Every finding on record at Blessings Hospice LLC

Based on observation, interview, and record review the agency failed to follow written policies regarding infection control and preventing the spread of infections for 3 (#7, #8, & #9) of 4 patients observed on home visits. The failure could result in the spread of infections. --- Findings: Record review of patient #7s medical record indicated the client was a 71-year-old male, recertified to hospice services effective 2/16/23 with a terminal diagnosis of Atherosclerotic heart disease (narrowing of the heart blood vessels). During an observation on 8/21/23 at 9:00 a.m. of a home visit RN 1 sanitized gloved hands with hand sanitizer after gathering supplies. RN 1 then removed the dressing to the left forearm and cleaned the wound with wound cleanser and covered the area with a non-adherent dressing and wrapped the arm with a gauze dressing and secured it with paper tape. RN 1 then removed the dressing to the left middle finger and steri-strips (tape like fasteners) were removed. RN 1 sanitized gloved hands with hand sanitizer and removed supplies from the cabinet. RN 1 then cleaned the wound and applied new steri-strips and applied a small dressing. RN 1 then removed the gloves and applied hand sanitizer. Record review of patient #8s medical record indicated the client was a 98-year-old female, recertified to hospice services effective 3/4/2023 with a terminal diagnosis of severe protein-calorie malnutrition (inadequate intake of protein calories). During an observation on 8/21/23 at 10:00 a.m. of a home visit, RN 1 sanitized her hands and donned gloves. After the assessment of the client, RN 1 applied hand sanitizer to gloved hands and then cleaned the equipment and again applied hand sanitizer to gloved hands. RN 1 removed the dressing to the right lower leg and cleansed the wounds. RN 1 removed the gloves and obtained gauze wrap dressing from supplies. RN 1 applied hand sanitizer then donned gloves. Xeroform gauze (type of Vaseline type gauze dressing) was applied and covered with a gauze wrap and secured with paper tape. RN 1 then removed the gloves and applied hand sanitizer. Record review of patient #9s medical record indicated the client was an 84-year-old female, recertified to hospice services effective 3/29/2023 with a terminal diagnosis of Chronic Obstructive Pulmonary Disease (inability to breathe properly). During an observation 8/21/2023 at 11:05 a.m. of a home visit, RN 1 cleaned gloved hands with hand sanitizer prior to cleaning up the area and equipment used during the visit. During an interview 8/22/2023 about 1:40 p.m. the administrator stated, ";our check off states you can use hand sanitizer on gloves. The expectation when going from one wound to another or dirty to clean etc. use hand sanitizer on the glove in between. If gloves are visibly soiled remove them and wash hands. We use Lippincott for procedures. I will print a copy of what we use." Administrator brought a copy of pages from Lippincott procedure manual pages 370 to 372 regarding hand hygiene. During an interview 8/23/2023 about 11:17 a.m. the administrator was asked if there was a specific policy regarding wound care or that the agency followed the Lippincott procedures. The administrator stated, ";let me investigate that." About11:55 a.m. the Administrator produced the Standard Operating Procedure: Nursing Procedures established January 1, 2023. During an interview 8/23/2023 about11:50 a.m. RN 1 stated, ";instead of changing gloves," when asked why they used hand sanitizer with gloves. RN 1 stated, ";basically when I was hired my trainer and the Administrator told me to use hand sanitizer as hand hygiene even with gloves." On 8/23/2023 about 12:20p.m. the administrator returned with policy IC.15 and stated, ";this is what we use but I cant find where it specifically states to use hand sanitizer and gloves together." The agency had a Standard Operating Procedure: Nursing Procedures established January1, 2023. It read in parts: ";...Purpose to establish the process by which clinicians follow guidelines for nursing procedures. ...Procedure: Refer to the following: Lippincott Nursing Procedures. Lippincott Williams & Wilkins. 2023. Ninth Edition..." Lippincott Nursing Procedures. Lippincott Williams & Wilkins. 2023. Ninth Edition; page 372 states, ";...Special considerations: ...If your hands arent visibly soiled, you can use an alcohol-based hand rub for routine decontamination. ...Keep in mind that glove use doesnt eliminate the need for hand hygiene..." The agency had a policy (IC.2a) titled, ";Infection Control Program Addendum Infectious Disease Pandemic" dated 7/1/20. The policy read in parts, ";...Purpose: To provide guidance on protecting patients and staff during an outbreak of an infectious disease. Policy: I. The agency will stay abreast of current information and practice guidelines provided by local, state, and federal agencies related to any infectious outbreak, pandemic, or epidemic... IV. The agency will provide appropriate education to their staff on disease specific infection control measures, including hand hygiene, appropriate use of personal protective equipment (PPE), standard precautions, and transmission-based precautions to prevent the spread of infection..." The agency had a policy (IC.3) titled, ";Hand Hygiene" dated 4/1/17. The policy read in parts, ";...Purpose: To ensure patient/ client care staff practice proper hand hygiene techniques and nail care to aid in the prevention and spread of infection per CDC guidelines. ...Policy: I. All agency staff providing patient/ client care will observe proper hand hygiene techniques: A. When hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, staff will wash hands with either a non-antimicrobial soap and water or an antimicrobial soap and water... III. If hands are not visibly soiled, staff may use an alcohol-based hand rub for routinely decontaminating hands in all other clinical situations described below. Alternately, staff may wash hands with an antimicrobial soap and water in all clinical situations described below: A. Decontaminate hands prior to entry into supply bag; B. Decontaminate hands before having direct contact with patients/ clients; C. Decontaminate hands before and after performing any invasive procedure such as inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure, or before or after wound care; D. Decontaminate hands after contact with a patients/ clients intact skin (e.g. when taking a pulse or blood pressure, and lifting a patient) even when gloves are worn; E. Decontaminate hands after contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings if hands are not visibly soiled; ...H. Decontaminate hands after removing gloves; ...Procedure:...II. Hand hygiene with an alcohol-based hand rub: A. Apply product to palm of one hand B. Rub hands together covering all services of hands and fingers, until hands are dry C. Follow the manufacturers recommendations regarding the volume of product to use..." Further review of the policy revealed no documented evidence that hand hygiene can be done with gloved hands. The agency had a policy (IC.15) titled, ";Hand Hygiene" dated 12/15/22. The policy read in parts: ";...Purpose: To ensure patient care staff practice proper hand hygiene techniques in the prevention and spread of infection per CDC guidelines. ...Policy: All hospice staff providing patient care will perform hand hygiene in accordance with Centers for Disease Control and Prevention (CDC) recommendations. ...Procedure: ...II. Hand hygiene with an alcohol-based hand rub: A. Staff will apply product to palm of one hand B. Staff will rub hands together covering all services of hands and fingers, until hands are dry. This should take around 20 seconds. ...D. Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water in most clinical situations due to evidence of better compliance compared to soap and water. Staff may use an alcohol-based hand rub for routinely decontaminating hands in the clinical situations described below: ...4. After contact with body fluids or secretions, mucous membranes, nonintact skin, and wound dressings and used supplies (PPE) if hands are not visibly soiled. ...8. After removing gloves..." Further review of the policy revealed no documented evidence that hand hygiene can be done with gloved hands. According to a CDC publication titled Hand Hygiene Guidance, accessed on 8/24/23 at https://www.cdc.gov/handhygiene/providers/guideline.html, indicated staff should always clean hands immediately before touching a patient, after touching a patient or the patients immediate environment, after contact with blood, body fluids, or contaminated surfaces and immediately after glove removal. ... Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water in most clinical situations due to evidence of better compliance compared to soap and water. Hand rubs are generally less irritating to hands and, in the absence of a sink, are an effective method of cleaning hands."