§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.
§483.80(e) Linens.
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.
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Observations:
Based on review of the facility policies and clinical records, observations and resident family and staff interviews, it was determined that the facility failed to implement infection control measures to prevent the potential spread of infection on four of four nursing units (First, Second, Third and Fourth Floor nursing units), failed to have an effective infection control plan in place for one of two residents with suspected Norovirus (Resident R1) and failed to store clean linen properly on one of four nursing units (Second floor).
Findings include:
Review of the facility "Nursing-Isolation categories" policy last reviewed on June 2018, indicated that Transmission Based Precautions will be used when caring for residents who are documentated or suspected to have a communicable disease that can be transmitted to others.
During an interview on 1/24/19, at 8:10 a.m. Assistant Director of Nursing Employee E1 stated that there were two residents currently in precautions for the Norovirus. Other residents in isolation were for other reasons.
Review of the facility "Norovirus - Prevention/Control" policy last reviewed June 2018, indicated that strict infection control practices are implemented. That included residents being placed on Contact Precautions and soap and water are used for hand hygiene after providing care or having contact with suspected or confirmed cases.
Review of the facility "Contact Precautions" policy last reviewed June 2018, indicated that gloves and handwashing would occur, gowns are to be worn upon entering room and cubicle and signs to alert staff of isolation are to be used.
During observations of all nursing units on 1/24/19, from 7:50 a.m. through 10:30 a.m. and from 12:15 p.m. through 1:15 p.m. signs indicating a Norovirus outbreak were on the walls and at all nurses stations.
The linen cart in the 2300 hall was uncovered.
Resident R1 and Resident R6 were identified as the two residents currently with the Norovirus on the First floor.
During an observation on 1/24/19, at 8:00 a.m. there was no signage or isolation equipment at the entrance of Resident R1's room
During an observation on 1/24/19, at 8;00 a.m. there was no signage or gowns on the equipment cart at the entrance of Resident R6's room
During observation of the second floor nursing unit on 1/24/19, from 7:45 a.m. through 8:05 a.m. the following occurred:
Resident R10 was in isolation for Clostridium Difficile (a bacterial infection from overuse of antibiotics causing diarrhea and abdominal pain). There was no signage to alert staff and visitors of the infection.
Resident R9, who was not listed as needing isolation. had isolation signage at the door indicating isolation was required but had no isolation equipment.
During an observation of the first floor nursing unit on 1/24/19, from 8:17 a.m. through 8:45 a.m. the following occurred:
During an observation on 1/24/19, at 8:22 a.m. Nurse Aide (NA) Employee E2 entered room 1319 with a food tray, assisted the resident into chair, came out of the room and went to food cart and took a food tray to the resident in room 1326 without washing their hands between tray service or touching the resident in room 1319.
During an observation on 1/24/19, at 8:25 a.m. an opened container of orange juice was sitting on a stand between two chairs in hall and an unused incontinence pad was sitting on top of two novels under the table between the two chairs.
Interview with a private duty resident caregiver on the third floor on 1/24/19, at 8:45 a.m. indicated that she has had to return plates and silverware to the kitchen due to food particles still being present.
During an observation of the fourth floor nursing unit on 1/24/19, at 9:05 a.m. NA Employee E3 was observed assisting the resident in room 4415 with gathering soiled linens and clothing. NA Employee E3 then took the residents bowl of food and heated at the country kitchen area, went back into the resident room, made the residents bed, left the room and went into resident room 4412 and asked resident if she was ready to get cleaned up. NA Employee E3 did not perform hand washing between any of these tasks.
28 Pa. Code:201.14(a) Responsibility of licensee.
28 Pa. Code: 201.18(b)(1)(e)(1) Management.
28 Pa. Code: 201.20(c) Staff development.
28 Pa. Code: 211.10(d) Resident care policies.
28 Pa. Code: 211.12(d)(1)(2)(3)(5) Nursing services.
| | Plan of Correction - To be completed: 03/04/2019
The certified nursing assistant was immediately in-serviced on proper hand hygiene procedures.
There was an immediate audit done for all residents requiring isolation. For those residents, the proper signage/equipment was displayed and/or removed.
Environmental rounds were done to ensure items in common areas are meeting the community's standards i.e. briefs and other items removed from common area, linen carts covered.
The DON or designee will provide education to the nurse aides and nursing team on the community's policy and/or practice for the timing and technique for hand hygiene, environmental standards, including no briefs in common areas and linen carts covered, as well as proper isolation equipment and signage.
Dishes and silverware will be audited by dining services director or designee before being transported to the neighborhood for distribution daily for two weeks. Spot checks will be done daily as a practice daily thereafter to ensure ongoing compliance.
The Director of Nursing or designee will complete random audits of personnel and the timing and technique of hand hygiene procedure. These audits will occur 5 days per week for 6 weeks.
The Director of Nursing or designee will audit all residents needing isolation for proper isolation signage/equipment 5 days per week for 6 weeks.
The Director of Nursing or designee will perform an environmental round 5 times per week for 6 weeks to audit for environmental hygienic standard, to include no briefs in common areas, linen carts covered.
This plan of correction will be monitored by the QAPI committee until such time consistent substantial compliance has been met.
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