Homefirst of Middle Tennessee, LLC

“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 policy review, observation, and interview, the agency failed to perform appropriate hand hygiene by 3 of 7 (Licensed Practical Nurses (LPN) #1, #2 and Registered Nurse (RN) #1) staff observed during home visits. The findings included: 1. Review of the agency’s “Hand Hygiene,” policy dated 7/2021, revealed, “…To prevent transfer of germs and transmission of infections to patients…The agency will follow the Centers for Disease Control and Prevention (CDC) guidelines for hand hygiene… After removing gloves…” 2. Review of the medical record revealed Patient #1 was admitted with a start of care date of 12/6/2023 with diagnoses of Stage 4 Sacral Pressure Ulcer, Obesity, Colostomy and Acquired Absence of Left Leg Below Knee. Review of the “Home Health Certification and Plan of Care,” dated 5/29/2025 to 7/27/2025, revealed “…CLEANSE WOUND WITH NORMAL SALINE…APPLY MOISTENED PRISMA [dressing to help create a moist wound bed] TO WOUND…COVER WITH AVANT [non-woven] GAUSE…COVER WITH BORDERED FOAM [dressing with a non-adherent pad in the center surrounded by a flexible adhesive border to secure the dressing in place]…DRESSING…” Observations in Patient #1’s home on 7/7/2025 at 1:15 PM, revealed LPN #1 performed a dressing change to Patient #1’s sacrum. LPN #1 failed to perform hand hygiene1 time between glove change after the removal of the soiled dressing and the application of new dressing. During an interview on 7/7/2025 at 1:25 PM, the Director of Nursing (DON) confirmed LPN #1 was supposed to perform hand hygiene between each glove change. 3. Review of the medical record revealed Patient #5 was admitted with a start of care date of 5/6/2025 with diagnoses of Surgical Aftercare Following Surgery on the Circulatory System, Peripheral Vascular Disease, Essential Hypertension, Long Term Use of Aspirin, Long Term Use of Antithrombotics/Antiplatelets and History of Falling. Review of the physician order dated 7/5/2025, revealed, “…SKILLED NURSE TO PERFORM/[and]TEACH INCISION CARE TO L [left] CALF - cleanse with wound cleanser, apply hydrogel [water-based substance with a soft consistency and moisturizing properties] with SORBACT [dressing that binds and removes bacteria] to wound bed, cover with ABD [type of sterile, highly absorbent dressing] using clean technique. Change dressing twice weekly and PRN [as needed]...” Observations in Patient #5’s home on 7/8/2025 at 8:25 AM, revealed LPN #2 performed a dressing change to Patient #5’s left calf. LPN #2 failed to perform hand hygiene 2 times between glove changes during the removal of the soiled dressing and the cleaning of the wound and failed to perform hand hygiene 1 time between glove changes during the application of the new dressing. During an interview on 7/8/2025 at 8:55 AM, the DON confirmed staff were to perform hand hygiene between glove changes. 4. Review of the medical record revealed Patient #6 was admitted with a start of care date of 11/13/2024 with diagnoses of Diabetes Mellitus with Foot Ulcer, Chronic Obstructive Pulmonary, Atherosclerotic Heart Disease, Hypertensive Heart and Chronic Kidney Disease. Review of the physician order dated 7/3/2025, revealed, “…SN [Skilled Nurse] to perform weekly dressing change to RIGHT UPPER ARM/PICC [Peripherally Inserted Central Catheter] LINE using sterile technique...” Observations in Patient #6’s home on 7/8/2025 at 9:45 AM, revealed RN #1 performed a sterile dressing change to Patient #6’s PICC line. RN #1 failed to perform hand hygiene 1 time between glove changes during the removal of the soiled dressing and failed to perform hand hygiene 1 time between glove changes during the application of the sterile dressing. During an interview on 7/8/2025 at 10:20 AM, the DON confirmed staff were to perform hand hygiene between glove changes.”