**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure a resident who is incontinent of bladder received appropriate treatment and services to prevent urinary tract infections for 3 of 3 residents (Resident #43, #391, #20) reviewed for treatment of urinary tract infections and 3 of 4 residents (Resident #12, #66, and #2) reviewed for incontinent care. 1. Resident #43 was admitted to the hospital on [DATE] with septic shock related to a urinary tract infection. 2. Resident #391 was admitted to the hospital on [DATE] with a diagnosis of sepsis related to a urinary tract infection. 3. Resident #20 was admitted to the hospital on [DATE] with a diagnosis of urinary tract infection. 4. CNA M failed to clean the foley catheter tubing during foley catheter care for Resident #12 who currently had a urinary tract infection. 5. CNA P failed to provide appropriate incontinent care for Resident #66 who had a recent history of urinary tract infection. 6. The facility failed to ensure CNA V provided proper incontinent care to Resident #2. 7. The facility failed to ensure in-services were provided since May 2023 regarding hand hygiene, foley catheter care, and incontinent care. An Immediate Jeopardy (IJ) situation was identified on 9/20/2023 at 10:50 a.m. While the IJ was removed on 9/21/2023 at 2:22 p.m., the facility remained out of compliance at a severity level of actual harm with a scope of pattern, due to the facility's need to evaluate the effectiveness of the corrective systems. These deficient practices could place residents at risk for infections, serious infections, and even death due to improper care practices. Findings included: 1. Record review of Resident #43's face sheet, dated 09/21/2023, indicated Resident #43 was a [AGE] year-old female, originally admitted to the facility on [DATE] with diagnoses which included COVID-19 (an infectious disease caused by a virus), urinary tract infection (an infection in any part of the urinary system), and sepsis (occurs when your body has a life-threatening response to an infection). Record review of annual MDS assessment, dated 12/7/2022, indicated Resident #43 made herself understood and usually understood others. The assessment indicated Resident #43's BIMS score was 3, which indicated her cognition was severely impaired. The assessment indicated Resident #43 required total dependence for toilet use. The assessment indicated Resident #43 was always incontinent of bladder and bowel. The assessment indicated Resident #43 did not have an UTI in the last 30 days of this assessment. Record review of Resident #43's care plan, revised on 08/16/2023, indicated Resident #43 returned from the hospital with a diagnosis of urinary tract infection and sepsis The care plan interventions included administer antibiotic therapy as prescribed, encourage fluids, encourage resident to void frequently and fully empty bladder and monitor laboratory results. Record review of Resident #43's hospital Discharge summary dated [DATE] revealed resolved septic shock and UTI. 2. Record review of Resident #391's face sheet, dated 09/21/2023, indicated Resident #391 was an [AGE] year-old male, originally admitted to the facility on [DATE] with diagnoses which included unilateral (one side) primary osteoarthritis ( degeneration of joint cartilage and the underlying bone) to the right knee, urinary tract infection, and sepsis. Record review of annual MDS assessment, dated 07/28/2023, indicated Resident #391 made himself understood and understood others. The assessment indicated Resident #391's BIMS score was 9, which indicated his cognition was moderately impaired. The assessment indicated Resident #391 required limited assistance for toilet use. The assessment indicated Resident #391 was occasionally incontinent of bladder and always continent with bowel. The assessment indicated Resident #391 did not have an UTI in last 30 days of this assessment. Record review of Resident #391's care plan, revised on 08/14/2023, indicated Resident #391 had a urinary tract infection and was at risk for dehydration. The care plan interventions included administer antibiotic therapy as prescribed, monitor cognitive changes, and evaluate for urinary complaints. Record review of Resident #391's hospital Discharge summary dated [DATE] revealed urosepsis (caused by a bacterial infection that starts in the urinary tract and spreads to the blood). The hospital microbiology report dated 08/05/2023 revealed Escherichia coli (a bacteria that lives in the intestines). 3. Record review of Resident #20's face sheet, dated 09/21/2023, indicated Resident #20 was an [AGE] year-old female, originally admitted to the facility on [DATE] with diagnoses which included urinary tract infection. Record review of annual MDS assessment, dated 04/03/2023, indicated Resident #20 made herself understood and understood others. The assessment indicated Resident #20's BIMS score was 13, which indicated her cognition was intact. The assessment indicated Resident #20 required total dependence for toilet use. The assessment indicated Resident #20 was always incontinent of bladder and bowel. The assessment indicated Resident #20 did not have a UTI in last 30 days of this assessment. Record review of Resident #20's care plan, revised on 07/26/2023, indicated Resident #20 had a urinary tract infection. The care plan interventions included encourage adequate fluid intake, give antibiotic therapy as ordered and monitor/document/report to MD for s/sx of UTI. Record review of Resident #20's hospital Discharge summary dated [DATE] revealed UTI due to extended ESBL (enzymes that break down and destroy some commonly used antibiotics) producing Escherichia coli (a bacteria that lives in the intestines). 4. Record review of a face sheet dated 9/20/2023 indicated Resident #12 was initially admitted [DATE] and readmitted on [DATE] with the diagnoses of urinary tract infection, shock (a life-threatening medical condition as a result of insufficient blood flow throughout the body. Shock often accompanies severe injury or illness), and acute kidney failure with tubular necrosis (kidney disorder involving damage to the tubule cells of the kidneys, which can lead to acute kidney failure caused by a lack of blood and oxygen to the kidneys). Record review of the consolidated physician orders dated 9/20/2023 indicated as of 9/15/2023 Resident #12 was receiving Merrem (meropenem) 1 gram intravenously two times daily for 14 administrations ending on 9/23/2023. Record review of an annual MDS dated [DATE] indicated Resident #12 understands and was understood. The MDS indicated Resident #12's BIMS score was 8 indicating moderate cognitive impairment. Record review of Resident #12's MDS indicated she required extensive assistance of two staff with personal hygiene and toileting. Record review of the MDS indicated Resident #12 had an indwelling catheter. Record review of the comprehensive care plan dated 11/07/2019 and updated on 9/12/2023 indicated Resident #12 had a foley catheter related to urine retention and overactive bladder with a history of urinary tract infections. The care plan indicated Resident #12 was treated: 7/18/2023 with Levofloxacin 500 milligrams one tablet by mouth daily for 7 days related to UTI provider urologist 7/31/2023 with Bactrim DS one tablet by mouth twice daily for 7 days for UTI. 8/18/2023 Merrem 1 gram twice daily for 7 days for an UTI The interventions included was to change the foley catheter per the physician orders, check the catheter tubing for kinks with turning and repositioning and monitor/report symptoms of an UTI. Record review of the medication administration record dated July 2023 indicated Resident #12 received Levofloxacin 500 milligrams daily for 6 days for a urinary tract infection starting on 7/18/2023 and ending on 7/24/2023. Record review of a urinalysis culture and sensitivity report dated 7/25/2023 indicated Resident #12's urine had 50,000 - 100,000 Escherichia coli (E coli) organism colony count. Record review of the medication administration record dated July 2023 indicated on 7/31/2023 Resident #12 was administered Bactrim DS 800-160 milligrams one tablet twice daily for 10 days for a UTI. Record review of a UTI Screener Evaluation dated 7/31/2023 indicated Resident #12 had an indwelling foley catheter and had suprapubic pain. Record review of a urinalysis culture and sensitivity report dated 8/13/2023 indicated Resident #12's urine had 50,000 - 100,000 colony count of Escherichia coli (E coli) organism count. Record review of a medication administration record dated August 2023 indicated Resident #12 was administered Meropenem intravenously 1 gram twice daily for 13 administrations. The intravenous meropenem was started on 8/19/2023 and ended on 8/24/2023 for a urinary tract infection. Record review of a medication administration record dated September 2023 indicated Resident #12 was administered Meropenem intravenously 1 gram twice daily starting on 9/17/2023 and completing on 9/23/2023 for a urinary tract infection. During an interview on 9/18/2023 at 10:31 a.m., Resident #12 said she had her intravenous antibiotic therapy for repeat urinary tract infections. Resident #12 said the urologist said the urinary tract infections were caused from not cleaning her perineal area well. Resident #12 said she did not feel as though the staff provided her good catheter care. Resident #12 said she had to complete the antibiotics before he would do the surgery to give her a suprapubic catheter (a catheter placed directly in the bladder by entering the skin on the abdomen). During an observation on 9/20/2023 at 9:26 a.m., CNA M raised Resident #12's bed to an appropriate height, Resident #12's brief was opened, then she obtained the clean under pad. CNA M rolled the clean pad up and instructed Resident #12 to roll to her right while CNA M placed the rolled pad underneath the current pad. CNA N then had Resident #12 roll toward her left while removing the current pad. CNA M took Resident #12's foley catheter bag from the side of the bed and laid it up in the bed at Resident #12's feet. CNA M had not changed her gloves when she took a clean washcloth, placed the washcloth in the basin of clean water and sprayed the washcloth with perineal cleanser. CNA M then wiped Resident #12's perineal area from top to bottom 4 times using a different fold of the cloth with each wiping. Then CNA M obtained a clean bath towel and dried Resident #12's perineal area without changing her gloves. Then CNA M discarded the used washcloth in the dirty linen bag. Resident #12 was instructed to roll to her right then CNA M obtained a clean washcloth, moistened the towel in the basin of water and then sprayed perineal wash on the toweling. CNA M then cleansed Resident #12's buttocks, 4 times wiping away and folding the cloth each time. CNA M discarded the cloth in the dirty linen. CNA M then used the bath towel and dried Resident #12's buttocks. CNA M then obtained the barrier cream, squeezed the cream in her hand and applied the barrier cream using the same pair of gloves throughout the incontinent care process. CNA M applied Resident #12's clean brief. CNA M then changed her gloves and repositioned Resident #12. During an interview on 9/20/2023 at 9:26 a.m., CNA N said CNA M failed to clean the foley catheter tubing. CNA N said Resident #12 could get a urinary tract infection from not doing catheter care correctly. CNA M said she failed to clean the foley catheter tubing and she failed to change her gloves between clean and dirty when she provided incontinent care to Resident #12. CNA M said catheter care and incontinent care should be done correctly to prevent urinary tract infections. Record review of a Certified Nursing Assistant Competency Checklist indicated CNA M was evaluated on 6/03/2023 for perineal care-female (with/without a catheter). The evaluation indicated CNA M received a satisfactory (S) score. 5. Record review of a face sheet dated 9/21/2023 indicated Resident #66 was an [AGE] year-old female who admitted on [DATE] and readmitted on [DATE] with the diagnoses of dementia, left hip fracture, urinary tract infection, and dehydration. Record review of an Annual MDS dated [DATE] indicated Resident #66 was usually understood and usually understood others. The MDS indicated Resident #66's BIMS score was 3 indicating severely impaired cognition. The MDS indicated Resident #66 required extensive assistance of one staff with bed mobility, transfers, dressing, eating, toilet use, and personal hygiene. The MDS indicated Resident #66 was frequently incontinent of bowel and bladder. Record review of the comprehensive care plan dated 8/23/2023 and revised on 9/04/2023 indicated Resident #66 had a urinalysis with a culture and sensitivity completed on 8/14/2023 due to confusion and altered mental status. The care plan indicated on 8/21/2023 Resident #66 had another urinalysis with a culture and sensitivity due to altered mental status and increased confusion. The care plan indicated on 8/24/2023 the physician ordered Macrobid 2 capsules by mouth twice daily for 7 days for a urinary tract infection. The goal of the care plan included Resident #66 would not have signs or symptoms of infection. The interventions included administering the antibiotics as ordered, encouraged fluids, evaluate pain, evaluate urinary complaints, monitor for cognitive changes, and monitor laboratory results. Record review of a urinalysis dated 8/15/2023 indicated Resident #66 had 0-5 red blood cells (none seen), bacteria was many (none seen), mucous light (none seen), appearance cloudy (clear), and leukocyte esterase moderate (negative). There were no orders written on the laboratory sheet but was signed by the physician. Record review of a urinalysis with a culture dated 8/22/2023 indicated Resident #66 had a urinary tract infection with greater than 100,000 Raoultella Planticola (bacteria) organism. The order provided on the laboratory result was Macrobid 100 milligrams one capsule twice daily for 7 days. During an observation on 9/18/2023 at 2:36 p.m., Resident #66 was assisted to her bed by two staff using a gait belt. Resident #66 was assisted by CNA P to remove her pants. CNA P, with her gloves on, touched the clean wipes and the brief. Resident #66's brief was opened by CNA P. CNA P then used a wipe and wiped down on each side of Resident #66's perineal area. Then CNA P wiped one wipe down the middle. Resident #66 was assisted by CNA O to roll to the right and CNA P cleansed her buttocks using three wipes. CNA P then removed her gloves, washed her hands, reapplied gloves, and then attempted to apply the brief. During the application of the brief. The brief tabbed area tore. CNA P removed her gloves and washed her hands again. Resident #66 urinated again on the clean brief. CNA O was aware Resident #66 urinated on the clean brief. Upon CNA P's return to the bedside CNA O indicated to CNA P Resident #66 urinated again. CNA P applied the clean brief and Resident #66 was repositioned. During an interview on 9/18/2023 at 2:36 p.m., CNA O said she believed incontinent care went well with no mistakes. During an interview with CNA P she said she was nervous but she thought the incontinent care went well. When asked why she failed to provide Resident #66 incontinent care again after she urinated on her torn brief, she said she did not have any more wipes. CNAs O and P said Resident #66 could get a UTI or a rash from improper incontinent care. Record review of CNA P's Certified Nursing Assistant Competency Checklist dated 8/24/2023 indicated CNA P was evaluated for perineal care-female with and without a catheter. The evaluation indicated CNA P met the evaluation criteria with a satisfactory (s) skill level. 6. During an observation and interview on 09/20/2023 starting at 8:45 AM, CNA V provided incontinent care to Resident #2. CNA V unfastened Resident #2's dirty brief and removed it. CNA V wiped Resident #2's front perineal area with the same wipe twice in different areas. CNA V failed to use a new wipe when going to a different area. CNA V turned Resident #2 and wiped her buttocks and removed the dirty brief. CNA V removed her dirty gloves and applied new gloved. CNA V did not perform hand hygiene after removing her gloves. CNA V placed the new brief under Resident #2 and applied barrier cream to her buttocks. CNA V removed her gloves and applied clean gloves. CNA V did not perform hand hygiene after removing her gloves. CNA V finished applying the new brief. CNA V removed her gloves and gathered the bag with trash. CNA V repositioned Resident #2 in her bed. CNA V exited the room and disposed of the trash and washed her hands. CNA V said when providing perineal care, she was supposed to use a different wipe every time she wiped. CNA V said she did not realize she had wiped twice in different areas with the same wipe. CNA V said she should have performed hand hygiene after removing her gloves. CNA V said she got nervous and forgot to perform hand hygiene. CNA V said she had been checked off on incontinent care about a month ago. CNA V said the CNAs were responsible for providing proper incontinent care. CNA V said it was important to provide proper incontinent care and perform hand hygiene during incontinent care to prevent cross contamination and UTIs. During an interview on 09/21/2023 at 3:15 PM, LVN Q said the charge nurses were responsible for making sure the CNAs provided proper incontinent care. LVN Q said she monitored the CNAs by going in with them when they provided incontinent care at least once a shift. LVN Q said sometimes she had to prompt them to change their gloves, and she had to prompt them to completely clean the residents. LVN Q said it was important for the CNAs to provided proper incontinent care and perform hand hygiene to decrease UTIs and any kind of infections, and to make sure the residents were clean and did not have any skin breakdown. During an interview on 09/21/2023 at 3:34 PM, the ADON said as a team the nurses and department heads were responsible for making sure the CNAs were providing proper incontinent care and performing hand hygiene adequately while providing incontinent care. The ADON said skills check offs were performed by the DON yearly and in-services were done as needed. The ADON said the CNAs providing proper incontinent care was monitored by the skills check offs and random checks. The ADON said she had not noticed any issues with incontinent care. The ADON said it was important for the CNAs to provide proper incontinent care and perform hand hygiene to keep infections down and so the residents would not get a UTI. During an interview on 09/21/2023 at 4:01 PM, the DON said the nurse managers and herself were responsible for ensuring the CNAs were providing proper incontinent care and performing hand hygiene. The DON said this was monitored by the competency checks and random pop-ins on the CNAs while they were performing incontinent care. The DON said it was important for the CNAs to provide proper incontinent care and perform hand hygiene to prevent infection and UTIs. During an interview on 09/21/2023 at 4:19 PM, the Administrator said she expected the CNAs to provide proper incontinent care and perform hand hygiene. The Administrator said the charge nurses and nurse managers were responsible for ensuring the CNAs provided proper incontinent care and performed hand hygiene. The Administrator said it was important for the CNAs to provide proper incontinent care and perform hand hygiene for cleanliness and to reduce infections. During an interview on 9/21/2023 at 11:52 a.m., the ADON said she expected incontinent care and catheter to be performed correctly. The ADON said when incontinent care and catheter care was not performed correctly the resident was at risk for a urinary tract infection. The ADON said she expected catheter care to include cleaning of the tubing. The ADON said changing of the gloves should occur as often as needed but no less than 3 times during the process. The ADON said when a resident urinated again after just receiving incontinent care, she expected the resident to receive incontinent care again. The ADON said she expected the CNAs to clean the labia to prevent bowel movement from being pressed inside the urethral area causing an infection. The ADON said she had been in-serviced on incontinent care male and female, foley catheter, she had been checked off on skills in this area. The ADON said she had been given the task of infection control now. The ADON said she was unsure of her role as of yet, but her role would include identifying the infectious organism. The ADON said identification of the organism was important to monitor for trends. During an interview on 9/21/2023 at 12:04 p.m., RN C (unit manager) said she had in-serviced CNAs on incontinent care, catheter care, and infection control. RN C said she had in serviced the DON and ADON on tracking and trending of infections, monitoring of organisms, and the importance of identification of the organism to in-service staff on hydration and cleanliness, and to perform skills checks on incontinent care. RN C said she expected the CNAs to not wipe the residents from back to front, to change gloves between dirty and clean, and to ensure the female labia were cleansed. During an interview on 9/21/2023 at 12:15 p.m., the DON said she had conducted in-services regarding catheter care, hand hygiene, incontinent care, and prevention of infections. The DON said she had been in-serviced by RN C on tracking and trending of the organism and the importance. The DON said the tracking and trending log for infections had a column now added for organism. The DON said the tracking of the organism would help to see a trend and to identify if a certain hall or staff member may factor in on the results. The DON said the team will meet weekly and discuss the bacteria in the infections and then implement interventions. The DON said prior to this, there had been no formal meetings to involve everyone. The DON said the infection preventionist would just look over the infections. The DON said she had in serviced the hospice provider and the medical director on the antibiotic stewardship. The DON said she in-serviced in May and had the staff checked off on their skills but was still unsure of the deficient practice at an IJ level. During an interview on 9/21/2023 at 12:27 p.m., the Administrator said she would be more involved in monitoring, competencies, and in-servicing for infection control. The Administrator said she would attend the weekly infection control meetings and ensure during the QA meetings the infections were also discussed. The Administrator said she believed the tracking and trending of the organisms could help not to spread infections. During an interview on 9/21/2023 at 12:29 p.m., the Assistant Administrator/Owner said she would be involved in looking over the infections, and in-services. The Assistant Administrator/Owner said she was present in the facility 7 days a week and she would be involved in the monitoring more so. The Administrator/Owner said the infections would also be discussed in the morning meeting. The Assistant Administrator said she had been more involved in the past, but her spouse had become ill over the summer, and she had spent half days away from the facility and the DON herself had suffered a loss which took her away from the facility, but she remained unsure why the in-service in May and the staff check offs failed to prevent the deficient practice. 7. Record review of the Infection Control-Donning/Doffing, PPE and Handwashing in-service was completed on 01/02/2023. Record review of the Incontinent Care/UTI in-service was completed on 05/08/2023. Record review of the undated Antimicrobial Stewardship policy, indicated, the facility will establish a multidisciplinary antimicrobial stewardship program that defines and provides guidance for optimal antimicrobial use 3. The members of the antimicrobial stewardship program will develop, endorse, and adopt established guidelines for use by facility staff for appropriate identification and assessment of infections and treatment guidelines 4. The members of the antimicrobial stewardship program will meet at least quarterly to review collected date and facility trends, analyze performance, and develop action plans to improve antimicrobial date and facility trends, analyze performance and develop action plans to improve antimicrobial use. Essential date to review includes a. antimicrobial orders b. clinical documentation c. supplemental information from d. effective communication among nursing staff and between nurses and physicians/prescribers Record review of the undated Infection Control Program policy, indicated It is the policy of this facility to have an infection control program, which assures a clean, safe, and sanitary environment for the residents 1. The facility will have an infection control system which will monitor and identify concerns in the following areas: Provides definition of acquired and communicable diseases, A means of identification of risk for infection factors, A means of identification and tracking of infections in the facility, to prevent spread of infections, Protocols for identification and isolation of residents with infectious process, Education information process to assure the staff understands how to care for residents and contain the infectious process to prevent further spread, Education and refresher in-services on infection control and standard precautions, Screening of staff to assure a decrease in the odds of transmission of infectious processes in the community, Sanitization methods for use in showers, whirlpools and multiple use equipment 2. The Director of Nursing or Designee will review staff procedures observations of standard precaution, infection control and isolation procedures 4. Labs will be reviewed by DON and/or Designee 5. Infection control log will be maintained with documentation of Resident/type of infection/antibiotic/treatment, start date . Record review of the facility's policy effective date 06/09/2023, titled, Hand Hygiene, indicated, Policy It is the policy of this facility to sanitize/clean hands properly to prevent the spread of infection . https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447 A urinary tract infection (UTI) is an infection in any part of the urinary system. The urinary system includes the kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract - the bladder and the urethra. Women are at greater risk of developing a UTI than are men. If an infection is limited to the bladder, it can be painful and annoying. But serious health problems can result if a UTI spreads to the kidneys. Health care providers often treat urinary tract infections with antibiotics. You can also take steps to lower the chance of getting a UTI in the first place. UTIs typically occur when bacteria enter the urinary tract through the urethra and begin to spread in the bladder. The urinary system is designed to keep out bacteria. But the defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract. The most common UTIs occur mainly in women and affect the bladder and urethra. o Infection of the bladder. This type of UTI is usually caused by Escherichia coli (E. coli). E. coli is a type of bacteria commonly found in the gastrointestinal (GI) tract. But sometimes other bacteria are the cause. When treated promptly and properly, lower urinary tract infections rarely lead to complications. But left untreated, UTIs can cause serious health problems. Complications of a UTI may include: o Repeated infections, which means you have two or more UTIs within six months or three or more within a year. Women are especially prone to having repeated infections. o Permanent kidney damage from a kidney infection due to an untreated UTI. o Delivering a low birth weight or premature infant when a UTI occurs during pregnancy. o A narrowed urethra in men from having repeated infections of the urethra. o Sepsis, a potentially life-threatening complication of an infection. This is a risk especially if the infection travels up the urinary tract to the kidneys. Prevention These steps may help lower the risk of UTIs: o Drink plenty of liquids, especially water. Drinking water helps dilute the urine. That leads to urinating more often - allowing bacteria to be flushed from the urinary tract before an infection can begin. o Try cranberry juice. Studies that look into whether cranberry juice prevents UTIs aren't final. However, drinking cranberry juice is likely not harmful. o Wipe from front to back. Do this after urinating and after a bowel movement. It helps prevent the spread of bacteria from the anus to the vagina and urethra. https://www.cdc.gov/nhsn/pdfs/pscmanual/7psccauticurrent.pdf Record review of Urinary Tract Infection (Catheter-Associated Urinary Tract Infection (CAUTI) and Non-Catheter-Associated Urinary Tract Infection (UTI) events Urinary tract infections (UTIs) are the fifth most common type of healthcare-associated infection, with an estimated 62,700 UTIs in acute care hospitals in 2015. UTIs additionally account for more than 9.5% of infections reported by acute care hospitals1 . Virtually all healthcare associated UTIs are caused by instrumentation of the urinary tract. Approximately 12%-16% of adult hospital inpatients will have an indwelling urinary catheter (IUC) at some time during their hospitalization, and each day the indwelling urinary catheter remains, a patient has a 3%-7% increased risk of acquiring a catheter-associated urinary tract infection (CAUTI).2-3 CAUTI can lead to such complications as prostatitis, epididymitis, and orchitis in males, and cystitis, pyelonephritis, gram-negative bacteremia, endocarditis, vertebral osteomyelitis, septic arthritis, endophthalmitis, and meningitis in patients. Complications associated with CAUTI cause discomfort to the patient, prolonged hospital stay, and increased cost and mortality4 . It has been estimated that each year, more than 13,000 deaths are associated with UTIs.5 . https://www.ncbi.nlm.nih.gov/books/NBK436013/ Record review of Complicated Urinary Tract Infections: Urinary tract infections (UTIs) are among the most common presenting causes of sepsis in hospitals. Some are simple UTIs that can be managed with outpatient antibiotics and lead to almost universally good outcomes. However, complicated urinary tract infections may lead to florid urosepsis, which can be fatal. Several risk factors can complicate urinary tract infections and lead to treatment failure, repeat infections, or significant morbidity and mortality. It is vitally important to determine if the patient's infection may have resulted from one of these risk factors and whether the episode is likely to resolve with first-line antibiotics. Complicated urinary tract infections are those that present with greater morbidity, carry a higher risk of treatment failure, and typically require longer antibiotic courses, fr[TRUNCATED]

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to establish and maintain an infection prevention and control program designed to provide a safe and sanitary environment and to help prevent the development hospitalizations for 3 of 3 residents (Resident #'s 43, 391, and 20) reviewed for infection control practices related to hospitalized residents with urinary tract infections resulting from E coli, 3 of 6 facility staff members (CNA 's M,P, V) reviewed for infection control practices related to incontinent care and foley catheter care, the provision of antibiotic stewardship for 1 of 1 residents (Resident #191) receiving hospice services and tracking and trending of organisms causing 28 urinary tract infections in July 2023 and 19 urinary tract infections in August 2023. 1. Resident #43 was admitted to the hospital on [DATE] with septic shock related to a urinary tract infection. 2. Resident #391 was admitted to the hospital on [DATE] with a diagnosis of sepsis related to a urinary tract infection. 3. Resident #20 was admitted to the hospital on [DATE] with a diagnosis of urinary tract infection. 4. The facility's tracking and trending of infections failed to identify urinary tract infectious organisms. The facility's tracking and trending of infections for the month of July 2023 indicated there were 28 urinary tract infections. The facility's tracking and trending of infections for the month of August 2023 indicated there were 19 urinary tract infections. 5. The facility failed to ensure the contacted hospice services were practicing antibiotic stewardship. 6. CNA M failed to clean the foley catheter tubing during foley catheter care for Resident #12 who currently had a urinary tract infection. 7. CNA P failed to provide appropriate incontinent care for Resident #66 who had a recent history of urinary tract infection. 8. The facility failed to ensure CNA V provided proper incontinent care to Resident #2. 9. The facility failed to ensure in-services were provided since May 2023 regarding hand hygiene, foley catheter care, and incontinent care. An Immediate Jeopardy (IJ) situation was identified on 9/20/2023 at 10:50 a.m. While the IJ was removed on 9/21/2023 at 2:22 p.m., the facility remained out of compliance at a severity level of actual harm with a scope of pattern, due to the facility's need to evaluate the effectiveness of the corrective systems. These deficient practices could place residents at risk for infections, serious infections, and even death due to improper care practices. Findings included: 1. Record review of Resident #43's face sheet, dated 09/21/2023, indicated Resident #43 was a [AGE] year-old female, originally admitted to the facility on [DATE] with diagnoses which included COVID-19 (an infectious disease caused by a virus), urinary tract infection (an infection in any part of the urinary system), and sepsis (occurs when your body has a life-threatening response to an infection). Record review of annual MDS assessment, dated 12/7/2022, indicated Resident #43 made herself understood and usually understood others. The assessment indicated Resident #43's BIMS score was 3, which indicated her cognition was severely impaired. The assessment indicated Resident #43 required total dependence for toilet use. The assessment indicated Resident #43 was always incontinent of bladder and bowel. The assessment indicated Resident #43 did not have an UTI in the last 30 days of this assessment. Record review of Resident #43's care plan, revised on 08/16/2023, indicated Resident #43 returned from the hospital with a diagnosis of urinary tract infection and sepsis The care plan interventions included administer antibiotic therapy as prescribed, encourage fluids, encourage resident to void frequently and fully empty bladder and monitor laboratory results. Record review of Resident #43's hospital Discharge summary dated [DATE] revealed resolved septic shock and UTI. 2. Record review of Resident #391's face sheet, dated 09/21/2023, indicated Resident #391 was an [AGE] year-old male, originally admitted to the facility on [DATE] with diagnoses which included unilateral (one side) primary osteoarthritis ( degeneration of joint cartilage and the underlying bone) to the right knee, urinary tract infection, and sepsis. Record review of annual MDS assessment, dated 07/28/2023, indicated Resident #391 made himself understood and understood others. The assessment indicated Resident #391's BIMS score was 9, which indicated his cognition was moderately impaired. The assessment indicated Resident #391 required limited assistance for toilet use. The assessment indicated Resident #391 was occasionally incontinent of bladder and always continent with bowel. The assessment indicated Resident #391 did not have an UTI in last 30 days of this assessment. Record review of Resident #391's care plan, revised on 08/14/2023, indicated Resident #391 had a urinary tract infection and was at risk for dehydration. The care plan interventions included administer antibiotic therapy as prescribed, monitor cognitive changes, and evaluate for urinary complaints. Record review of Resident #391's hospital Discharge summary dated [DATE] revealed urosepsis (caused by a bacterial infection that starts in the urinary tract and spreads to the blood). The hospital microbiology report dated 08/05/2023 revealed Escherichia coli (a bacteria that lives in the intestines). 3. Record review of Resident #20's face sheet, dated 09/21/2023, indicated Resident #20 was an [AGE] year-old female, originally admitted to the facility on [DATE] with diagnoses which included urinary tract infection. Record review of annual MDS assessment, dated 04/03/2023, indicated Resident #20 made herself understood and understood others. The assessment indicated Resident #20's BIMS score was 13, which indicated her cognition was intact. The assessment indicated Resident #20 required total dependence for toilet use. The assessment indicated Resident #20 was always incontinent of bladder and bowel. The assessment indicated Resident #20 did not have a UTI in last 30 days of this assessment. Record review of Resident #20's care plan, revised on 07/26/2023, indicated Resident #20 had a urinary tract infection. The care plan interventions included encourage adequate fluid intake, give antibiotic therapy as ordered and monitor/document/report to MD for s/sx of UTI. Record review of Resident #20's hospital Discharge summary dated [DATE] revealed UTI due to extended ESBL (enzymes that break down and destroy some commonly used antibiotics) producing Escherichia coli (a bacteria that lives in the intestines). 4. Record review of the undated tracking and trending infection log for July 2023 did not address the urinary tract infectious organisms. Record review of the undated tracking and trending infection log for August 2023 did not address the urinary tract infectious organisms. Record review of the facility's July 2023 monthly infection control data log revealed 28 residents who had a urinary tract infection. 15 of those residents had Escherichia coli and 5 of those 15 had Escherichia coli with ESBL. Record review of the facility's August 2023 monthly infection control data log revealed 9 residents who had a urinary tract infection. 9 of those residents had Escherichia coli and 3 of those 9 had Escherichia coli with ESBL. 5. Record review of the progress note dated 07/07/2023 indicated Resident #191 complained of burning with urination. The progress note indicated Resident #191 reported she did not urinate very much or very often. Record review of the physician's telephone order sheet dated 07/07/2023 indicated Resident #191 was prescribed cefdinir (antibiotic to treat UTI) 250 mg/5ml by mouth BID x 7 days for UTI. Record review of the facility's electronic charting system on 07/07/2023 did not reveal urinalysis or urine culture for Resident #191. During a telephone interview on 09/21/2023 at 12:47, the DON for the hospice company stated a urinalysis or urine culture was not done on Resident #191. The DON for the hospice company stated due to the resident being on hospice a urinalysis was not required. During an interview on 09/21/2023 at 3:18 p.m., the DON stated a UTI could not be treated without a urine. The DON stated a urinalysis had to be obtained prior to prescribing an antibiotic. The DON stated an antibiotic ordered for a hospice resident without a urinalysis was against the antibiotic stewardship. 6.Record review of a face sheet dated 9/20/2023 indicated Resident #12 was initially admitted [DATE] and readmitted on [DATE] with the diagnoses of urinary tract infection, shock (a life-threatening medical condition as a result of insufficient blood flow throughout the body. Shock often accompanies severe injury or illness), and acute kidney failure with tubular necrosis (kidney disorder involving damage to the tubule cells of the kidneys, which can lead to acute kidney failure caused by a lack of blood and oxygen to the kidneys). Record review of the consolidated physician orders dated 9/20/2023 indicated as of 9/15/2023 Resident #12 was receiving Merrem (meropenem) 1 gram intravenously two times daily for 14 administrations ending on 9/23/2023. Record review of an annual MDS dated [DATE] indicated Resident #12 understands and was understood. The MDS indicated Resident #12's BIMS score was 8 indicating moderate cognitive impairment. Record review of Resident #12's MDS indicated she required extensive assistance of two staff with personal hygiene and toileting. Record review of the MDS indicated Resident #12 had an indwelling catheter. Record review of the comprehensive care plan dated 11/07/2019 and updated on 9/12/2023 indicated Resident #12 had a foley catheter related to urine retention and overactive bladder with a history of urinary tract infections. The care plan indicated Resident #12 was treated: 7/18/2023 with Levofloxacin 500 milligrams one tablet by mouth daily for 7 days related to UTI provider urologist 7/31/2023 with Bactrim DS one tablet by mouth twice daily for 7 days for UTI. 8/18/2023 Merrem 1 gram twice daily for 7 days for an UTI The interventions included was to change the foley catheter per the physician orders, check the catheter tubing for kinks with turning and repositioning and monitor/report symptoms of an UTI. Record review of the medication administration record dated July 2023 indicated Resident #12 received Levofloxacin 500 milligrams daily for 6 days for a urinary tract infection starting on 7/18/2023 and ending on 7/24/2023. Record review of a urinalysis culture and sensitivity report dated 7/25/2023 indicated Resident #12's urine had 50,000 - 100,000 Escherichia coli (E coli) organism colony count. Record review of the medication administration record dated July 2023 indicated on 7/31/2023 Resident #12 was administered Bactrim DS 800-160 milligrams one tablet twice daily for 10 days for a UTI. Record review of a UTI Screener Evaluation dated 7/31/2023 indicated Resident #12 had an indwelling foley catheter and had suprapubic pain. Record review of a urinalysis culture and sensitivity report dated 8/13/2023 indicated Resident #12's urine had 50,000 - 100,000 colony count of Escherichia coli (E coli) organism count. Record review of a medication administration record dated August 2023 indicated Resident #12 was administered Meropenem intravenously 1 gram twice daily for 13 administrations. The intravenous meropenem was started on 8/19/2023 and ended on 8/24/2023 for a urinary tract infection. Record review of a medication administration record dated September 2023 indicated Resident #12 was administered Meropenem intravenously 1 gram twice daily starting on 9/17/2023 and completing on 9/23/2023 for a urinary tract infection. During an interview on 9/18/2023 at 10:31 a.m., Resident #12 said she had her intravenous antibiotic therapy for repeat urinary tract infections. Resident #12 said the urologist said the urinary tract infections were caused from not cleaning her perineal area well. Resident #12 said she did not feel as though the staff provided her good catheter care. Resident #12 said she had to complete the antibiotics before he would do the surgery to give her a suprapubic catheter (a catheter placed directly in the bladder by entering the skin on the abdomen). During an observation on 9/20/2023 at 9:26 a.m., CNA M raised Resident #12's bed to an appropriate height, Resident #12's brief was opened, then she obtained the clean under pad. CNA M rolled the clean pad up and instructed Resident #12 to roll to her right while CNA M placed the rolled pad underneath the current pad. CNA N then had Resident #12 roll toward her left while removing the current pad. CNA M took Resident #12's foley catheter bag from the side of the bed and laid it up in the bed at Resident #12's feet. CNA M had not changed her gloves when she took a clean washcloth, placed the washcloth in the basin of clean water and sprayed the washcloth with perineal cleanser. CNA M then wiped Resident #12's perineal area from top to bottom 4 times using a different fold of the cloth with each wiping. Then CNA M obtained a clean bath towel and dried Resident #12's perineal area without changing her gloves. Then CNA M discarded the used washcloth in the dirty linen bag. Resident #12 was instructed to roll to her right then CNA M obtained a clean washcloth, moistened the towel in the basin of water and then sprayed perineal wash on the toweling. CNA M then cleansed Resident #12's buttocks, 4 times wiping away and folding the cloth each time. CNA M discarded the cloth in the dirty linen. CNA M then used the bath towel and dried Resident #12's buttocks. CNA M then obtained the barrier cream, squeezed the cream in her hand and applied the barrier cream using the same pair of gloves throughout the incontinent care process. CNA M applied Resident #12's clean brief. CNA M then changed her gloves and repositioned Resident #12. During an interview on 9/20/2023 at 9:26 a.m., CNA N said CNA M failed to clean the foley catheter tubing. CNA N said Resident #12 could get a urinary tract infection from not doing catheter care correctly. CNA M said she failed to clean the foley catheter tubing and she failed to change her gloves between clean and dirty when she provided incontinent care to Resident #12. CNA M said catheter care and incontinent care should be done correctly to prevent urinary tract infections. Record review of a Certified Nursing Assistant Competency Checklist indicated CNA M was evaluated on 6/03/2023 for perineal care-female (with/without a catheter). The evaluation indicated CNA M received a satisfactory (S) score. 7. Record review of a face sheet dated 9/21/2023 indicated Resident #66 was an [AGE] year-old female who admitted on [DATE] and readmitted on [DATE] with the diagnoses of dementia, left hip fracture, urinary tract infection, and dehydration. Record review of an Annual MDS dated [DATE] indicated Resident #66 was usually understood and usually understood others. The MDS indicated Resident #66's BIMS score was 3 indicating severely impaired cognition. The MDS indicated Resident #66 required extensive assistance of one staff with bed mobility, transfers, dressing, eating, toilet use, and personal hygiene. The MDS indicated Resident #66 was frequently incontinent of bowel and bladder. Record review of the comprehensive care plan dated 8/23/2023 and revised on 9/04/2023 indicated Resident #66 had a urinalysis with a culture and sensitivity completed on 8/14/2023 due to confusion and altered mental status. The care plan indicated on 8/21/2023 Resident #66 had another urinalysis with a culture and sensitivity due to altered mental status and increased confusion. The care plan indicated on 8/24/2023 the physician ordered Macrobid 2 capsules by mouth twice daily for 7 days for a urinary tract infection. The goal of the care plan included Resident #66 would not have signs or symptoms of infection. The interventions included administering the antibiotics as ordered, encouraged fluids, evaluate pain, evaluate urinary complaints, monitor for cognitive changes, and monitor laboratory results. Record review of a urinalysis dated 8/15/2023 indicated Resident #66 had 0-5 red blood cells (none seen), bacteria was many (none seen), mucous light (none seen), appearance cloudy (clear), and leukocyte esterase moderate (negative). There were no orders written on the laboratory sheet but was signed by the physician. Record review of a urinalysis with a culture dated 8/22/2023 indicated Resident #66 had a urinary tract infection with greater than 100,000 Raoultella Planticola (bacteria) organism. The order provided on the laboratory result was Macrobid 100 milligrams one capsule twice daily for 7 days. During an observation on 9/18/2023 at 2:36 p.m., Resident #66 was assisted to her bed by two staff using a gait belt. Resident #66 was assisted by CNA P to remove her pants. CNA P, with her gloves on, touched the clean wipes and the brief. Resident #66's brief was opened by CNA P. CNA P then used a wipe and wiped down on each side of Resident #66's perineal area. Then CNA P wiped one wipe down the middle. Resident #66 was assisted by CNA O to roll to the right and CNA P cleansed her buttocks using three wipes. CNA P then removed her gloves, washed her hands, reapplied gloves, and then attempted to apply the brief. During the application of the brief. The brief tabbed area tore. CNA P removed her gloves and washed her hands again. Resident #66 urinated again on the clean brief. CNA O was aware Resident #66 urinated on the clean brief. Upon CNA P's return to the bedside CNA O indicated to CNA P Resident #66 urinated again. CNA P applied the clean brief and Resident #66 was repositioned. During an interview on 9/18/2023 at 2:36 p.m., CNA O said she believed incontinent care went well with no mistakes. During an interview with CNA P she said she was nervous but she thought the incontinent care went well. When asked why she failed to provide Resident #66 incontinent care again after she urinated on her torn brief, she said she did not have any more wipes. CNAs O and P said Resident #66 could get a UTI or a rash from improper incontinent care. Record review of CNA P's Certified Nursing Assistant Competency Checklist dated 8/24/2023 indicated CNA P was evaluated for perineal care-female with and without a catheter. The evaluation indicated CNA P met the evaluation criteria with a satisfactory (s) skill level. 8. During an observation and interview on 09/20/2023 starting at 8:45 AM, CNA V provided incontinent care to Resident #2. CNA V unfastened Resident #2's dirty brief and removed it. CNA V wiped Resident #2's front perineal area with the same wipe twice in different areas. CNA V failed to use a new wipe when going to a different area. CNA V turned Resident #2 and wiped her buttocks and removed the dirty brief. CNA V removed her dirty gloves and applied new gloved. CNA V did not perform hand hygiene after removing her gloves. CNA V placed the new brief under Resident #2 and applied barrier cream to her buttocks. CNA V removed her gloves and applied clean gloves. CNA V did not perform hand hygiene after removing her gloves. CNA V finished applying the new brief. CNA V removed her gloves and gathered the bag with trash. CNA V repositioned Resident #2 in her bed. CNA V exited the room and disposed of the trash and washed her hands. CNA V said when providing perineal care, she was supposed to use a different wipe every time she wiped. CNA V said she did not realize she had wiped twice in different areas with the same wipe. CNA V said she should have performed hand hygiene after removing her gloves. CNA V said she got nervous and forgot to perform hand hygiene. CNA V said she had been checked off on incontinent care about a month ago. CNA V said the CNAs were responsible for providing proper incontinent care. CNA V said it was important to provide proper incontinent care and perform hand hygiene during incontinent care to prevent cross contamination and UTIs. During an interview on 09/21/2023 at 3:15 PM, LVN Q said the charge nurses were responsible for making sure the CNAs provided proper incontinent care. LVN Q said she monitored the CNAs by going in with them when they provided incontinent care at least once a shift. LVN Q said sometimes she had to prompt them to change their gloves, and she had to prompt them to completely clean the residents. LVN Q said it was important for the CNAs to provided proper incontinent care and perform hand hygiene to decrease UTIs and any kind of infections, and to make sure the residents were clean and did not have any skin breakdown. During an interview on 09/21/2023 at 3:34 PM, the ADON said as a team the nurses and department heads were responsible for making sure the CNAs were providing proper incontinent care and performing hand hygiene adequately while providing incontinent care. The ADON said skills check offs were performed by the DON yearly and in-services were done as needed. The ADON said the CNAs providing proper incontinent care was monitored by the skills check offs and random checks. The ADON said she had not noticed any issues with incontinent care. The ADON said it was important for the CNAs to provide proper incontinent care and perform hand hygiene to keep infections down and so the residents would not get a UTI. During an interview on 09/21/2023 at 4:01 PM, the DON said the nurse managers and herself were responsible for ensuring the CNAs were providing proper incontinent care and performing hand hygiene. The DON said this was monitored by the competency checks and random pop-ins on the CNAs while they were performing incontinent care. The DON said it was important for the CNAs to provide proper incontinent care and perform hand hygiene to prevent infection and UTIs. During an interview on 09/21/2023 at 4:19 PM, the Administrator said she expected the CNAs to provide proper incontinent care and perform hand hygiene. The Administrator said the charge nurses and nurse managers were responsible for ensuring the CNAs provided proper incontinent care and performed hand hygiene. The Administrator said it was important for the CNAs to provide proper incontinent care and perform hand hygiene for cleanliness and to reduce infections. During an interview on 9/21/2023 at 11:52 a.m., the ADON said she expected incontinent care and catheter to be performed correctly. The ADON said when incontinent care and catheter care was not performed correctly the resident was at risk for a urinary tract infection. The ADON said she expected catheter care to include cleaning of the tubing. The ADON said changing of the gloves should occur as often as needed but no less than 3 times during the process. The ADON said when a resident urinated again after just receiving incontinent care, she expected the resident to receive incontinent care again. The ADON said she expected the CNAs to clean the labia to prevent bowel movement from being pressed inside the urethral area causing an infection. The ADON said she had been in-serviced on incontinent care male and female, foley catheter, she had been checked off on skills in this area. The ADON said she had been given the task of infection control now. The ADON said she was unsure of her role as of yet, but her role would include identifying the infectious organism. The ADON said identification of the organism was important to monitor for trends. During an interview on 9/21/2023 at 12:04 p.m., RN C (unit manager) said she had in-serviced CNAs on incontinent care, catheter care, and infection control. RN C said she had in serviced the DON and ADON on tracking and trending of infections, monitoring of organisms, and the importance of identification of the organism to in-service staff on hydration and cleanliness, and to perform skills checks on incontinent care. RN C said she expected the CNAs to not wipe the residents from back to front, to change gloves between dirty and clean, and to ensure the female labia were cleansed. During an interview on 9/21/2023 at 12:15 p.m., the DON said she had conducted in-services regarding catheter care, hand hygiene, incontinent care, and prevention of infections. The DON said she had been in-serviced by RN C on tracking and trending of the organism and the importance. The DON said the tracking and trending log for infections had a column now added for organism. The DON said the tracking of the organism would help to see a trend and to identify if a certain hall or staff member may factor in on the results. The DON said the team will meet weekly and discuss the bacteria in the infections and then implement interventions. The DON said prior to this, there had been no formal meetings to involve everyone. The DON said the infection preventionist would just look over the infections. The DON said she had in serviced the hospice provider and the medical director on the antibiotic stewardship. The DON said she in-serviced in May and had the staff checked off on their skills but was still unsure of the deficient practice at an IJ level. During an interview on 9/21/2023 at 12:27 p.m., the Administrator said she would be more involved in monitoring, competencies, and in-servicing for infection control. The Administrator said she would attend the weekly infection control meetings and ensure during the QA meetings the infections were also discussed. The Administrator said she believed the tracking and trending of the organisms could help not to spread infections. During an interview on 9/21/2023 at 12:29 p.m., the Assistant Administrator/Owner said she would be involved in looking over the infections, and in-services. The Assistant Administrator/Owner said she was present in the facility 7 days a week and she would be involved in the monitoring more so. The Administrator/Owner said the infections would also be discussed in the morning meeting. The Assistant Administrator said she had been more involved in the past, but her spouse had become ill over the summer, and she had spent half days away from the facility and the DON herself had suffered a loss which took her away from the facility, but she remained unsure why the in-service in May and the staff check offs failed to prevent the deficient practice. 9. Record review of the Physical and Psychosocial Changes-Nutrition and Hydration in-service was completed 12/09/2022. Record review of the Infection Control-Donning/Doffing, PPE and Handwashing in-service was completed on 01/02/2023. Record review of the Fresh ice water was to be passed every shift in-service was completed 01/06/2023. Record review of the Incontinent Care/UTI in-service was completed on 05/08/2023. Record review of the undated Antimicrobial Stewardship policy, indicated, the facility will establish a multidisciplinary antimicrobial stewardship program that defines and provides guidance for optimal antimicrobial use 3. The members of the antimicrobial stewardship program will develop, endorse, and adopt established guidelines for use by facility staff for appropriate identification and assessment of infections and treatment guidelines 4. The members of the antimicrobial stewardship program will meet at least quarterly to review collected date and facility trends, analyze performance, and develop action plans to improve antimicrobial date and facility trends, analyze performance and develop action plans to improve antimicrobial use. Essential date to review includes a. antimicrobial orders b. clinical documentation c. supplemental information from d. effective communication among nursing staff and between nurses and physicians/prescribers Record review of the undated Infection Control Program policy, indicated It is the policy of this facility to have an infection control program, which assures a clean, safe, and sanitary environment for the residents 1. The facility will have an infection control system which will monitor and identify concerns in the following areas: Provides definition of acquired and communicable diseases, A means of identification of risk for infection factors, A means of identification and tracking of infections in the facility, to prevent spread of infections, Protocols for identification and isolation of residents with infectious process, Education information process to assure the staff understands how to care for residents and contain the infectious process to prevent further spread, Education and refresher in-services on infection control and standard precautions, Screening of staff to assure a decrease in the odds of transmission of infectious processes in the community, Sanitization methods for use in showers, whirlpools and multiple use equipment 2. The Director of Nursing or Designee will review staff procedures observations of standard precaution, infection control and isolation procedures 4. Labs will be reviewed by DON and/or Designee 5. Infection control log will be maintained with documentation of Resident/type of infection/antibiotic/treatment, start date . Record review of the facility's policy effective date 06/09/2023, titled, Hand Hygiene, indicated, Policy It is the policy of this facility to sanitize/clean hands properly to prevent the spread of infection . https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447 A urinary tract infection (UTI) is an infection in any part of the urinary system. The urinary system includes the kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract - the bladder and the urethra. Women are at greater risk of developing a UTI than are men. If an infection is limited to the bladder, it can be painful and annoying. But serious health problems can result if a UTI spreads to the kidneys. Health care providers often treat urinary tract infections with antibiotics. You can also take steps to lower the chance of getting a UTI in the first place. UTIs typically occur when bacteria enter the urinary tract through the urethra and begin to spread in the bladder. The urinary system is designed to keep out bacteria. But the defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract. The most common UTIs occur mainly in women and affect the bladder and urethra. o Infection of the bladder. This type of UTI is usually caused by Escherichia coli (E. coli). E. coli is a type of bacteria commonly found in the gastrointestinal (GI) tract. But sometimes other bacteria are the cause. When treated promptly and properly, lower urinary tract infections rarely lead to complications. But left untreated, UTIs can cause serious health problems. Complications of a UTI may include: o Repeated infections, which means you have two or more UTIs within six months or three or more within a year. Women are especially prone to having repeated infections. o Permanent kidney damage from a kidney infection due to an untreated UTI. o Delivering a low birth weight or premature infant when a UTI occurs during pregnancy. o A narrowed urethra in men from having repeated infections of the urethra. o Sepsis, a potentially life-threatening complication of an infection. This is a risk especially if the infection travels up the uri[TRUNCATED]