|§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 observations, review of facility policies, and staff interviews, it was determined that the facility failed to ensure proper handwashing during a dressing change for one of 26 residents (Resident R38), and failed to prevent cross contamination (bacteria unintentionally transferred from one object to another) related to a dressing change, breathing equipment, administering eye drops and glucometer (device used to check blood sugar levels) usage for five of 26 residents (Resident R37, R106, R92, R62, and R14) .
The "To change dressings using aseptic technique" policy, dated 7/23/19, revealed that during a dressing change, hands should be washed after removing the soiled dressing.
During a dressing change observation for Resident R38 on 8/21/19, at 10:45 a.m. Licensed Practical Nurse (LPN) Employee E1 did not sanitize or wash hands after removing Resident R38's soiled dressing. LPN Employee E1 confirmed the above information on 8/21/19 at 10:55 a.m.
During an interview on 8/22/19, at 11:13 a.m. the Interim Director of Nursing confirmed that the LPN's hands should have been washed or sanitized after removal of the soiled dressing.
The "Infection Prevention and Control" policy dated 7/23/19, revealed that cross contamination is to be prevented and controlled by facility staff.
During a breathing treatment for Resident R37, on 8/21/19, at 2:08 p.m. his/her breathing treatment cord (connected from the breathing treatment machine to the breathing mask) came unconnected and fell to the floor. LPN Employee E1 took off Resident R37's breathing mask, took the breathing treatment cord off the floor and reattached it to the breathing mask, and put the breathing mask back on him/her to finish the breathing treatment.
LPN Employee E1 did not clean the part of the breathing treatment cord that fell to the ground with alcohol to prevent cross contamination of bacteria to Resident R37. LPN Employee E1 confirmed the above information on 8/21/19, at 2:11 p.m.
During an interview on 8/22/19, at 11:14 a.m. the Interim Director of Nursing confirmed that the breathing treatment cord should have been cleaned with alcohol or replaced.
Resident R14's clinical record revealed an admission date of 4/01/15, with diagnoses that included Parkinson's disease (a progressive nerve disease impacting muscles), atrial fibrillation (an irregular heart rhythm originating in the upper chamber), and a delusional disorder. An 8/22/19 Weekly Wound Observation form revealed that Resident R14 had a Stage II (partial thickness loss of skin presenting as a shallow ulcer with a red/pink wound bed) pressure ulcer of the left buttock, measuring 0.3 centimeters (cm) by 0.3 cm by 0.0 cm.
An observation of wound care to Resident R14's pressure ulcer, on 8/22/19, at 9:54 a.m. revealed LPN Employee E5, washing the wound with saline and wiping over the wound from multiple directions, in some instances from the direction of the rectal area upward over the wound bed.
LPN Employee E5 confirmed at the time of the observation that cleansing from multiple directions without changing the gauze or wiping from a clean to dirty area increased the risk for contamination of the wound.
The "Cleaning Thermoscan Ear Thermometer and Glucometer," policy dated 7/23/19, revealed "cleaning and disinfecting should be done after each use."
Observation of administration of eye drops to Resident R106 on 8/20/19 at 3:03 p.m. revealed that Registered Nurse (RN) Employee E17 did not wash their hands prior to administering the eye drop, gave one drop in each eye and removed their gloves. The RN did not wash their hands after removal of their gloves. The RN proceeded to administer a second drop into Resident R106's eyes, did not wash/sanitize their hands before administering the eye drops and again, did not wash their hands after removal of their gloves.
Observation of obtaining a blood sugar reading on Resident R62 on 8/20/19, at 4:55 p.m. revealed that LPN Employee E18 entered Resident R62's room, obtained a fingerstick blood sugar and returned to the medication cart without first washing their hands or cleaning the glucometer. LPN Employee E18 then entered Resident R92's room at 5:09 p.m., placed the glucometer on the residents walker in the room, and when LPN Employee E18 returned to the medication cart, LPN Employee E18 did not cleaned the glucometer.
During an interview on 8/23/19 at 3:07 p.m. LPN Employee E13 confirmed that the LPN should have washed their hands prior to donning gloves and washed their hands after removal of their gloves after administering the eye drops and removal of gloves and the glucometer should be cleaned before after each use.
28 Pa. Code 201.14(a) Responsibility of licensee
Previously cited 9/21/18
28 Pa. Code 211.12(d)(1)(5) Nursing services
Previously cited 9/21/18
| ||Plan of Correction - To be completed: 10/15/2019|
1. Resident #38, Resident #37, Resident #14, Resident #62 and Resident #92 show no signs and symptoms of infections in relation to areas identified as deficient. Resident 106 was not identifiable.
2. Current policies and procedures regarding standard and transmission-based precautions to be followed to prevent spread of infection, specifically regarding hand washing, dressing changes, breathing equipment, administering eye drops and glucometer usage will be reviewed and updated as needed. All Licensed Nursing staff will be in-service/re-educated on policies and procedures.
3. Wound care, administering eye drops, and glucometer usage competencies will be performed on all Licensed Nurses to ensure adherence to policies and procedures. Any non-compliance will be addressed with further education occurring immediately after the competency. The Licensed Nurse will perform the competency over to ensure adherence and understanding to the re-education.
4. The DON, or designee, will complete visual checks to ensure standard and transmission-based precautions are being followed to prevent spread of infection, specifically regarding handwashing, dressing changes, breathing equipment, administering eye drops and/or glucometer usage daily on rotating shifts for four weeks, then 3 times a week for 4 weeks, then semi-monthly for 4 months to ensure compliance with policies and procedures. Any issues will immediately be noted and addressed.
All audit results will be forwarded to the QAPI Committee for review and recommendations.