Abundant Health Care Services

“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 record review, observation and interview, the Agency failed to follow written policies to control infections including how to keep infections and communicable disease from spreading, including the use of standard precautions to prevent the transmission of infections and communicable diseases for 1 (Patient #2) of 5 active Patient whose records were reviewed for infection control in that: 1. LVN A failed to follow aseptic technique (Aseptic technique is a procedure that healthcare providers use to prevent the spread of germs that cause infection.) while performing a blood glucometer check (A blood sugar test is a procedure that measures the amount of sugar, or glucose, in your blood.) 2. LVN A failed to minimize potential exposure of infections and bloodborne borne pathogens to, Patient #2, and other family members in the home setting during the use of the Glucometer during a Blood sugar Check. These deficient practices could place active Patients at risk of exposure and infection and inadequate care when infection control practices are not applied. The findings included: Record review of Agency policy titled, “Blood Collection”, with revised date noted 05/01/2006, quoted in part, “[All staff]” Performing a collection of Blood, will wear gloves…” Record review of Agency policy titled, “Infection Control Program”, with revised date noted 01/01/20025, quoted in part, “[Agency]” Infection Control program will be based in the Following Criteria: D. CDC guidelines updated annually … F. The Occupational Safety and Health Administration (OSHA) 29 CFR Part 1910.1030 and Appendix A relating to Blood borne Pathogens… C.3 Other policies to be followed by the staff to prevent, control, and improve Infections include but not limited to Hand Hygiene, Cleaning and Management of Supplies and Equipment and disposal of needles and sharps policy… Education, A. Employees Upon hire and annually thereafter all agency employees will be educated regarding the policies and procedures related to Infection control, Bloodborne /Airborne/ HIV Pathogen Program, Patient/ Patient care procedures for preventing and /or controlling infections and standard precautions. Record review of Agency policy titled, “Disposal of Needles and Sharps”, with revised date noted 05/01/20024, quoted in part, “[All Staff] providing patient care will be educated regarding the appropriate procedure for disposal of Needles/ sharps and will follow this procedure to ensure conformity with all federal/ state laws and regulations… Procedures I. Contaminated needles and syringes are not recapped or Broken,,, Individual Puncture- resistant biohazardous waste Containers will be provided for the Nurse and taken into the patients home…III. Needles and syringes used for injections; Blood Draws wound aspiration will be placed intact in the Needle waste container. The contaminated needle will be placed in the container immediately after use…” Record review of Agency policy titled, “Cleaning and Management of supplies and Equipment”, … Agency staff providing patient care will follow Agency procedure for the Cleaning and management of supplies and equipment according to the CDC guidelines, Federal/ state laws and regulations and appropriate manufacturers recommendations… The Agency will refer to the CDC guidelines for the disinfecting/ Cleaning of supplies and equipment. … Record review of Agency policy titled, “Safety Management”, with no revised date noted, quoted in part, “[Agency] will plan for a safe environment, addressing physical safety in the work place and the patient’s environment… (3) All personnel, patients, and caregivers will receive applicable safety instruction including, but not limited to…(g) safe use of medical equipment, (i) use of gloves… (k) safe disposal of needles in a puncture-resistant container…(l) infection control, (m) proper hand washing, (n) universal precautions…” Record review of Patient #2’s electronic medical record included a “Home Health Certification and Plan of Care” (POC) signed and dated 03/12/25 that documented a start of care date of 03/12/25 and a certification period of 03/12/25 through 05/10/25. Furthermore, the POC documented a principal diagnosis of Type 2 diabetes mellitus with diabetic polyneuropathy (high blood sugars with damage to nerves affecting the whole body). The POC documented the following orders for disciplines and treatment: · SN frequency: 1 time a week for 3 weeks, I visit per Month with 2 as needed Visits for falls and Diabetes Complications · SN to wash hands for 20 seconds using proper handwashing technique, disinfect equipment and don CDC recommended PPE. SN to perform Skilled head to toe assessment Q (every) visit using standard precautions. SN to use sterile supplies and aseptic technique when applicable including blood sugar checks Prior to leaving home. SN to disinfect all equipment prior to placing in nursing bag, remove all PPE, dispose of all waste per OSHA guidelines, and wash hands for 20 seconds using proper handwashing technique. · SN to obtain blood sugar level via fingerstick PRN signs/symptoms of hyperglycemia/hypoglycemia, (Hyperglycemia – Elevated Blood Sugar / Hypoglycemia Low Blood Sugar) per request or if not checked prior to SN visit. During a home visit to Patient #2 on 03/18/25 at 10:20 p.m., an observation was made of LVN A performing blood sugar level via fingerstick. Upon arrival to the home visit, LVN A and Surveyor entered into Patient #2’s Living room where Patient #2 was observed to be sitting in a clean home, well dressed, and sitting comfortably in a recliner. After introductions were briefly made, LVN A set up her field on a disposable pad in the adjacent living room sofa (LVN A did not wash her hands for 20 seconds using aseptic technique per ordered on POC and Agency policies prior to performing blood sugar check via Fingerstick). LVN A proceeded to sanitize her hands with an alcohol-based rub and gathered supplies to take patients Vital signs. She then put away supplies and asked Patient if she had Checked her Blood sugar for the morning, Patient#2 stated that she had not checked her blood sugar this morning. LVN A asked Patient for her Blood sugar monitor and patients Caregiver handed the patient the blood sugar monitor. Patient #2 opened the case, and LVN A helped in removing the lancet device (small medical tool used to make a tiny prick in the skin to collect a small blood sample for testing blood glucose levels.). LVN A took the small sample of blood with the glucometer and swabbed the remaining blood with the alcohol pad. After the glucometer analyzed the blood sample and beeped producing the random glucose reading of 158 mg/dL LVN A removed the used glucose testing strip and disposed of it in the nearby garbage. The lancet used during the home visit was not disposed of in a biohazard container. LVN A said her goodbyes and exited patient’s home. In an interview on 03/18/25 at 11:30 a.m., LVN A stated she did not wash or sanitize her hands because she was not the one checking the blood sugar; that the patient was the one who was checking her blood sugar. In an interview on 03/19/25 at 02:35 p.m., the Surveyor, Director OF Nurses and LVN A met in the conference room to discuss the procedure. LVN A Stated that she did not dispose of lancet and strip in the biohazard container. Director Of nurses stated that they follow the CDC guidelines and have their policy for disposal of sharps and instruct the patients of proper procedure for blood sugar checks, The Surveyor, asked DON and LVN A, was the Patient Taught on the proper procedure for blood sugar Checks with the Blood sugar Monitor and disposal of lancets and strips, they Both stated that yes teaching is always done at the initial visit and at all other visits and corrections are made when something is done incorrectly. The Surveyor asked LVN A why she had not corrected the patient at the time of visit. LVA A stated “I Don’t Know. I just did not realize it.” The DON stated the incident was an infection control and safety issue. The DON stated the Agency used CDC and OSHA guidelines for infection control. DON Stated that she used Lippincott (a leading international medical publisher of professional health information for practitioners, faculty, residents, students, and healthcare institutions as reference for education in training the nurses for Procedures.) The DON stated this was a potential exposure for risk infection and bloodborne pathogens. The DON stated it was her responsibility to in-service nurses and staff on infection control. The DON stated the Agency followed OSHA guidelines for infection control. The DON stated the incident was not appropriate and did not follow infection control measures by Agency. The DON stated the nurse should have washed or sanitized her hands prior to and after the visit per the orders on the plan care and Agency policies. The DON stated the potential negative effects of this was a risk of infection for staff and other patients. The DON stated the Agency and LVN A did not follow Agency policies regarding infection control and safety. The DON stated that according to the POC, LVN A should have followed aseptic technique and washed his hands for 20 seconds. The DON stated LVN A also failed to follow Agency policies regarding infection control and safety because of procedure that was used in regard to the Blood sugar Check by not disposing of the lancet used in the biohazard container. The DON stated it was her responsibility to ensure Agency policies regarding infection control and safety policies were implemented. The DON stated not implementing infection control or safety policies could negatively affect patients because staff could injure patients or cause infection. Review of LVN A’s personnel File revealed a nurse competency Check list dated 10/15/2020 with a score of 4 (4= Feel competent to orient others) Finger Stick Blood Glucose 3(3 = Feel Competent to perform without supervision). Performance Evaluation dated 10/18/2024 stated that LVN A Provides patient / Patient and caregiver education, provides care using infection control measures that protect staff and patient /Patient Participate in Agency – sponsored in-service training, all with a score of 4 (4= Meets and occasionally exceeds job requirement) The DON stated Agency staff get in-serviced at least once a year on infection control and safety precautions by the director of nurses. Last in-service was 01/03/2025 in which LVNA did Attend. Review of OSHA 29 CFR 1910.1030, titled Bloodborne pathogens, accessed 02/27/25, quoted in part, “Occupational Exposure means reasonably anticipated skin, eye mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties… Parenteral means piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions…Regulated waste…contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials… (d)(1) General. Universal precautions shall be observed to prevent contact with blood or other potentially infectious materials. Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials…(d)(2)(v) Employers shall ensure that employees wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment…(d)(2)(vi) Employers shall ensure that employees wash hand and any other skin with soap and water, or flush mucous membranes with water immediately or as soon as feasible following contact of such body areas with blood or other potentially infectious materials…. (2)(vii)(B) Such bending, recapping or needle removal must be accomplished through the use of a mechanical device or a one-handed technique… (d)3(ix) Gloves. Gloves shall be worn when it can be reasonably anticipated that the employee may have hand contact with blood, other potentially infectious materials, mucous membranes, and non-intact skin; when performing vascular access procedures except as specified in paragraph(d)(3)(ix)(D); and when handling or touching contaminated items or surfaces…. (d)(4)(iii) Regulated waste… (d)(4)(iii)(A)(1) Contaminated sharps shall be discarded immediately or as soon as feasible in containers that are… (d)(4)(iii)(A)(1)(i) Closable…(d)(4)(iii)(A)(1)(ii) Puncture resistant… (d)(4)(iii)(A)(1)(iii) Leakproof on sides and bottom; and… (d)(4)(iii)(A)(1)(iv) Labeled or color-coded in accordance with paragraph (g)(1)(i) of this standard.” Record review of Lippincott Advisor and Lippincott Procedures titled, “Sharps Disposal”, with a revised date 08/18/24, quoted in part, “Sharps are medical devices that have points or edges capable of puncturing or cutting the skin, such as needles, syringes, lancets, scalpels, broken glass, dental wires, and other devices…Injuries involving contaminated sharps are linked to transmission of various pathogens, including hepatitis B, hepatitis C, and human immunodeficiency virus. Proper handling and disposal of sharps can help prevent injury and transmission of pathogens to everyone in the health care environment…Perform hand hygiene…Handle all sharps carefully to avoid injury. Remember that gloves don’t provide protection from injury with a sharp object… Always keep sharps pointed away from yourself and others…Avoid recapping needles; if a safe needle device isn’t available and you must recap a needle, use a one-handed scoop recapping technique…” Record review of Lippincott Advisor and Lippincott Procedures titled, “Standard Precautions, home care”, with a revised date 08/18/24, quoted in part, The Centers for Disease Control and Prevention (CDC) developed standard precautions to protect against the transmission of infection. Standard precautions are a group of infection prevention practices based on the idea that all blood, body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes may be infectious. CDC officials recommend that health care workers assume that all patients, regardless of their diagnosis, are potentially infected or colonized (carrying an organism but not showing signs or symptoms of infection) with an organism that the patient may transmit to others. Standard precautions include hand hygiene, appropriate use of personal protective equipment (PPE), and proper handling of potentially contaminated items, including patient equipment, items in the environment, sharps, and specimens… Perform hand hygiene before and after patient care; before putting on and after removing gloves; before handling an invasive device; when moving from a contaminated body site to a clean body site; after contact with body fluids, excretions, mucous membranes, nonintact skin, or wound dressings (even if you wore gloves); and after contact with inanimate objects in the patient’s environment. If your hands aren’t visibly soiled, use an alcohol-based hand rub for routine hand hygiene. If they’re visibly soiled, wash them with soap and water and dry them with a paper towel… Change your gloves and perform hand hygiene if your gloves become damaged or heavily soiled and when moving from a contaminated to a clean site during patient care to avoid cross-contamination. Avoid touching your face, body, and other surfaces and items not needed for direct patient care with your gloved hands to reduce the risk of transmitting infectious organisms…Wear gloves if you may or will come into contact with blood, specimens, tissue, body fluids, secretions, excretions, mucous membranes, broken skin, or contaminated surfaces or objects… Handle used needles and other sharps carefully. Don’t bend, clip, recap, or otherwise manipulate them. Activate any safety mechanisms, such as a retraction feature on a syringe or lancet and a hinged or sliding shield on a needle, immediately after use… Discard the sharps immediately after use into a puncture-resistant sharps disposal container. Never force a sharp into a container or put your fingers into the container. Never place used sharps in regular household trash, recycling bins, or plastic biohazard bags… The agency did not dispute the survey findings and did not provide this surveyor with any additional requested documents upon exit.”