An inquiry into Scotland's worst Clostridium difficile (C.diff) outbreak has heard nurses treating patients were too busy to fill out some paperwork.
Sister Lesley Fox said an assessment form was not completed by staff on ward six at the Vale of Leven Hospital, where some C.diff patients died.
But she said this had not affected patient care on the ward.
A total of 55 patients developed the bug and 18 died at the hospital between December 2007 and June 2008.
C.diff was blamed for nine deaths and was a contributory factor in nine more.
Sister Fox was giving evidence for a second day at the inquiry into the deaths at the hospital in Alexandria, West Dunbartonshire.
She was responsible for ward six, where a number of women tested positive for C.diff in 2007 and 2008. Some of those patients later died.
Sister Fox said a document called the Waterlow assessment, which looked at a patient's skin and would set out how at risk of pressure sores they were, was not completed by staff on ward six during the time of the C.diff cases.
She said: "I also do know that when my nursing staff admitted a patient, the principles of that Waterlow scoring tool was used in assessment.
"What was not used was that document."
She agreed with Colin MacAulay QC, senior counsel to the inquiry, that the Waterlow scale was "very important".
In her statement, shown to the inquiry, she wrote that the assessment of skin was important as it was the "first barrier" to infection.
The Waterlow assessment document had been used on ward six since June 2008, the inquiry was told.
But Sister Fox told the inquiry that even if the document had not been completed, this had not affected care for the patients.
"Our assessment of the patient was constant and care of the patient was no different," she said.
Asked why the document was not completed for patients from January 2007 to June 2008, she said: "We were so busy that we could not complete, we did not complete the tool as a piece of paper."
The inquiry heard that part of her role at the time of the outbreak was to teach other nurses about using the Waterlow assessment document.
The inquiry, which is chaired by retired judge Lord MacLean, started in June last year at the Community Central Halls in Maryhill, Glasgow.
This section of hearings is due to run until 15 September.
A final report and recommendations are expected to be published by September 2012.