|§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 observation, facility policy review, clinical record review, and staff interview, it was determined that the facility failed to 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 in two of two nursing units (Floors 1, and 2).
Review of facility document titled, "Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007)" with a review date of February 15, 2017 revealed, "Healthcare personnel caring for patients on Contact Precautions wear a gown and gloves for all interactions that may involve contact with the patient or potentially contaminated areas in the patient's environment. Donning Personal Protective Equipment (PPE) upon room entry and discarding before exiting the patient room is done to contain pathogens, especially those that have been implicated in transmission through environmental contamination (e.g., VRE, C. difficile, noroviruses, and other intestinal pathogens; RSV)"
Observation on February 3, 2020, at 8:56 AM revealed Nurse Aide (NA) 1 entering Resident 41's room, who is on contact precautions for RSV (Respiratory Syncytial Virus -a respiratory virus that usually causes mild, cold-like symptoms). NA 1 entered the room, wearing only a mask (which NA 1 was observed wearing at all times), and gave Resident 41 his breakfast tray. NA 1 then exited the room, did not perform hand hygiene or change her mask and then proceeded to take Resident 80's breakfast tray into his room.
Observation on February 3, 2020, at 9:00 AM revealed NA 1 and NA 2 enter Resident 13's room, who is on contact precautions for RSV. Neither NA 1 or NA 2 donned any PPE, except a mask that NA 1 was wearing continuously. NA 1 and NA 2 were observed, with no PPE, pulling Resident 13 up in the bed. Upon leaving the room, NA 1 did not change her mask.
Observation during medication administration on February 4, 2020, at 8:52 AM revealed Registered Nurse (RN) 1 enter Resident 67's room, who is on contact precautions for RSV. RN 1 donned PPE prior to entering the room and then proceeded to check Resident 67's blood glucose level using a glucometer. RN 1 then exited the room, still wearing the PPE, and was observed putting the glucometer on top of the clean isolation bin outside of the room and removing her PPE and placing it in the trash can in the room across the hall from Resident 67's room. RN 1 stated that since both Residents were on contact precautions for RSV, they were sharing the bins to discard the used PPE.
On February 5, 2020, at 3:08 PM the Nursing Home Administrator (NHA) and the Director of Nursing (DON) were both made aware of the aforementioned observations.
During an interview with RN 3 on February 6, 2020, at 9:16 AM she stated that each room should have two garbage cans in them, one with a red biohazard bag, and that nursing is responsible to put them in the rooms when a resident gets placed on precautions.
Observation during medication administration on February 4, 2020, at 8:33 AM revealed RN 1 checking Resident 54's blood glucose. RN 1 did not clean or disinfect the glucometer after using it on Resdient 54. RN 1 then used the same glucometer to check Resident 67's blood glucose.
Observation during medication administration on February 5, 2020, at 8:31 AM revealed RN 2 checking Resident 46's blood glucose. RN 2 did not clean or disinfect the glucometer after using it to check Resident 46's blood glucose.
Review of the manufacturer's guidelines for the glucometer revealed "The meter should be cleaned and disinfected after use on each patient."
On February 5, 2020, at 3:08 PM the NHA and DON were made aware of the aforementioned observations. No additional information was provided to the surveyor.
Review of facility policy Urinary Catheter, revised September 2014; revealed "be sure the catheter tubing and drainage bag are kept off the floor."
Review of Resident 36's clinical record revealed diagnoses that included; multiple sclerosis (a chronic progressive disease involving damage to the sheaths of nerve cells in the brain and spinal cord, symptoms include numbness, impaired speech, muscle coordination, blurred vision, and severe fatigue),chronic kidney disease (gradual loss of kidney function), and depression (feelings of severe despondency and dejection).
Review of Resident 36's February 2020 physician orders revealed orders that included: Foley catheter (a thin sterile tube inserted into the bladder to drain urine) care every shift related to multiple sclerosis, with start date of November, 25, 2019.
Review of Resident 36's care plan revealed a focus area for alteration in elimination of bowel and bladder related to chronic kidney disease, indwelling urinary catheter (a thin sterile tube inserted into the bladder to drain urine) due to neurogenic bladder (lack of bladder control due to a brain, spinal cord or nerve problem), multiple sclerosis, with an initiated date of August 5, 2011, and a revision date of September 10, 2019. Interventions for the aforementioned focus area included: check placement and function of colostomy bag every shift and as needed, with an initiated date of December 18, 2016, and a revision date of February 15, 2017; deep drainage bag of catheter below the level of the bladder at all times and off the floor, with a n initiated date of August 5, 2011, and a revision date of August 2, 2018.
Observation on February 4, 2020, at approximately 2:42 PM revealed Resident 36 in her room, in her chair with the catheter bag on the floor at the right side of her chair, visible from the hallway.
During an interview with the Nursing Home Administrator on February 6, 2020, at approximately 10:47 AM it was revealed the expectation the catheter bag should not be on the floor, it was also revealed that at times the catheter bag will become un hooked from a bed or chair.
Review of Resident 43's clinical record revealed diagnoses including acute lower respiratory infection (infection of the lung alveoli) and respiratory syncytial virus (a syncytial virus that causes respiratory tract infections).
Review of Resident 43's current physician orders dated February 5, 2020 revealed an order for Contact Precautions ordered January 24, 2020 and started January 24, 2020.
Observation of Nurse Aide 4 (NA 4) on February 3, 2020 at 12: 55 PM revealed NA 4 was in Resident 43's room wearing only vinyl gloves as PPE preparing Resident 43's meal and assisting her with setting up her meal on her over-bed table. NA 4 also adjusted Resident 43's bed so she was in position to eat. NA 4 then stopped assisting Resident 43 with meal preparation went to the exit of the room and retrieved a gown from the PPE bin located outside of Resident 43's room, donned a gown and continued assisting the resident with meal preparation.
Review of Resident 73's February 2020 physician orders revealed diagnoses including hypertension ( elevated blood pressure) and a history of falling.
Observations in Resident 73's room, on February 4, 2020, at 8:43 AM and 1:09 PM revealed one glove on the floor next to her bedside table.
An interview with the Nursing Home Administrator, on February 6, 2020, at approximately 1:30 PM revealed an expectation staff would have picked up and disposed of the glove on Resident 73's floor.
Review of Resident 76's clinical record revealed diagnoses of respiratory syncytial virus (a syncytial virus that causes respiratory tract infections). and altered mental status (a disruption in how your brain works that causes a change in behavior).
Review of Resident 76's current physician orders revealed an order for Droplet precautions ordered January 27, 2020 and started January 27, 2020.
Observation of a PPE bin outside of room 209 (Resident 76's room) on February 3, 2020 at 10:00 revealed a used lancet sitting on top of the PPE bin. When asked about the whether or not the lancet was used, RN3 agreed that it was used and should have been placed into the sharps container hanging in the hallway. RN3 then pointed to the sharps container and the container was full with 4 used disposable razors hanging out of the top of the box. RN3 then directed another staff member to dispose of the container and replace it with a new one. At that time I also made the observation that the PPE disposal bins that are supposed to be located in the room 209 were located in the hallway outside of the room. RN3 agreed and with the observation and moved the PPE disposal bins inside of the room and out of the hallway.
28 Pa code 211.10(d) Resident care policies
28 Pa code 211.12(d)(5) Nursing services
| ||Plan of Correction - To be completed: 03/25/2020|
1. Nurse Aide 1 has been educated on entering R41's room while on contact precautions for RSV for proper Donning/Doffing and hand sanitation prior to exiting this pts room. Nurse Aide 1 and 2 have been educated on donning of PPE including mask changing for R13. Nurse Aide 4 was educated on donning and doffing PPE equipment for resident R43. RN 1 has been educated on the Doffing of PPE equipment before exiting R 67's room, cleaning the glucometer immediately upon exiting R67's and R54's room. RN 2 has been educated on the cleaning of glucometer after checking blood sugar for R 46. The glucometers have since been properly disinfected per manufacturer's guidelines. R36's Foley catheter bag has been appropriately placed and no longer on the floor. The glove observed on the floor in R73's room has been removed and discarded. The lancet observe on the top of the PPE bin for R76 has been removed. The sharps container outside of R76's room has been discarded and a new sharps container has been placed inside the resident's room.
2. Residents requiring Contact precautions and use of glucometers are at risk for this alleged deficient practice. Staff were immediately provided on the spot education regarding appropriate hand hygiene, PPE usage, glucometer cleaning between resident use.
3. The facility will provide staff education regarding the appropriate use, maintaining an infection prevention and control program to ensure a safe sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.
4. The DNS or designee will perform 5 random audits observing infection control practices weekly x 4 weeks, then monthly x 2 or until substantial compliance has been achieved. All results will be presented at QAPI committee for further review and recommendations as appropriate.
5. The facility will be in substantial compliance by 3/25/2020.