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Based on record review and interview, the facility's registered nurses failed to ensure patients were offered/ administered daily hygiene care which were documented in 2 of 10 sampled patients' clinical records reviewed. Patient #s 2 and 5
Findings:

Patient #2
Review of Patient #2's closed clinical record (History and Physical), dated 6/21/2017 revealed he was admitted to the facility on 6/21/2017 with history of: "The patient is a 36- year old male with past medical history significant for paraplegia and severe stage 1V sacral wound with sacral osteomyelitis."


Review of Patient # 2's daily hygiene assessment by direct care staff revealed the following entries:
07/17/ 2017 - blank
07/16/ 2017 - blank
07/15/ 2017 - blank
07/14/ 2017 - blank
07/13/ 2017 - S indicated self
07/12/ 2017 - blank
07/10/ 2017 - blank
07/7/ 2017 - C indicated Complete bed bath
07/6/ 2017 - indicated Complete bed bath
07/5/ 2017 - S indicated Self
07/2/ 2017 - blank
06/30/ 2017 - blank

The blank areas on the daily hygiene assessment record did not indicate if the Patient had a shower, complete bed bath or self administered bath.
There was no justification documented in the Patient's clinical record why the areas on the Patient's clinical record for daily Hygiene assessments were blank.

On 03/15/2018 at 3:12 p.m. the Facility's Chief Clinical Officer reviewed Patient #2's clinical record. She stated that it was not documented that the Patient received a bath or shower the days that there were blank spaces for daily hygiene assessment.


Patient #5
Review of Patient #5's daily hygiene assessment documentation, revealed on 03/10/2018 and 3/14/2018 they were blank. The sheets did not indicate if the patient was offered or had a shower, complete bed bath or self administered bath.

Interview on 03/15/2018 at 2:30 p.m. with Registered Nurse (C), revealed she was assigned to Patient #5 on 03/10/2018. The Surveyor reviewed the Patient's daily hygiene assessment sheet and nurses' notes with the Registered Nurse and notified the Registered nurse that there was no documentation that the Patient was offered of had a bath, shower.

Registered Nurse (C) stated "If it's not documented in my nurse's notes or on the space provided on the form it's not done."

On 03/15/ 2018 at 3:11 p.m. the facility's Chief Clinical Officer reviewed the Patient's record and said it was not documented that the Patient received a bath or shower.

Based on observation, interview and record review, the facility's licensed nurse failed to change gloves and wash/ sanitize hands when moving from dirty to clean, during wound care in 2 of 2 observations from 10 sampled patients. Patient #s 6 and 5

Findings:

Review of the facility's current Policy and Procedure on Infection Control and Prevention Manual; Policy # ICP. 03.03 direct facility's staff as follows:

"Hand Hygiene indication:
Hand washing with soap and water remains a sensible strategy for hand hygiene in non- healthcare setting and is recommended by Center of Disease Control (CDC) World Health Organization (WHO) and other experts.
Before and after patient contact
When hands are visible soiled, they should wash with soap and water.
If a patient has a diagnosis of C-Diff, hands should be washed with soap and water instead of waterless hand gel.
The use of gloves does not eliminate the need for hand hygiene. Likewise, the use of hand hygiene does not eliminate the use of gloves reduce hand contamination and protects patients and health care personnel from infection.
When moving from a contaminated patient body site to a clean patient body site. After contact with inanimate objects or medical equipment that comes in contact with the patient. "

Patient #6

On 03/15/2018 at 10:15 a.m. Licensed Vocational Nurse (A) was observed in room #309. The Licensed Vocational Nurse was providing wound care to Patient #6 who had two wounds to his legs bilaterally, covered with Hydrocolloid dressings and a PEG tube insertion site.

Observation revealed Licensed Vocational Nurse (A) donned two pairs of gloves, examined Patient #6's PEG tube insertion site which was inserted on 03/14/2018.
Observation of the site revealed it was encrusted with dried blood. After examining the Patient's PEG tube insertion site, Licensed Vocational Nurse (A) removed one of the two pairs of gloves she had donned and then proceeded to provide wound care to Patient#6's legs.

Licensed Vocational Nurse (A) removed the soiled hydrocolloid dressings from the Patients legs and placed the soiled dressing directly on the patient's bed linen.
The Licensed Vocational Nurse then examined both wounds and made a decision that the wound on the Patient's left leg had healed.

She then proceeded to apply clean dressing to the wound on the Patient's right leg using the contaminated gloves. She did not remove her gloves and wash/sanitize her contaminated gloves after removing the soiled dressings. She did not clean the wound bed after removing the soiled hydrocolloid dressings.

Review on 03/15/2018 of the Patient's clinical record, revealed a physician's progress note dated 3/14/2018 which documented the following:" Patient does have venous stasis dermatitis present and venous stasis ulceration present on the legs."

Patient #5

On 03/15/2018 at 10:35 a.m. Licensed Vocational Nurse (A) was observed in room #310. The Licensed Vocational Nurse was providing wound care to Patient #5 who had a sacral wound.
Observation revealed Licensed Vocational Nurse (A) donned two pairs of gloves outside the Patient's room. She did not wash/ sanitize her hands prior to applying the gloves.

On entering the Patient's room, the Licensed Vocational Nurse examined the Patient's buttocks. Observation revealed the Patient was lying on a disposable incontinent pad soiled with feces. Licensed Vocational Nurse (A) rolled back unto itself the soiled incontinent pad. She then walked over to the clean cupboard and secured a clean washcloth from linen stored in the patient's cupboard, using her contaminated gloved hands that she had used to roll back the feces soiled pad.

The Chief Clinical Officer who was present in the room instructed her to change her gloves. Observation revealed, Licensed Vocational Nurse (A) removed both pairs of contaminated gloves and then proceeded to secure clean gloves from a clean box of gloves stored in the room.
Licensed Vocational Nurse (A) did not wash/ sanitize her hands after removing her contaminated gloves.

Licensed Vocational Nurse (A) then provided incontinent care to the Patient which included cleaning feces from the Patient's buttocks. After cleaning the Patient's buttocks, Licensed Vocational Nurse (A) applied Zinc Oxide Cream to a stage 2, ulcer on the Patient's sacral area using the gloves she had used to clean the Patient's Buttocks.

Interview on 03/15/2018 at 10:50 a.m. with Licensed Vocational Nurse (A) in the presence of Facility's Chief Clinical Officer, the Surveyor notified her that she did not wash / sanitize her hands before and after removing gloves, and that she had placed soiled dressing with exudate directly on the patient's bed linen.
She stated "I thought I did."