Failure to Implement and Enforce C-Diff Infection Control Precautions
Penalty
Summary
The facility failed to identify, assess, treat, and implement appropriate contact precautions for residents exhibiting symptoms of Clostridioides difficile (c-diff), as well as failed to ensure staff followed proper infection control practices. Multiple residents with persistent loose stools and diarrhea were not assessed in a timely manner, and there was no evidence that physicians were contacted regarding these symptoms. In several cases, residents were only diagnosed with c-diff after being sent to the hospital, despite ongoing symptoms documented in their records. Staff were observed not following required infection control protocols for c-diff, including not washing hands with soap and water after providing care to affected residents. Instead, staff frequently used alcohol-based hand rubs (ABHR), which is not the recommended practice for c-diff. Some staff members were unclear about the correct hand hygiene procedures, and others cited being too busy to follow proper protocols. Contact precaution signage was present, but staff either misunderstood or did not adhere to the requirements, leading to potential cross-contamination between residents and clean areas such as linen closets. Interviews with staff and review of records revealed a lack of consistent assessment and communication regarding residents with repeated loose stools. The Director of Nursing Services (DNS) acknowledged that staff were not following appropriate infection control practices and that there were concerns about staff understanding and compliance with c-diff precautions. These failures resulted in an Immediate Jeopardy situation, as determined by surveyors, due to the risk of exposure and spread of c-diff among all residents.
Removal Plan
- Identify and assess residents with suspected c-diff. Place affected residents on contact precautions with appropriate signage and review by a physician.
- Sanitize or remove shared equipment from use by affected residents.
- Monitor affected residents.
- Inservice staff on c-diff precautions and infection control practices.
- Inservice oncoming staff prior to their shift.
- Inservice nurses on assessing residents with signs and symptoms of c-diff.
- Conduct PPE competency testing.
- Conduct infection control audits and monitoring.
- Report to QAPI.
- Governing body review.
- Retrain and discipline non-compliant staff members.