Improper Hand Hygiene and Glove Use During Direct Resident Care
Penalty
Summary
The deficiency involves a failure to maintain proper infection prevention and control practices during direct care for one resident. The resident was an older female with medical diagnoses including hypertension, lobar pneumonia, rheumatoid arthritis, and atherosclerotic heart disease, and was originally admitted with a UTI and lobar pneumonia. Her care plan identified her as being at risk for UTIs and upper respiratory infections, and she was receiving oxygen therapy via a pleural catheter to the right chest, with monitoring for signs and symptoms of respiratory distress. She was also on hospice services related to her atherosclerotic heart disease and was at risk for shortness of breath, anxiety, and pain, with interventions including medication administration and monitoring. On the day of the observation, the resident was in bed and reported that something felt stuck in her throat, using her hand to indicate the area of discomfort. LVN A was informed of the resident’s complaint while in the hallway. Without sanitizing her hands, LVN A took gloves from a box on her medication cart and placed them in her pant pocket. She then donned a gown and subsequently removed the same gloves from her pocket and put them on before entering the resident’s room. Once in the room, LVN A asked the resident about her discomfort, held a tissue near the resident’s mouth, and instructed her to try to expel what was stuck in her throat. The resident coughed up greenish phlegm, which LVN A wiped from the resident’s mouth with the tissue before discarding it. Interviews conducted after the observation confirmed that LVN A recognized she should not have used gloves that had been stored in her pocket for resident care and acknowledged this could be an infection control issue. She stated she believed it was less serious because the resident did not have a draining wound and was on hospice, and that she would have used fresh gloves from the cart for a resident with an open wound. The Infection Prevention Nurse (IPN) stated that LVN A should have discarded the gloves once they had been in her pocket and that she should have sanitized her hands before donning PPE, while also indicating she would look into whether pocketed gloves could be used. The DON and Administrator both stated that staff should sanitize hands before putting on gloves and should not use gloves that had been in their pockets, and that such practices could cause cross-contamination. Facility policies on PPE for gloves and gowns required the use of disposable single-use gloves when indicated and handwashing before putting on a gown.
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