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Based on observation, interview and record review the facility's direct care staff failed to wash/ sanitized hands and wear gloves while handling potentially contaminated equipment in 3 of 6 sampled staff observed. Staff C, D and Contract Registered Nurse ( M)


Findings:

Registered Nurse (C)
On 08/09/2017 at 9:51 a.m. Registered Nurse (C) was observed in room 524 at the bedside of Patient #3.

The Registered Nurse was administering oral and intravenous medication to Patient #3 using a common medication cart which she pushed into the Patient's room.
After preparing and administering intravenous medication via Patient #3's right double lumen intra jugular central venous catheter, Registered Nurse (C) examined and touched the Patient's Jackson Pratt drain attached to Patient #3's right stump. The drain bag contained bloody drainage.
After touching and examining the Jackson Pratt drain bag, Registered Nurse (C) then proceeded to the clean medication cart with her contaminated gloved hands, picked up medication wrappers and touched other items on top of the cart with her contaminated gloved hands. She then removed her contaminated gloves and then proceeded to push the cart from the room without washing/ sanitizing her contaminated hands.

Registered Nurse (C) did not remove her contaminated gloves and wash/ sanitize her contaminated hands after providing direct care to patient prior to touch the common medication cart.

On 08/09/2017 at 9:58 a.m. the Surveyor notified Registered Nurse (C) of her observation of she the nurse having direct contact with the Patient, the Patient's central venous catheter and wound drain bag and that she did not remove her contaminated gloves and sanitized her contaminated hands before touching the common medication cart which held other patients' medications.
Registered Nurse (C) stated "You are correct"


Registered Nurse (D)

Interview on 08/09/2017 at 8:55 a.m. with Unit Charge Nurse (B) revealed Patient # 4 was admitted to the facility with a wound to her left lower leg with a diagnosis of cellulitis left lower extremity on antibiotic of Zithromax and Rocephin.

Interview with Patient #4 on 08/09/2017 at 11:50 a.m. revealed the doctor had seen her and told her that he was stopping her antibiotic because she was having diarrhea.

On 08/09/2017 at 12:07 P.M Registered Nurse (D) was observed in room 509 at the bedside of Patient #4. Registered Nurse (D) was observed applying treatment/dressing to Patient # 4's left leg which had a scabbed over wound.

Observation revealed Registered Nurse (D) pushed the common medication cart into the Patient's room and set up for the wound care treatment. She donned a pair of clean gloves, and cleaned the Patient's left leg with a 4x4 swab soaked with Normal Saline.
After cleaning the Patient's wound, the nurse removed her contaminated gloves, picked up a clean pair of clean gloves from the boxes of gloves stored on the wall in the patient's room, then walked over to the common medication cart and picked up a roll of gauze with her contaminated hands. Registered Nurse (D) interchanged touching the Patient's wound and touching the common medication cart with her contaminated gloved hands while doing the dressing on the Patient's leg.

After completing the dressing to the Patient's wound, Registered Nurse (D) pushed the contaminated cart from the Patient's room into another Patient's room. She did not clean/ disinfect the contaminated cart.
The medication cart contains medications for several patients housed on the unit.

During an interview on 08/09/2017 at 12:10 p.m. with Registered Nurse (D) the Surveyor informed Registered Nurse (D) that she the Surveyor had observed that she the Registered Nurse did not wash her hands after removing her contaminated gloves and that she had used her contaminated hands to remove clean gloves from the box of gloves on the wall.
The Surveyor also informed her that she had moved from cleaning the Patient's wound to the medication cart and back to the Patient. The common cart was not cleaned or disinfected after it was contaminated.

Registered Nurse (D) stated "I am sorry."


Contract Registered Nurse (M)
On 08/09/2017 at 8:30 a.m a.m Contract Registered Nurse (M) was observed in the unit's hemodialysis suite located on the 500 unit of the facility.
The Registered Nurse was observed setting up clean blood lines and priming the blood lines. The Registered Nurse was not wearing personal protective device. The Registered Nurse was handling bicarbonate and other dialysate solution.

Subsequent observation on 08/09/2017 at 11:45 a.m revealed Contract registered Nurse (M) was observed dialyzing Patient (#11) in the hemodialysis suite. Contract Registered Nurse (M) was observed touching the Patient's contaminated hemodialysis machine. Contract Registered Nurse (M) was not wearing personal protective equipment and was not observed washing or sanitizing her hands after direct contact with the potentially contaminated equipment.
Located in the suite was another hemodialysis machine which was cleaned and sanitized for another patient usage. The telephone that is used by staff was anchored to the side of the hemodialysis machine.

On 08/09/2017 at 11:50 a.m the Surveyor notified Contract Registered Nurse (M) of the observation of her not wearing personal protective device while touching potentially contaminated equipment.
She stated " I put it on when I am initiating treatment and terminating treatment."


Review of the Facility's current Policy and Procedure on Infection Control, Policy # IC revised 6/2017 directs staff as follows: Specific indications for handwashing Before patient contact and after contact with Patient's skin, Before donning gloves and after removing gloves, after contact with objects ( including equipment) located in the Patient care area."