Munster Med-Inn: Hand Hygiene Failures During Wound Care - IN
Inspectors watched it happen at least ten times in a single afternoon at Munster Med-Inn.
The October 2025 complaint inspection documented two separate wound care sessions in which the facility's wound nurse repeatedly skipped hand hygiene between glove changes. The violations were cited under infection control standards, with inspectors noting that a few residents were affected and that the lapses carried potential for actual harm.
The first session involved a resident with a wound on the left heel and a separate wound on the left hip that had a heavy amount of dried and fresh bloody drainage. The wound nurse cleaned the heel wound, patted it dry, removed her gloves, and put on a clean pair without washing her hands. She applied skin prep, then an antibiotic ointment called Mupirocin, and bandaged the heel. Then she moved to the hip wound, removed that bandage, pulled off her gloves, put on a new pair, and again did not wash her hands.
The second session was longer. The wound nurse was treating a different resident, identified in the report as Resident C, who had pressure ulcers on the right foot in two locations, the coccyx, the left knee, and the left hand. Inspectors counted the lapses as the nurse worked through each site. She cleaned the right lateral foot wound, removed her gloves, put on clean ones, no hand hygiene. She applied ointment to the same wound, removed her gloves, put on clean ones, no hand hygiene. She moved to the medial foot, cleaned it, removed her gloves, put on clean ones, no hand hygiene. Ointment on the medial foot, gloves off, clean gloves on, no hand hygiene. Then the coccyx wound, gloves discarded, clean pair on, no hand hygiene. Cleaned that wound, gloves off, new pair on, no hand hygiene. Then the left knee, bandage removed, gloves discarded, clean pair on, no hand hygiene. Cleaned the knee wound, gloves off, new pair on, no hand hygiene. Then the left hand, kerlix bandage removed, gloves off, clean pair on, no hand hygiene. Cleaned the wound and palm, gloves discarded, clean pair on, no hand hygiene.
She completed the treatment and washed her hands.
When inspectors interviewed the wound nurse that same afternoon, she said she was unaware she had to perform hand hygiene every time she removed her gloves.
The Director of Nursing, interviewed the following morning, said hand hygiene was required before and after every glove removal. The facility's own hand hygiene policy, dated September 1, 2020, and provided to inspectors that afternoon, said the same thing.
The policy had been in place for more than five years. The wound nurse, whose job is to manage and treat the facility's most serious skin injuries, did not know it applied to her.
The gap between what the policy required and what the nurse understood matters most in the context of what she was actually doing. Pressure ulcers are open wounds. The coccyx wound on Resident C had enough drainage that inspectors noted it specifically. The left hip wound on the first resident was visibly bloody. Gloves protect against contamination in both directions, and the moment they are removed, whatever was on them, or on the hands beneath them, becomes a transfer risk to the next surface touched. Hand hygiene between glove changes is not a formality. It is the mechanism that makes glove changes meaningful.
The wound nurse was swapping gloves throughout both sessions. She was not skipping infection control out of haste or inattention to the broader protocol. She was following most of the steps. She simply did not know that the handwashing belonged between the gloves coming off and the new ones going on, and nobody had caught it.
The Director of Nursing confirmed the standard. The policy confirmed the standard. The wound nurse, treating open wounds on residents with pressure ulcers across multiple body sites, had not been trained to it, or had not retained it, and the gap had gone undetected long enough that inspectors observed it happening repeatedly, across two patients, on the same day.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Munster Med-inn from 2025-10-28 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 23, 2026 · Our methodology
MUNSTER MED-INN in MUNSTER, IN was cited for violations during a health inspection on October 28, 2025.
Inspectors watched it happen at least ten times in a single afternoon at Munster Med-Inn.
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.