Kentucky nursing homes failed at basic infection control for years. Then COVID-19 hit.

Public records show that many Kentucky nursing homes failed at infection prevention and control even before the novel coronavirus blazed through them over the last two months, infecting more than 1,000 of their residents and staff as of Friday and killing more than 120.

Among the places cited for errors as routine as a lack of hand-washing are seven of the 10 long-term care facilities now hardest hit by COVID-19, such as Rivers Edge Nursing and Rehabilitation Center in Jefferson County, Signature HealthCARE at Summit Manor in Adair County and Signature HealthCARE at Jackson Manor in Jackson County.

“Yes, we are amazed at how simple some of the infection control practices are that are continually violated,” Sherry Culp, executive director of the Nursing Home Ombudsman Agency of the Bluegrass in Lexington, said this week.

However, state regulators almost never issued a serious penalty for infection control violations, so they seldom resulted in fines or affected the federal government’s five-star rating system that the public uses to compare the quality of nursing homes, according to a Herald-Leader review of the 333 infection control citations issued to Kentucky nursing homes from April 2016 to December 2019.

It’s the same story across the country, said Toby Edelman, senior policy attorney for the Center for Medicare Advocacy, which lobbies for better care for the elderly and disabled. Infection control citations are among the most commonly issued to nursing homes, as well as among the least penalized, Edelman said.

“We have a lot of nursing homes that get cited for infection control deficiencies year after year, and for really basic stuff like nursing aides not washing their hands between rooms. But our regulatory system is pretty toothless, so we haven’t been solving the problem,” Edelman said.

“Unfortunately, at a time like this, during a pandemic, we’re all seeing the results,” she said.

The Kentucky Cabinet for Health and Family Services nearly always determined there was “minimal harm” as nursing home employees failed to wash their hands, change gloves and disinfect equipment and supplies while walking from room to room among elderly and ailing residents, even when they handled urine and feces and cared for infectious patients in isolation, according to its own citations.

At various Kentucky nursing homes over the last three years, aides passed out food, drinks and pills to residents with their unwashed bare hands while also touching their own faces, hair and communal objects such as light switches and refrigerator door handles, according to inspection reports. Feces-stained bed sheets were put on residents’ bed tables where personal items were kept. Residents’ surgical wounds were not properly cleaned and dressed.

At Landmark of River City, a Louisville nursing home with 33 resident infections from COVID-19 and six resident deaths, a resident was placed in isolation in August 2017 with an infectious condition — Clostridium difficile — that causes symptoms ranging from diarrhea to life-threatening colon inflammation.

State inspectors watched the director of nursing and a maintenance technician enter the resident’s isolation room, touch his bed and various other objects and then leave for different rooms in the facility without ever donning gloves or gown or washing their hands, all in violation of infection control rules.

When the dietary supervisor delivered a meal tray to the isolation room, he did put on the requisite gown and gloves. Unfortunately, rather than remove the gear and toss it in the trash just inside the door, as he was supposed to, he walked down the hall to the nurses station, stripped next to a medication cart used for other residents and then, with his unwashed hands, delivered another resident’s meal tray.

“Minimal harm,” state inspectors concluded in their report.

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