on both of the resident’s hands, which were at chest level, while the resident was being assisted with his meal by a CNA. The family member reported being extremely upset that the resident was being fed without his hands being cleaned. The social worker, who was in the facility at the time, responded to the complaint, went to the dining room, and also observed fecal matter on both of the resident’s hands while the CNA was feeding him. The social worker stated the amount of fecal matter was enough to be noticed and that the resident was known to scratch himself and put his hands in his pants. The CNA who was feeding the resident reported that he had been assisting the resident with his meal for approximately 10 minutes before the family member alerted him to the fecal matter on the resident’s hands. He stated he had not noticed the fecal matter because the resident did not use his hands during feeding and that there was no smell, describing the fecal matter as appearing dried. An LVN working in the dining room as the nurse checking meal trays stated he became aware of the situation when he heard the family member bring attention to it and then saw the CNA feeding the resident while the resident had fecal matter on his hands. The DON and ADM both acknowledged that the resident had known behaviors of putting his hands in his briefs and that residents were expected to be clean when being fed. The facility’s Infection Prevention and Control policy required implementation of a program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections, which was not followed in this instance.
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