SPOKANE, WA - A state inspection found widespread infection control violations at Spokane Health & Rehabilitation that put residents at risk of contracting serious infections, with staff repeatedly failing to follow basic hygiene protocols during medication administration, wound care, and meal service.
Breakdown in Infection Prevention Protocols
The April 2025 inspection revealed systematic failures in the facility's infection prevention program, with particular concerns around Enhanced Barrier Precautions (EBP) - specialized safety measures required for residents with medical devices or antibiotic-resistant infections.
Enhanced Barrier Precautions involve using gowns and gloves during high-contact care activities for residents with indwelling medical devices like catheters, feeding tubes, or central lines. These precautions are critical because such devices create direct pathways for bacteria to enter the body, significantly increasing infection risk.
Inspectors found that five residents requiring EBP had no warning signs posted outside their rooms to alert staff. This included residents with urinary catheters, feeding tubes, and a PICC line (a central venous catheter used for medication delivery). Without proper signage, staff remained unaware of the need for enhanced protective equipment, creating dangerous exposure scenarios.
The infection preventionist acknowledged that EBP signage "should be put up upon admission" but admitted the system had failed. This represents a fundamental breakdown in the facility's infection control infrastructure, as proper identification of high-risk residents forms the foundation of any effective prevention program.
Dangerous Medication and Wound Care Practices
Perhaps most concerning were the observed violations during direct patient care. During medication administration through a PICC line - a procedure requiring sterile technique due to the direct connection to major blood vessels - nursing staff repeatedly failed to follow basic infection control protocols.
PICC lines carry particularly high infection risks because they provide direct access to the bloodstream. Infections can rapidly progress to life-threatening bloodstream infections (sepsis), making proper sterile technique absolutely critical. The observed failures included staff not wearing required gowns and failing to perform hand hygiene between different care activities.
One resident receiving antibiotics through their PICC line stated that "staff had not always worn a gown when administering their antibiotics." This violation occurred despite the resident being on isolation precautions for an active infectious disease process, amplifying the potential consequences.
During wound care procedures, staff failed to change gloves between removing contaminated dressings and applying clean ones - a basic principle that prevents transferring bacteria from infected tissue to clean wound surfaces. One nurse was observed touching the sterile portion of new dressings with contaminated gloves, directly compromising the wound's healing environment.
These failures violate fundamental medical principles. Proper wound care requires a clean-to-dirty approach, where staff must change gloves and perform hand hygiene after handling contaminated materials before touching clean supplies. This prevents introducing additional bacteria into healing tissue, which can lead to delayed healing, increased pain, and potential systemic infections.
PICC Line Maintenance Violations
The facility also failed to maintain proper schedules for PICC line dressing changes. One resident's dressing went nine days between changes, despite physician orders requiring weekly changes. PICC line dressings must be changed regularly to maintain the sterile barrier protecting the insertion site from bacterial contamination.
The extended interval occurred because staff improperly applied the initial dressing and had to redo it, but failed to reset the change schedule appropriately. The resident told inspectors: "the dressing was changed yesterday but was not placed correctly so it had to be re-done."
Delayed dressing changes significantly increase infection risk by allowing moisture accumulation and bacterial growth at the insertion site. The infection preventionist acknowledged that dressing changes "should have been completed within seven days" and were "important to prevent infections."
Food Service and Equipment Sanitation Failures
The inspection also documented failures in basic hygiene during meal service. Staff was observed blowing on a resident's food to cool it down - a practice that directly transfers respiratory droplets and oral bacteria onto food intended for a vulnerable individual.
This behavior is particularly dangerous in nursing home settings where residents often have compromised immune systems and may be more susceptible to foodborne illnesses. The practice violates basic food safety principles and represents a direct transmission pathway for respiratory infections.
Additionally, staff failed to sanitize mechanical lifts between residents, potentially spreading pathogens through shared equipment. Proper equipment cleaning between uses is essential because surfaces can harbor bacteria and viruses that transfer between individuals during care activities.
Antibiotic Stewardship Program Failures
The facility's antibiotic stewardship program showed significant gaps in monitoring appropriate antibiotic use. For three consecutive months, the facility failed to evaluate whether newly admitted residents or those prescribed antibiotics by outside providers met established criteria for antibiotic treatment.
Antibiotic stewardship programs are crucial for preventing the development of antibiotic-resistant bacteria by ensuring medications are only used when medically necessary and for appropriate durations. The facility's infection preventionist stated they didn't apply stewardship protocols because they assumed "the hospital ensures McGeer is being followed on their end."
This assumption represents a dangerous gap in continuity of care. Each healthcare facility must independently verify that antibiotic use meets established medical criteria, regardless of prescribing source, to prevent contributing to the growing problem of antibiotic resistance.
Additional Issues Identified
The inspection revealed several other concerning violations:
Vaccination compliance failures affected two residents who had consented to receive influenza and pneumonia vaccines but never received them, despite facility policies requiring timely administration.
Equipment safety issues included a resident's call light with exposed wiring that remained unrepaired for over a week despite the resident reporting it to staff multiple times.
Call light accessibility problems left two residents with fall risks unable to reach their emergency call systems, with one resident stating they "would have to wait for staff to walk past their room and yell out for help."
Environmental hygiene concerns included a shared room with persistent foul odors that affected both residents, with one stating they had "mentioned it numerous times to the staff, but nothing was done."
These violations collectively demonstrate systemic failures in basic care standards that could have serious health consequences for vulnerable nursing home residents. The facility's infection control failures are particularly concerning given the high-risk population served and the potential for serious complications from healthcare-associated infections.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Manor Care Health Services-spo from 2025-04-24 including all violations, facility responses, and corrective action plans.
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