Home Health of Randolph Hospital

“Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This Standard is not met as evidenced by: Based on agency policy, direct observation, and staff interviews, the skilled nurse failed to perform proper hand hygiene and infection control practices when completing wound care for 2 of 2 patients with home visits who required wound care (#6 and #9). Findings included: 2. Patient # 9 had a Start of Care date of 3/4/25 with an admitting diagnosis of type 2 diabetes mellitus with foot ulcer. Review of the Plan of Care [POC] for the certification period 5/3/25-7/1/25 included orders for SN [skilled nursing] 2 times a week for 8 weeks, 1 time a week for 1 week and “SN or patient/caregiver to perform wound care daily to bi [bilateral] feet, clean with dermal cleanser, pat dry, apply nick thick santyl to wound bed, cover with maxorb AG, paint periwound with betadine, cover with foam dressing...” On 5/27/25 at approximately 9 am a joint visit was made with RN # 5. During the visit wound care was performed by RN # 5. RN # 5 removed the soiled dressings from the top of each foot. The areas were cleaned in accordance with the plan of care. RN # 5 applied santyl to the wound bed on each foot using the same cotton tipped swab. The RN was then noted to use the same betadine swab to paint around the periwound on the top of each foot. During an interview with employee # 2 on 5/21/25 at approximately 11:30 am, employee # 2 confirmed RN # 5 failed to complete proper wound care by cross contamination of the wounds. Policy HH IC-006 Bag Technique (reviewed 5/21/25), received on 5/29/2025 at 10:25 am from the agency director stated: “Staff will practice proper bag technique procedures while providing care in the home…to establish guidelines for use/care of visiting staff’s supply bag to decrease the potential for cross-contamination…all equipment will be cleaned prior to returning it to the bag”. Policy Aseptic Wound care (reviewed 5/21/25), received on 5/29/2025 at 10:24 am from the agency director stated: “To provide standard of practice for aseptic (aim to prevent contamination) wound care in order to promote healing and prevent wound infection…all wound care will be performed using aseptic technique and standard precautions will be observed…assemble the following equipment on a clean work surface…clean gauze…perform hand hygiene and don (put on) non-sterile gloves…remove soiled dressing…doff (take off) gloves and place in plastic bag…perform hand hygiene and don non-sterile gloves…perform wound care…perform hand hygiene.” Policy OW-IP-001 Hand Hygiene (reviewed 3/5/2024), received on 5/29/2025 at 10:24 from the agency director stated: “…perform proper hand hygiene techniques at the appropriate times and indications…to protect…from potential disease-causing microorganisms…5 moments of hand hygiene: before patient contact, before clean/aseptic procedure, after body fluid exposure risk, after touching a patient, after touching patient surroundings”. The policy also stated “glove use is not a substitute for hand hygiene, clean hands prior to putting on gloves, wear gloves when contact with blood or other infectious materials, mucous membranes or non-intact skin could occur, change gloves during patient care if moving from a contaminated body site to a clean body site, clean hands after taking off gloves and before putting on new gloves, clean hands after removing gloves”. 1.Patient #6 was admitted on 05/02/2025 with a primary diagnosis of varicose veins (bulging, enlarged veins) of left lower extremity with ulcers (persistent sores, usually caused by poor blood circulation) on other part of lower leg. Review of the Plan of Care for the certification period of 5/2/25-5/27/25 included orders for SN (skilled nursing) 1 time a day for 1 day, 2 times a week for 8 weeks and “Skilled nurse to perform wound care to left lower leg, right lower leg: cleanse wound with wound cleaner, apply medihoney, xeroform, and alginate, wrap with kerlix and secure with coban. Change twice weekly”. A joint home visit was conducted with RN #1 on 5/27/2025 at approximately 1:15 pm. RN #1 cleaned her hands with hand sanitizer and applied clean gloves. RN #1 then removed saturated wound dressings from patient #6’s right leg using bandage scissors. RN #1 dropped the bandage scissors onto patient’s floor and then picked them up and put them on patient’s chair without a barrier. RN #1 then removed saturated wound dressings from patient #6’s left leg using a different pair of scissors. After using all the gauze pads she had on the barrier, RN #1 was observed reaching gloved hand into bulk 4x4 gauze pack while cleaning left leg. The only hand hygiene RN#1completed was prior to moving from right leg wound to left leg wound. Hand hygiene was not performed until the dressing change to the left leg was completed. RN #_ was observed picking up scissors that were used to cut saturated dressings off right leg and putting them back in nursing bag without cleaning them. An interview was conducted on 5/29/2025 at approximately 12:20 pm with the agency director and the clinical manager present. The director and clinical manager were asked what their expectations were in this situation and they confirmed that RN #1 should have performed hand hygiene and changed gloves after removing dressings from left leg, before wrapping leg with clean bandages, and before reaching into multi-use bulk gauze package. They also confirmed that nurse #1 should have cleaned bandage scissors prior to putting back in her travel bag.”