|§483.80 Infection Control|
The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.
§483.80(a) Infection prevention and control program.
The facility must establish an infection prevention and control program (IPCP) that must include, at a minimum, the following elements:
§483.80(a)(1) A system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to §483.70(e) and following accepted national standards;
§483.80(a)(2) Written standards, policies, and procedures for the program, which must include, but are not limited to:
(i) A system of surveillance designed to identify possible communicable diseases or
infections before they can spread to other persons in the facility;
(ii) When and to whom possible incidents of communicable disease or infections should be reported;
(iii) Standard and transmission-based precautions to be followed to prevent spread of infections;
(iv)When and how isolation should be used for a resident; including but not limited to:
(A) The type and duration of the isolation, depending upon the infectious agent or organism involved, and
(B) A requirement that the isolation should be the least restrictive possible for the resident under the circumstances.
(v) The circumstances under which the facility must prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease; and
(vi)The hand hygiene procedures to be followed by staff involved in direct resident contact.
§483.80(a)(4) A system for recording incidents identified under the facility's IPCP and the corrective actions taken by the facility.
Personnel must handle, store, process, and transport linens so as to prevent the spread of infection.
§483.80(f) Annual review.
The facility will conduct an annual review of its IPCP and update their program, as necessary.
Based on review of facility policy and clinical records, observations, and staff interviews, it was determined that the facility failed to exercise proper infection control technique during dressing changes for two of two residents (Resident R52 and R59).
The facility policy "Wound Dressing Change" dated 10/23/17, and last reviewed by the facility on 1/2/19, indicated that the nurse cleansed hands, opened all dressing supplies, removed soiled gloves, cleansed hands and applied clean gloves, cleansed the wound, removed soiled gloves, cleansed hands and applied clean gloves and applied the ordered treatment to the wound.
The Admission Record indicated that Resident R52 was admitted to the facility on 9/21/18, with diagnoses that included repair of a fractured left hip, diabetes and high blood pressure.
A review of the pressure wound tool indicated that Resident R52 developed a wound on the left heel on 11/6/18, treatment was initiated at that time and that the resident had various treatment changes as needed.
A physician order dated 12/27/18, instructed the nurse to cleanse the left heel wound with normal saline and apply Medihoney (advanced wound care product) to wound base then cover with clean, dry dressing daily and as needed.
During an observation of a dressing change on 1/4/19, at 10:30 a.m. Licensed Practical Nurse (LPN) Employee E6 gathered all packages of supplies needed for Resident R52's wound care, which included a small bottle of normal saline, 3 packages of 4x4 gauze, 1 package of border gauze, a box with a tube of Medihoney in it and several skin prep pads, and placed them on the overbed table. LPN Employee E6 did not sanitize or prepare a clean field on the overbed table. LPN Employee E6 washed hands but then donned a pair of gloves that she/he removed from uniform pocket, opened the bottle of normal saline, a package of gauze, removed the old dressing, dipped gauze in the bottle of normal saline and cleansed the left heel wound. LPN Employee E6 did this procedure several times removing exudate from the resident's wound. LPN Employee E6 then removed the soiled gloves, retrieved another pair of gloves from her/his uniform pocket, opened another package of gauze and removed the tube of Medihoney from the box. When the attempt to squirt Medihoney on the gauze pad was unsuccessful, he/she squirted it directly on the wound. LPN Employee E6 then opened a package of border gauze, retrieved a felt-tipped pen from her/his pocket, dated/initialed the border gauze and then applied the border gauze to the resident's left heel wound. LPN Employee E6 did not perform hand washing during the multiple steps of the dressing change procedure.
During an interview on 1/4/19, at 10:35 a.m. LPN Employee E6 confirmed not preparing a clean field, the multiple cross contamination issue and lack of handwashing during Resident R52's dressing change.
The Admission Record indicated that Resident R59 was admitted to the facility on 11/19/14, with diagnoses that included a stroke, depression, Parkinson's disease (a disease of the nervous system) and heart disease. The Minimum Data Set (MDS-periodic assessment of care needs) dated 11/30/18, included an additional diagnosis of anemia.
A physician order dated 12/21/18, instructed the nurse to apply Mupirocin ointment (antibiotic) to the left ear of Resident R59 two times a day and then cover with a gauze pad to protect from glasses.
During an observation of a dressing change on 1/7/19, at 9:35 a.m. LPN Employee E7 gathered all the supplies needed for Resident R59's dressing, which included two packages of 2x2 gauze, a tube of Mupirocin ointment which was in a plastic bag, a small bottle of normal saline, a roll of tape and two packages of cotton-tipped applicators, and placed them on the overbed table. LPN Employee E7 then donned gloves, opened two packages of the 2x2 gauze, and two packages of cotton-tipped applicators, removed the soiled dressing from Resident R59's left ear, dipped a 2x2 gauze in the normal saline, cleansed the wound on the left ear and then applied the new dressing. LPN Employee E7 did not change gloves or perform hand washing between the soiled and clean dressing procedure.
During an interview on 1/7/19, at 9:45 a.m. LPN Employee E7 confirmed the failure to exercise proper infection control technique during the dressing change for Resident R59's left ear.
During an interview on 1/7/19, at 1:00 p.m. the Director of Nursing confirmed that the facility failed to exercise proper infection control technique during dressing changes for Residents R52 and R59.
28 Pa. Code: 211.10(d) Resident care policies.
28 Pa. Code: 211.12(d)(1)(5) Nursing services.
| ||Plan of Correction - To be completed: 02/22/2019|
- Licensed Nursing staff will be given educational training and visual instruction on proper dressing changes per facility policy and procedure and this will also include proper technique for taking treatment items to the rooms until 100% compliance is achieved
- Licensed staff involved with inappropriate dressing changes will be provided one on one training regarding proper policy and procedure dressing changes
- Residents 52 and 59 did not suffer adverse results from the improper dressing technique, no signs or symptoms of infection noted.
Responsible Party: Director of Nursing or Designee
- Audits and observations of actual dressing changes will be completed of the licensed nursing staff by the Director of Nursing or designee to include at least 4 dressing changes per week for 3 months. The audits will include proper technique for carrying supplies to the rooms.
- Results of audits will be reviewed at the next scheduled quality assessment and assurance meetings