Every finding on record at Nebraska Home Health - Opco, LLC

Home Nursing with Heart is in compliance with the requirements of 42 CFR 484.102 Condition of Participation for Home Health Agencies.

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, policy and procedure review, observation of the provision of cares, and staff interview, 2 of 7 staff (Skilled Nurse (SN)-H and SN-I) observed during the provision of cares to Patient 5 and Patient 6 respectively, failed to follow the agency's infection control policies and procedures to prevent the spread of potentially infectious organisms between patients and staff. The census 274. Findings are: A. Review of the agency policy and procedure titled Handwashing/Hand Hygiene D-330, no date indicated, revealed staff are to wash hands before contact with clients susceptible to infection, after caring for client, between tasks on the same client, before performing invasive procedures, after touching items that are potentially contaminated, after removing gloves, before and after handling dressings or touching open wounds, and after handling contaminated equipment. The policy also reveals staff are to dispose of paper towels in a waste receptacle. B. Review of the agency policy and procedure titled, Bag Technique, no date indicated, revealed staff are to wash hands before entering the bag. It also revealed staff are to dispose of barriers and all other disposable items. C. Review of the agency policy and procedure titled PICC Dressing Change, dated 6/09, revealed: 1. The nurse is to apply non-sterile gloves to remove the old dressing covering the PICC (peripherally inserted central catheter, a PICC line goes from a vein in the upper arm to a large vein in the chest). 2. The nurse is to apply sterile gloves to apply the new dressing covering the PICC line. 3. The policy does not instruct the nurse to complete hand hygiene between removing the old dressing and prior to applying sterile gloves. D. Review of Patient 5's clinical record revealed The Home Health Certification and Plan of Care, for the certification period of 5/2/23 through 6/30/23, included orders for Skilled Nurse (SN) 1 time a week for 2 weeks, then 1 time every other week for 4 weeks to assess and evaluate the patient's condition. E. During the observation of the provision of cares to Patient 5 on 5/9/23 at 11:00 AM, SN-H failed to dispose of used gloves, used paper towels, and a used barrier in a proper waste receptacle; instead, SN-H placed these used items in a pocket of the nurse's uniform. F. Review of Patient 6's clinical record revealed the Home Health Certification and Plan of Care, for the certification periods of 3/3/23 through 5/1/23 and 5/2/23 through 6/30/23, included orders for SN 1 time per week to assess right upper extremity PICC and provide site dressing/line care using sterile technique (a set of specific practices and procedures performed to make equipment and areas free from contamination from microorganisms). G. During the observation of the provision of PICC line dressing change to Patient 6 on 5/9/23 at 12:50 PM, SN-I was observed to utilize sterile gloves to remove the old dressing from the patient's PICC line, and failed to sanitize hands and apply a new pair of sterile gloves prior to cleaning the PICC line insertion site and applying a new sterile dressing to the PICC line. SN-I also failed to perform hand hygiene prior to entering the supply bag to retrieve a blood pressure cuff after touching the patient. H. During an interview on 5/10/23 at 11:15 AM, the Administrator confirmed SN-H and SN-I failed to follow the agency policy and procedures for hand hygiene, bag technique, and PICC line dressing change while providing cares to Patient 5 and 6 respectively.