|§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, review of facility policy and clinical records, it was determined that the facility failed to ensure that staff maintained proper infection control techniques during wound care for one of three residents observed (Resident R202) and during medication administration on one of six nursing units (One South Nursing Unit - Resident R52).
Review of Resident R202's clinical record revealed the resident was admitted to the facility on May 7, 2008, with a diagnosis of peripheral vascular disease (A circulatory condition in which narrowed blood vessels reduces blood flow). Additionally, the clinical record identifed that the resident had four different wound areas on her skin. The resident's wound care physician orders included: 1. every day shift for left Ischium suspected deep tissue injury cleanse l ischium with normal saline (salt solution), pat dry. Apply Skin Prep No Sting (reduce friction during the removal of tape) and cover with foam dressing daily; 2. cleanse sacrum (lower back) wound with Dakins solution 0.125% (wound cleanser), pat dry. pack wound with Dakins solution 0.125% soaked; 3. every day shift for right inferior ischium suspected deep tissue injury cleanse with normal saline, pat dry. apply skin prep no sting, and cover with foam dressing; 4. cleanse right ischium pressure injury with Dakins solution 0.125%, pack/cover wound with Dakins Solution 0.125% soaked gauze packing, and cover with foam dressing daily.
Observation of Employee E4, LPN, perform wound care treatment on Resident R202 on August 16, 2019, at 9:45 a.m. revealed the following findings:
Employee E4, LPN, applied the skin prep no sting applicator film to the inside of the left ischium wound, then with the same applicator applied the film to the outer perimeter of the wound, then with the same applicator applied the no sting prep film to the inside of the wound, which potentially contaminated the wound by bringing in contaminates from outside of the wound to the inside of the wound.
Then Employee E4, LPN, moved to the left gluteal wound, where she donned clean gloves, then picked up the Dakins bottle and moved the Dakins bottle. Then, with the same gloves, picked up Dakins soaked gauzes and packed the soaked gauzes into the wound using the same gloves, which potentially contaminated the wound because the gloves used to pack the wound came into contact with potentially contaminated surfaces to include the bottle of Dakins solution.
Employee E4, LPN, then moved to the right inferior ischial wound, where she used a Dakins soaked gauze to cleanse the inside of the wound, then with the same gauze she cleansed the outer perimeter of the wound, and continuing with the same gauze cleansed the inside of the wound, again which potentially contaminated the wound by bringing in contaminates from outside of the wound to the inside of the wound.
Then, Employee E4, LPN, moved to the last right ischium wound where she donned clean gloves, then picked up the Dakins bottle and moved the Dakins bottle. Then, with the same gloves she picked up the Dakins soaked gauzes with the same gloves and packed the soaked gauzes into the wound, which potentially contaminated the wound because the gloves used to pack the wound came into contact with potentially contaminated surfaces to include the bottle of Dakins solution.
Interview with the DON on August 19, 2019, at 12:00 p.m. confirmed that the facility does not have policies on the correct technique of performing wound care to not contaminate the wounds.
The facility failed to perform wound care treatment in a manner that would not potentially contaminate the resident's wound.
Observation on August 19, 2019, at 9:30 a.m. of Employee E7, LPN, administering medications to Resident R52, revealed that the employee picked up two medications with her bare fingers/hands and touched the inside of the resident's water cup and the medication souffle cup.
The facility failed to adhere to effective infection control practices related to medication administration.
28 Pa. Code 211.12(d)(1) Nursing services.
| ||Plan of Correction - To be completed: 10/17/2019|
Residents R202 and R52 were monitored and no negative outcomes were observed.
1. E4 received standard of card education. Nursing practice reviewed. Treatment observed and competency checked by Education Director. Observed by infection control officer for proper wound cleaning technique. E4 will be observed for wound treatment and infection control competency during wound rounds weekly for 4 weeks, monthly for 4 months, and randomly.
2. House education was provided for all professional nurses on infection control and wound treatment policy. Treatment audit for infection prevention and control technique and wound care technique for professional nurses will be completed. Licensed nurses will be observed and audited for standard nursing practice.
3. E7 - received education on medication administration and infection control. Will be observed for medication pass and competency weekly for a month and monthly after.
4. Results of treatment and wound care audits will be reported to the facility Care and Services committee as part of the facility's QAPI program.Nurses identified as using improper infection control or wound care technique during audits or observation will receive additional education.