|§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 facility policy, observations, clinical records and staff interviews, it was determined that the facility failed to perform proper handwashing during medication passes and treatment for 6 of 9 residents (Residents R22, R25, R43, R46, R48, and R55), failed to proper sanitize glucose monitor, failed to make certain that the linens and laundry were handled in a sanitary manner in one of one laundry areas and failed follow transmission based precautions to prevent the potential for cross-contamination for one of one resident (Resident R55).
A review of the facility policy "Handwashing" last reviewed 10/4/18, indicated that the employees will be instructed to wash hands throughout the shift to prevent the spread on infection.
A review of the facility policy "Glucose Monitoring" last reviewed 10/4/18, indicated that the glucometer will be disinfected using a 10% bleach solution after each use.
During an observation on 2/4/19, at 8:30 a.m. of the Building 2 Shower/Tub room the following was observed: dirty linen hamper was uncovered, opened bar of soap, a brush and towel on the edge of the tub.
During an interview on 2/4/19, 10:06 a.m. Licensed Practical Nurse (LPN) Employee E6 confirmed that the facility created the potential for cross-contamination by soaps and care items being left for residents to share and leaving soiled linens uncovered.
A review of the clinical record revealed Resident R43 was admitted to the facility on 2/14/17, with the diagnoses that included difficulty walking, diabetes, coronary disease and muscle weakness.
A review of the clinical record revealed Resident R55 was admitted to the facility on 4/13/18, with the diagnoses that included falls, diabetes, pneumonia, irregular heart beat, difficulty walking, obesity, muscle weakness, MRSA (Methicillin-resistant Staphylococcus Aureus- a bacterium that causes infections in the body) infection of a buttocks wound.
A review of the Physician Orders dated 1/19, revealed that Resident R55 is on contact precautions related to a MRSA infection in a buttocks wound.
During the following observations on 2/5/19, at 11:02 a.m. through 11:09 a.m. of a medication pass with Registered Nurse (RN) Employee E2 entered Resident R43's room with gloved hands performed a blood glucose then went back to the medication cart in the hallway, removed gloves, obtained supplies for a breathing treatment went back to Resident R43 administered the breathing treatment, opened Resident R43's bathroom door and preformed handwashing then went back to the medication cart and reapplied gloves sanitized the glucose monitor, removed gloves failed to preform hand washing after RN Employee E2 removed gloves. RN Employee E2 reapplied gown and gloves then went in to Resident R55's room, preformed a blood glucose reading went to the Resident R55's shared bathroom opened the door with gloved hands and preformed hand washing. On the floor next to the bathroom door was an opened red biohazard bag that contained contaminated waste from treatments for Resident R55. Resident R55 Bathroom is a shared bathroom for two other residents in room 208.
During an interview on 2/5/19, at 11:40 a.m. RN Employee E2 confirmed that by touching door handles with gloved hands and not performing hand washing after each time gloves are removed and reapplying gloves prior to performing hand washing creates the potential for cross contamination. RN Employee E2 confirmed that biohazardous waste not being secured and the shared bathroom is were Resident R55's bed pans are emptied creates the potential for cross-contamination.
During an observation on 2/5/19, from 11:10 a.m. through 12:01 p.m. Licensed Practical Nurse (LPN) Employee E3 administered eye drops to Resident R25 removed gloves and then returned to the medication cart, applied gloves, prepared medication for Resident R48, removed gloves went to Resident R48's room administered medications, left Resident R48's room went back to the medication cart documentated in the Medication Administration Record (MAR), removed keys for his/her pocket, opened medication cart, prepared insulin injection(medication to lower blood sugar), applied gloves went into Resident R22's room and administered the injection, removed gloves, left the room and went back to the medication cart removed keys from his/her pocket removed the blood glucose monitor from the medication cart. LPN Employee E3 applied gloves then preformed a blood glucose check on Resident R46 in her room. LPN Employee E3 then removed one glove, with the ungloved hand removed keys from pocket and removed an alcohol pad and cleaned the blood glucose monitor then removed the second glove. LPN Employee E3 then documented on the MAR and reapplied gloves and prepared an insulin injection for Resident R46. After the insulin injection with the same gloved hands, LPN Employee E3 went to Resident R46's bathroom and obtained water to flush Resident R46's feeding tube. LPN Employee E3 then left Resident R46's room, removed gloved, documented on the MAR and then preformed hand sanitizing with an alcohol based sanitizer.
During an interview on 2/5/18, at 12:05 p.m. LPN Employee E3 confirmed that by not performing hand washing when gloves are removed and/or changing task and by not cleaning the blood glucose monitor per policy he/she created the potential for cross contamination.
During an observation on 2/7/19, 9:25 a.m. in the facility laundry area five boxes were on the concrete floor. One of the boxes closes to the entrance door was damaged and the contents were exposed.
During an interview on 2/7/19, at 9:30 a.m. the Director of Dietary/Housekeeping Employee E5 confirmed the boxes contain new whit resident bath towels and by storing them in contact with the floor it was determined that the facility failed to make certain that the linens and laundry were handled in a sanitary manner in one of one laundry areas
28 Pa. Code: 211.10 (d) Resident care policies.
28 Pa. Code: 201.14(a) Responsibility of licensee.
28 Pa. Code: 211.12(d)(1)(2)(3)(5) Nursing services.
28 Pa. Code: 201.18 (b) (1) (e) (1) Management.
28 Pa. Code: 205.26(c) Laundry.
| ||Plan of Correction - To be completed: 04/01/2019|
Five boxes in laundry were removed from the concrete floor. The red bag on the floor was removed. E3 will be re-educated on handwashing and glucometer cleaning & E2 will be re-in serviced including donning and removal of PPE, hand hygiene and glucometer cleaning to prevent cross contamination by the DON/Designee. Dirty linen hamper was closed, open bar of soap, brush and towel were removed from the shower room.
No other boxes were noted to be on the floor in laundry. No other red bags were noted to be on the floor in facility. The other facility shower room was checked for cross contamination items and any were removed.
Laundry staff will be re-educated by Laundry Manager/Designee on not storing items on the floor. Nursing staff will be re-in serviced on handwashing and glucometer cleaning including donning and removal of PPE, hand hygiene and preventing cross contamination by the DON/Designee. Nursing staff will be re-educated on cross contamination in the tub/shower rooms and proper handling and cleaning of bed pans to prevent cross contamination.
Monitoring to ensure compliance related to items being stored on the laundry room floor will be completed by Laundry Manager/Designee weekly x 4 and monthly x 2. Monitoring to ensure compliance of handwashing, glucometer cleaning, donning and removal of PPE, hand hygiene and cross contamination in the tub/shower rooms and cleaning of bed pans will be completed by the DON/Designee weekly x 4 and monthly x2.
Reports will be submitted to QA & A for recommendation.