BIRMINGHAM, AL - A March 2025 state inspection at Birmingham Nursing and Rehabilitation Center LLC uncovered multiple infection control violations that placed residents at risk of cross-contamination and disease transmission, including contaminated linen storage areas, improper laundry handling, and failure to follow enhanced barrier precautions for a resident with a stage 4 pressure wound.
Contaminated Linen Storage Areas
During the inspection, surveyors documented concerning conditions in the facility's north hall clean linen closet. The closet contained five used dirty gloves scattered throughout the area, used tissues on both floors and shelves, hair on the floor and on personal protective equipment gowns, and improperly stored medical equipment including a resident's leg brace.
When interviewed, the facility's Infection Preventionist acknowledged the severity of the situation, stating "it looked like a nightmare in there" and noting the closet appeared in similar condition "every Monday." The Infection Preventionist could not determine which items were clean versus contaminated and acknowledged "everything was contaminated."
This type of contamination in a clean linen storage area creates significant infection risks. Clean linens that come into contact with used gloves, tissues, or other contaminated materials can become vehicles for transmitting bacteria, viruses, and other pathogens. When these compromised linens are then used for resident care, they can introduce infections to vulnerable individuals with weakened immune systems. Proper infection control protocols require strict separation between clean and soiled items, with clean linen storage areas maintained in sanitary conditions free from any potential contaminants.
Improper Laundry Handling Practices
Inspectors observed a floor technician folding residents' personal laundry while allowing the clean clothing items to contact his body and uniform. The facility's own infection control policy explicitly stated that laundry employees should "not allow linen to touch their uniform or body" and required wearing gloves and gowns during laundry separation and folding activities.
When questioned, the floor technician demonstrated awareness of proper procedures, acknowledging that clothing should not touch staff bodies or clothing and identifying the concern as "cross-contamination." The Housekeeping Supervisor similarly recognized this as a cross-contamination issue during her interview.
This violation represents a fundamental breakdown in infection control practices. Staff uniforms accumulate microorganisms throughout the workday from multiple sources and environments within the facility. When clean laundry contacts contaminated clothing, bacteria and viruses can transfer to the supposedly clean items. These microorganisms can include antibiotic-resistant bacteria, respiratory viruses, and gastrointestinal pathogens that pose particular dangers to elderly nursing home residents. The facility's policy requiring gloves and gowns during laundry handling exists specifically to create a barrier preventing this type of contamination.
Failure to Implement Enhanced Barrier Precautions
The inspection revealed that staff failed to follow enhanced barrier precautions for a resident with a stage 4 pressure ulcer on the right hip. The resident had physician orders in place since January 2025 requiring enhanced barrier precautions due to the wound, and appropriate signage was posted on the resident's door indicating that gloves and gowns must be worn during high-contact care activities including transferring and changing linens.
Despite these clear requirements, a certified nursing assistant was observed entering the resident's room without wearing a gown. The aide proceeded to make contact with the resident, bed linens, and the bed itself while repositioning the resident and adjusting blankets—all activities specifically identified as requiring full protective equipment.
When interviewed, the nursing assistant acknowledged seeing the enhanced barrier precaution sign but stated she would only wear gloves (not a gown) unless the resident was "on a certain precaution." The aide indicated she did not believe the resident was on any type of precautions, despite the clearly posted signage.
Enhanced barrier precautions serve critical functions in preventing the spread of multi-drug resistant organisms. Stage 4 pressure ulcers extend through skin and subcutaneous tissue into muscle and potentially bone, creating open wounds highly susceptible to colonization with dangerous bacteria. These organisms can easily transfer to staff hands and clothing during care activities, then spread to other vulnerable residents. The precautions create protective barriers preventing this chain of transmission.
The Infection Preventionist confirmed that staff should wear both gloves and gowns when repositioning this resident and adjusting linens to prevent cross-contamination and transmission of germs between residents.
Additional Issues Identified
The inspection documented that these infection control failures affected 129 of 129 residents in the facility through the laundry handling violations and contaminated linen storage. The enhanced barrier precaution violation directly affected one resident with a serious pressure wound requiring protective measures.
The facility's own policies contained appropriate infection control procedures, indicating that the problems stemmed from implementation failures rather than lack of written protocols. Staff demonstrated awareness of proper procedures during interviews but failed to follow them during actual care delivery, suggesting inadequate supervision and accountability systems.
State regulations require nursing homes to maintain comprehensive infection prevention and control programs to protect residents from preventable healthcare-associated infections. These violations represent fundamental failures in that obligation, creating environments where dangerous pathogens can spread unchecked through contaminated linens, improper handling procedures, and inconsistent use of protective equipment.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Birmingham Nursing and Rehabilitation Ctr LLC from 2025-03-26 including all violations, facility responses, and corrective action plans.
💬 Join the Discussion
Comments are moderated. Please keep discussions respectful and relevant to nursing home care quality.