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Based on observation and interview it was determined the infection control officer failed to implement policies governing control of infections and communicable diseases. One (1) Registered Nurse (RN) was observed to give medications to three (3) patients without washing or sanitizing the hands between patient contact. Three (3) patient restrooms were found to be without paper towels or any other type of product to enable patients to dry their hands after using the toilet.

The findings include:

1. Observation on 01/05/10, at 4:00 PM revealed RN #1 administering medications to three (3) patients on the ISU (Intensive Services Unit). The nurse withdrew one tablet and a Nicoderm patch from the medication cart for the first patient, removed the tablet from its blister packaging, and carried the medications with a cup of water to the patient. The nurse donned plastic gloves to administer the patch, removed the gloves, handed the tablet in a pill cup and a cup of water to the patient, and took the cup from the patient after the patient took the pill. The nurse then returned to the medication cart, removed a capsule from the cart and from its packaging, and took the capsule with a cup of water to a second patient. The nurse attempted to check the patient's identification wrist band. The patient refused the medication and handed the nurse the wrist band which the nurse took and disposed of. Finally, the nurse removed four (4) medications from the medication cart and carried them to a third patient with a cup of water. The patient took the medications with the water and handed the cup back to the nurse. At no time did the nurse wash or sanitize the hands.

In an interview with RN #1 on 10/15/10, at 4:15 PM, the nurse stated he/she should have sanitized the hands during medication administration. The nurse said he/she did so on the unit the nurse regularly worked because there was hand sanitizer on the cart there. The nurse stated, "I was kind of neglectful".

Interview with the Infection Control Nurse for the hospital on 01/06/10, at 3:20 PM revealed the hospital did not have a specific policy regarding hand hygiene when administering medication, but nurses were expected to perform hand hygiene-washing or sanitizing- before and after patient contact. The nurse further stated hand sanitizing gel was to be available on all medication carts. The handwashing policy specified that staff were to wash hands before and after contact with a patient. If a nurse took a cup back from a patient, the nurse would be expected to wash the hands, according to the Infection Control nurse.

2. Observation of the ISU on 01/04/10 at 2:00 PM revealed the only restroom for patient use on the unit was without paper towels or means of drying the hands.

Interview with MHA (Mental Health Associate) #1 at 2:05 PM revealed the worker was not aware the dispenser was empty. The MHA added that he/she was responsible for refilling the dispenser and would do so if it was brought to his/her attention. Additionally, the MHA did not know how long the dispenser was empty or when it was last refilled.

Review of the facility's policy "General Hospital Policies, Section 7. Infection Control. F. Hospital-Wide Infection Control Plan Policy: The Hospital and appropriate Departments have detailed Infection Control Plans. Procedure: All employees will be aware of infection control policies and procedures. All employees will practice effective aseptic techniques and observe appropriate measure to avoid transmitting infections, including proper hand washing techniques."

3. Observation during a tour of the Wendell Four Unit on 01/04/10, at 1:30 PM revealed two (2) patient bathrooms were without paper towels or means of drying the patients hands. Each bathroom was equipped with two (2) paper towel dispensers and all dispensers were empty.

Interview with the Wendell Four Unit Nurse Manager on 01/04/10, at 1:30 PM revealed staff had removed the paper towels from the dispensers. The Nurse Manager stated patients used the paper towels to clog the commodes. The Nurse Manager gave no explanation how patients would dry their hands before exiting the bathroom.