Centennial Post Acute: Infection Control Gaps - AK
The makeshift repair at Centennial Post Acute involved wrapping tape around a torn gastric tube and using a rubber band as a clamp to prevent leakage. The patient's feeding tube had developed an internal tear that caused medications and nutrition to leak out during administration.
Licensed Nurse #4 defended the improvised fix during an August 29 interview with state inspectors. "I used the resident's clean room tape; the rubber band functioned as a clamp," the nurse said. "The rip was internal to the tubing; meds were delivered past the tear."
The nurse acknowledged the temporary nature of the repair wasn't ideal but claimed to see no additional risks beyond leakage at the time.
The facility's Infection Preventionist disagreed sharply. Using tape or rubber bands to manage a leaking tube was "not acceptable," she told inspectors. A medical grade clamp should have been used to prevent both leakage and electrolyte imbalance in the patient.
The correct action would have been to clamp the tube with proper equipment and replace it on-site, the Infection Preventionist explained. Centennial Post Acute had supplies available to replace gastric tubes in-house rather than sending patients to hospitals.
"Using rubber bands poses infection control risks," she said, though she noted tape was less risky if clean, since gastric tube care uses clean technique rather than sterile procedures.
Staff had not been trained to use rubber bands as medical clamps because proper equipment was available at the facility.
The Director of Nursing confirmed that most facilities keep standard medical grade clamps in stock. When asked about the rubber band incident, the nursing director acknowledged that "no specific follow-up was done at that time and the use of rubber bands was not the standard practice promoted by the facility."
The nursing director also revealed broader infection control problems. Audits were "not consistently conducted and needed to be revamped" across the facility.
Centennial Post Acute's own policies, last reviewed in March 2019, require staff to monitor gastric tube sites for signs of leakage and infection. The policy mandates clean technique including gloves when handling feeding tubes and states that "whenever possible, a closed system will be used for the administration of tube feedings."
The facility follows Lippincott procedures that explicitly warn against improvising repairs. When troubleshooting a leaking gastric tube, nurses must follow manufacturer guidelines and "use only medical-grade devices such as clamps or securement devices."
The procedures emphasize that nurses "should not improvise with non-sterile or non-medical materials to patch the tube."
The patient involved required a complete tube replacement the same day as the rubber band repair. Progress notes from May 10 show a new 15-French tube was placed using sterile technique, with proper balloon inflation and placement verification. The patient tolerated the replacement procedure well and received 300 cc of water immediately afterward.
The patient's care plan, revised in March, specifically aimed to keep the resident "free of side effects or complications related to tube feeding." Interventions included checking the gastric tube site before each feeding and medication administration for signs of skin irritation, infection, or leakage.
The plan required tube site care every shift and water flushes before and after all medication administrations and feedings.
State inspectors cited the facility for failing to follow accepted standards of practice in infection prevention and control. The violation affected few residents but created potential for actual harm through the use of non-medical materials in patient care.
The rubber band repair represented exactly the kind of improvised solution that medical protocols are designed to prevent, creating unnecessary infection risks for a vulnerable patient who depended entirely on the gastric tube for nutrition and medication.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Centennial Post Acute from 2025-08-29 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
CENTENNIAL POST ACUTE in ANCHORAGE, AK was cited for violations during a health inspection on August 29, 2025.
The makeshift repair at Centennial Post Acute involved wrapping tape around a torn gastric tube and using a rubber band as a clamp to prevent leakage.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.