Articles Posted in Infection

Brooklyn nursing home Keser Nursing and Rehabilitation Center received deficient ratings in ten standard health inspection categories during a March, 2014 inspection conducted by the New York State Department of Health. Among the deficiencies reported by the DOH were failure to establish an infection control program, failure to inform of accidents and/or significant changes in resident status, and failure to ensure that a resident’s nutritional status remains unchanged unless unavoidable.

A nursing home must establish and maintain an infection control program to minimize and help prevent the spread of infection. During its inspection of Keser, the DOH encountered several situations for which it cited the facility. First, a resident’s nasal tubing was not properly secured behind his ears, but rather allowed to hang in such a way that it was touching the floor. Inspectors also noted several instances in which garbage pails and trash bins were left uncovered in common eating areas, subjecting eating residents to a potential spread of infection from the refuse.

scale4.jpgThe remaining two deficiencies referenced above involve a single resident, a sixty year old male with multiple underlying conditions including diabetes, hypertension, and epilepsy. Per the report, the resident also displayed “severely impaired cognitive skills for daily decision making.” During routine weight checks, it was noted that the man had lost eighteen pounds, nearly eleven percent of his total body weight, in the several months prior to late October, 2013. The dietary note for this resident also documented conflicting information, at one time stating that the patient’s appetite was “fair to good,” yet at another stating that he was eating less than 75% of his meals. Despite this weight loss and the differing information in the notes, no new interventions were ordered for the resident. The physician’s notes from the relevant time period list the resident’s weight as steady at 170 pounds, again in conflict with the weight records. During an interview with the Department of Health regarding this patient, the current physician informed investigators that the doctor who had written the notes for August, September, and October 2013 was no longer employed by the nursing home.

Saints Joachim & Anne Nursing and Rehabilitation Center, a nursing home located in Brooklyn, NY, was cited in an October, 2013 certification survey issued by the Department of Health. Among the several deficiencies noted by the DOH was a failure to establish an infection control program at the facility.

hospital corridor.jpgA nursing home must ensure that it investigates, controls, and prevents infections within the facility. This includes proper disposal of bedclothes and linens of infected individuals when the situation warrants. During this investigation by the DOH, it found an individual who had been admitted to the rehabilitation center with numerous diagnoses, one of which was Possible Scabies. Although one of the most common ways to spread scabies is through used personal items, such as bedding or towels, the facility failed to properly place a “red bin” inside the resident’s room in order to properly monitor potentially infectious materials. The nursing home also failed to isolate the resident’s supplies from those of other inhabitants of the home.

Individual treatment of the possibly infected resident also deviated from the facility’s own procedures and protocols. Per a Registered Nurse at the nursing home, when treating an individual for a possible outbreak of scabies, contact precautions are to be taken, including wearing gloves and a protective gown at all times. Additionally, a sign should be posted outside the resident’s room as a warning that the resident is potentially infested. Although it appears from the report that gloves were worn while administering treatment, at least on Certified Nursing Assistant did not wear a gown while in close contact with the individual.

The New York State Department of Health (DOH) cited the East Neck Nursing & Rehabilitation Center, a 300-bed facility located in West Babylon, New York, for failing to respect patients’ dignity by not providing timely and adequate incontinence care. According to a DOH report issued in April 2013, the nursing home failed to “promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity.” In one instance, a resident diagnosed with bipolar disorder repeatedly asked a certified nursing assistant (CNA) to change her incontinence brief. However, the CNA ignored the patient’s requests for care, and the patient urinated in her bed. Staff members had to change the resident’s soiled clothes and linens as a result of her lack of care.

In another case, a resident’s care plan stated that he needed assistance while using the toilet to prevent him from falling. On the night of April 8, 2013, the resident asked a CNA if she could help him to use the bathroom. The CNA stated that she would be back in a few minutes to assist him. After repeatedly asking for help for over an hour, the resident stated that the CNA told him to “just wet the bed.” The patient was incontinent in bed due to the CNA’s neglect. As a result of the incident, the resident’s linens, clothes and wound dressing covering a bedsore were soaked with urine. When staff members finally came to clean him and change his bed, they simply threw the dirty linens in the corner of his room.

syringe1.jpgDuring the same certification survey, the DOH also cited the Long Island nursing home for not preventing “the development and transmission of disease and infection.” On April 12, 2013, a DOH inspector observed a licensed practical nurse (LPN) administer a blood glucose test to a diabetic patient. The patient had recently been diagnosed with a contagious infection, and a physician ordered that staff members follow certain contact precautions when entering the patient’s room. However, after administer the glucose test, the LPN failed to change her gloves or wash her hands and began touching items on the medication cart. The same LPN also failed to sterilize the top of a vial with an alcohol wipe before she inserted a syringe into it. When questioned about these two incidents, the LPN told a DOH inspector that she “forgot” to follow infection precautions because she was “nervous” about being observed.

According to a June 2013 report issued by the New York State Department of Health (DOH), the Saratoga Hospital Nursing Home, a 36-bed facility located in Saratoga Springs, New York, failed to maintain a safe, clean and homelike environment for its residents. In particular, DOH inspectors stated that the shower room used by many residents was dirty and not properly maintained. For instance, inspectors noted that mold was on the shower tiles and floor. A metal shelf, the shower door, and a grab bar had peeling paint and were rusty; a ceiling tile was also missing. In addition, inspectors noticed that an air vent was covered with plastic wrap and cut tape, preventing the air in the shower room from being properly circulated. The maintenance director and an administrator of the facility stated that they were unaware of the shower room’s condition. The nursing home fixed the room in July 2013 as a result of the DOH inspection.

During the same certification survey, the DOH also cited the nursing home for failing to “maintain practices that provide a safe, sanitary and comfortable environment to help prevent the development and transmission of disease and infection.” For example, while talking to the nurse in charge of the facility’s infection control program, a DOH inspector observed a maintenance worker wheeling a large uncovered trash bin filled with garbage through the hallway; the infection control nurse stated that the trash bin should have been covered. When questioned by a DOH inspector, the worker wheeling the bin stated that he usually covers it but that he was “behind” that particular day and was in a rush.

hospital lady.jpgIn another related finding, a DOH surveyor determined that the facility failed to provide staff members and visitors with detailed instructions pertaining to patients who had Contact/Isolation Precautions due to sickness and infections. There were four such residents in the facility. Signs outside the doors of two of these patients instructed visitors to wear a mask, gloves and a gown. Two different residents with such precautions did not have detailed instructions outside of their rooms. The infection control nurse stated that she was not aware of this matter and needed to look into the issue.

Two certified nursing assistants (CNAs) at the Barnwell Nursing and Rehabilitation Center, a 228-bed facility located in Valatie, New York, were caught on camera taunting and abusing an elderly dementia patient in August 2013. According to a New York State Department of Health investigation report, the two CNAs kicked, hit and yanked at dolls that the dementia patient carried; he believed that the dolls were his grandchildren. The video shows the elderly resident becoming visibly upset and starts kicking at one of the CNAs, who then runs into a closet while laughing. The resident then began kicking at the closet door.

After conducting an internal investigation when the resident’s son complained about the incident, the facility concluded that the CNAs failed to “maintain an environment that protects the resident from abuse, neglect or mistreatment.” While the incident occurred on August 19, 2013, the facility didn’t notify the DOH or the police until a week later. Moreover, even though the facility terminated both of the employees over the incident, one of the CNAs continued to work at the nursing home as a private aide. As a result, a high-functioning resident reported that she saw the CNA taunt the dementia patient again by “hitting and throwing” his dolls. An administrator told investigators that she had instructed her staff not to allow the CNA back into the building. Moreover, DOH investigators revealed that the dementia patient was never assessed by staff members for physical or psychological harm after being taunted.

In another instance, a CNA threw a bedpan at a resident twice. On August 24, 2013, a CNA was helping a resident who suffered from spinal stenosis go to the bathroom in a bedpan. After the CNA adjusted the resident’s body, the resident became upset and threatened to throw the bedpan at the CNA. After the CNA said, “go ahead, I dare you,” the resident picked up the bedpan and threw it at the staff member, who then threw the bedpan back at the resident. The resident then tossed the bedpan back at the CNA, who threw the bedpan at the resident for a second time. The CNA then walked out of the room. The facility reported the incident to the DOH three days later.

During a certification survey performed by the Department of Health in March of this year, Cobble Hill Health Center, a Brooklyn nursing home, received deficient ratings in several areas of care. Among these areas was a failure to properly establish an infection control program, in violation of federal regulation.

The violation documented by the DOH at Cobble Hill involves the treatment and cleansing of an elderly resident’s pressure ulcers. The resident was suffering from two pressure ulcers at the time of the incident: a Stage II wound of the right knee, and a Stage IV sore of the left ankle. The policy for cleaning pressure ulcers in place at Cobble Hill is very specific, as noted in the DOH report. It provides a step by step process, including when and how the staff member must wash his or her hands and change sterile gloves during treatment. During this particular wound cleansing, the nurse failed to follow this procedure. While treating the two wounds, the nurse failed to follow the procedures in place both for washing her hands and for changing her gloves. She also failed to provide a sterile area on which to rest the wounds while in the process of cleansing them.

As has been noted numerous times in the past here, the the development of pressure ulcers for an elderly nursing home resident is extremely painful and potentially deadly. Proper treatment of these wounds is essential to heal them as quickly as possible, and prevent possible infections from developing. In an interview with the Department of Health after this survey, the nurse acknowledged that she failed to follow protocol. She also relayed to the DOH that she would request further instruction regarding tending for these types of wounds. Fortunately her breach of protocol did not lead to any further harm for the resident. Perhaps this incident will lead to a more stringent application of the facility’s policies and procedures moving forward.

Park Nursing Home, located in Rockaway Park, Queens, was found deficient in a total of twenty-one separate areas in a Department of Certification Survey dated April 12, 2012. Divided into two separate categories, the deficiencies were for both the standard health inspection and the life safety code inspection.

Among the health categories for which the facility was found deficient were:

  • Activity Program to Meet Individual Needs;

n an August Certification Survey, the Department of Health cited Komanoff Center for Geriatric and Rehab Medicine for multiple deficiencies. Komanoff, a Nassau County nursing home located in Long Beach, received a deficient score for failing to establish an infection control program.

pill.jpgA facility must establish infection control program in order to help prevent the transmission and spread of disease and infection. The DOH noted two incidents in its report relating to this deficiency. First, an LPN was noted to break a resident’s pill in half without wearing gloves. The LPN had cleansed his hands with gel before beginning his treatment of the resident, however the DOH report states that he should have both washed his hands and put on gloves before handling the patient’s medication. In the second incident, an LPN failed to wash her hands and put on clean gloves after administering medications via a gastrostomy tube but before giving a resident eye drops. In the course of then dispensing the eye drops, the LPN’s uncleansed gloved hand to contact the area near the resident’s eye.

Although the LPN’s in both of the above instances corrected their mistakes while with the patient, carelessness such as the type demonstrated in these incidents can have serious consequences. Moreover, at first glance, these mistakes may not seem alarming. However, the failure to properly cleanse one’s hands can spread infection in the patient. It can also spread infection among other residents. It should be noted that both patients above had Hepatitis C. Vigilant attention must be paid on the part of the the nursing staff in order to avoid spreading such a disease to other residents throughout the home.

Rutland Nursing Home, located in Brooklyn, was fined $22,000 by the Department of Health in March after a less than satisfactory deficiency report in February of last year. The individual deficiencies are too numerous to discuss here. Of note, though, the facility was cited for failure to properly prevent/heal pressure ulcers .

A resident was admitted to the facility with pressure ulcers on the left buttock and sacrum, stages III and II, respectively. She received a Braden score of 12, making her at risk for the development of further ulcers. Despite this diagnosis, the resident developed several additional ulcers, between stages II and IV, over the next several months. The facility provided inconsistent documentation during this time as well.

washing hands.jpgInfection control was also an issue during this inspection for nurses treating residents with pressure ulcers. On two separate occasions, nurses improperly cleansed wounds on two different residents without following protocol for doing so. The nurses did not properly sanitize their hands while cleaning the wounds of their respective patients. An open wound is prone to infection without any additional urging. Failing to follow procedure, notably in this case the nursing home’s own procedure, increases the potential for possible infection.

In March, the Department of Health fined Brooklyn nursing home Lutheran Augustana Center for Extended Care and Rehabilitation $20,000. The fine is the result of multiple certification surveys finding the facility deficient in recent years. The fine report does not specify which specific incidents led to the monetary penalty.

Among the deficiencies noted by the DOH in the surveys prior to the fine was a failure to provide sufficient fluid intake. A resident was noted to have poor appetite and needed additional fluids. The notes indicate that the staff was to encourage her to take additional fluids, however the facility did not consistently document the amount of fluids consumed by the resident. She also had several incidents of vomiting throughout the period in question. These incidents were not consistently reported to the Nursing Supervisor or doctor.

Lutheran Augustana also failed to establish and maintain a satisfactory infection control program. It did not ensure that oxygen masks and nasal cannulas were properly stored and maintained when not in use. The oxygen masks were not covered properly. On one occasion, an oxygen cannula was observed lying on the floor. Keeping these devices in this manner, when they are to be used later in close contact with mouths and faces, could lead to the spread of germs, bacteria, and infection.

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