Long-Term Care Survey Alert

Are any of these lapses about to wreak F tags in your facility?

The facility floors may be gleaming on survey day but if surveyors spot common housekeeping gaffes, you can bet they will be scouring your facility to see just how clean everything really is.

Example: Roberta Reed, MSN, RN, has seen nursing facilities get slapped with substandard citations when surveyors see dirt build-up on the molding or crevices on the side of floors. "The dirt accumulates because the person mopping pushes everything to the side and then fails to clean the molding or edges of the floors," says Reed, a survey expert in Cleveland, OH.

Most facilities have housekeeping protocols that spell out cleaning routines and how to mop a floor correctly, etc.--but you have to include ongoing education and monitoring to ensure compliance, says Judy Gross, RN,C, CDONA/LTC, RAC-C, a consultant with LBK Health Care Inc. in Dayton, OH.

Clean With Infection Control in Mind

Every facility should also have infection control policies for what disinfectant to use for what purpose--and exactly how to use the product, advises Eleanor Alvarez, president of LeaderStat LLC, a consulting firm in Columbus, OH. Don't forget to include cleaning protocols for commonly overlooked items. For example, clean shower chairs in between each resident, advises Ellen Mullin, a consultant and former surveyor in Montgomery, AL.

To select effective disinfectants, refer to the products' label claims, advises James Marx, RN, CIC, an infection control specialist in San Diego. A product that says it kills viruses and bacteria should be effective against influenza and other viruses and bacterial pathogens, he says. Review the manufacturer's instructions, including contact times for cleaning a surface, Marx adds.

Tip: "Bleach solutions make great disinfectants but you run into safety issues in terms of handling concentrated solutions and using the right dilutions," Marx notes. "But there are chlorine-based products that come in the diluted form," he says.

Watch Out for the Gag Factor

What may seem like relatively minor or one-time hygiene infractions can set your facility up for serious F tags. For example, you don't want a surveyor to open a door to a stinking closet with a wet, moldy mop on the floor. "Mops should be hung up in closets that are clean, safe, orderly--and with no unpleasant odors," advises Reed.

Don't end up like one facility with an ongoing fruit fly problem that surveyors traced to the source: A basket of rotting food under a resident's bed.

Solution: You can help keep rooms vermin- and pathogen-free by asking residents' visitors to bring only non-perishable snacks in dated, sealed containers, advises Kim Malin, RN, director of nursing at Hillhaven Assisted Living Nursing & Rehabilitation Center in Adelphia, MD. For example, Hillhaven includes that reminder in its newsletter for residents' families.

Keep Housekeeping in the Survey Management Loop

Surveyors may observe housekeeping and even maintenance staff in action with infection control issues in mind, says Stephen Trosty, JD, MHA, a risk management consultant in East Lansing, MI. "Housekeeping staff and maintenance should wear gloves in patients' rooms and change the gloves and wash their hands in between rooms," he advises.

"The housekeeping staff should  work at arm's length from dirty surfaces when cleaning so as to avoid contact with them," adds Gross.