Failure to Implement Enhanced Barrier Precautions for Chronic Wound
Penalty
Summary
The facility failed to follow infection control standards for a resident with a chronic open wound to the left foot. Upon admission, there was no documentation in the clinical record indicating that enhanced barrier precautions were implemented for the resident, despite facility procedures requiring such precautions for conditions like chronic wounds. During an observed dressing change, staff placed an enhanced barrier precaution sign on the resident's door and donned appropriate PPE, but it was confirmed that prior to this, staff had not consistently worn the required PPE, such as gowns, when providing care. The resident reported that this was the first time staff had worn PPE gowns during wound care since admission. Staff interviews confirmed that enhanced barrier precautions should have been in place from admission, including signage and PPE use, but these measures were not implemented until the day of observation.