Excel Care Center was cited after the facility failed to ensure “appropriate infection practices were implemented” on multiple occasions. Appropriate infection practices were not taken in relation to glucometer disinfection; personal protective equipment (PPE) and proper hand washing for two residents on contact isolation; and proper eye drop administration for one resident. Failure to conduct appropriate infection practices in nursing home facilities puts residents at higher risk for the spread of infection.
Observations and Failures in Infection Practices
The surveyor of this citation conducted an observation of the facility to investigate the failure to ensure appropriate infection practices. During the observation, a Licensed Practical Nurse (LPN) used a glucometer on a resident. She put on gloves and cleaned the resident’s finger with an alcohol prep pad, taking a drop of blood for the glucometer test. She then removed her gloves, disposed of the materials, and washed her hands. After leaving the resident’s room, the LPN returned the glucometer to the medication cart without cleaning the contaminated glucometer. She also did not perform any hand hygiene after handling the contaminated glucometer.
The surveyor asked the LPN if she had cleaned the glucometer. The LPN said she had cleaned it before using it on the resident, and she thought she had after using it. The surveyor asked the LPN again if she was going to clean the glucometer. The LPN stopped and wiped the contaminated glucometer with a germicidal wipe for less than five seconds with her bare hands.
According to the cleaning and disinfecting instructions, “healthcare professionals should wear gloves when cleaning the [glucometer]” and “wash hands after taking off gloves.” They also “suggest cleaning and disinfecting the meter” for five seconds between each patient use because “contact with blood presents a potential infection risk.” In addition, the nursing home’s own policy states that medical personnel should “clean and disinfect reusable equipment between uses according to the manufacturer’s instructions and current infection control standards of practice.” Cleaning equipment between uses ensures there is no cross-contamination between residents.
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Personal Protective Equipment (PPE) and Hand Washing
In a separate observation, a CNA assisted a resident with eating. The resident was to be in isolation due to ESBL (Eschericha coli, Extended Spectrum Betalactamase) and Pseudomonas, which means that anyone caring for her should wear full PPE. According to this citation, the CNA did not use the isolation kit placed outside the door containing gloves, gowns, and masks. He entered the room and assisted the resident with her meal while only wearing gloves. He then removed his gloves before removing the resident’s dinner tray and exiting the room. He washed his hands again after exiting.
The surveyor conducted an interview with this CNA. He said he was new, and the resident required total care assistance; she had a foley catheter and was on contact isolation for her urine. He claimed he was told he only needed to wear gloves to feed the resident, despite being on contact isolation. “They did tell me she was on isolation for her urine. Yes, you wear a gown if you’re providing care, but I was just feeding her. If I was turning her or emptying her catheter I would wear a gown.”
Another CNA was asked to check on a different resident in bed who was also on contact isolation. The surveyor asked the CNA to remove the blanket from the resident’s legs to confirm her feet were propped up on a pillow as ordered. The CNA put on full PPE as instructed, but wasn’t sure what kind of isolation the resident was on. This resulted in the CNA not performing proper hand hygiene after caring for the resident.
According to the CDC’s 2008 infection prevention guidelines, contact precautions are important to prevent the spread of infections that are “spread by direct contact with the patient or patient’s environment.” It is important that nursing home staff caring for isolated patients wear a gown and gloves during all interactions that may involve contact with the resident or their environment. Staff should put on PPE before entering the resident’s room, and discard it before leaving the room. It is crucial for nursing home staff members to follow established rules to protect residents from infections and diseases.
Eye Drop Administration
The final observation in this citation occurred when a LPN was administering artificial tears to a resident. The staff retrieved the bottle of artificial tears and some tissues from the medication cart. She entered the resident’s room and opened the bottle of eye drops without performing any hand hygiene or putting on gloves before handing the resident a tissue with her bare hands. She also placed the eye drops in the resident’s eyes with her bare hands. The LPN then washed her hands and returned the eye drops to the medication cart.
The hand washing/hygiene policy at this facilities reveals the following: “this facility considers hand hygiene the primary means to spread of infections.” All personnel should be trained in proper hand washing in order to protect residents and visitors from the spread of infection. It is imperative nursing home staff maintains proper hand hygiene since germs can spread quickly throughout a facility.
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