Failure to Follow Enhanced Barrier Precautions During Wound Care
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program as evidenced by a Wound Care Nurse not wearing a gown while providing wound care to a resident on enhanced barrier precautions. The resident, a male with a history of cellulitis, lymphedema, and chronic venous hypertension with ulcers, was care planned for enhanced barrier precautions due to a vascular ulcer. Despite clear signage outside the resident's room and the availability of gowns in the room, the Wound Care Nurse only donned gloves and did not wear a gown while applying a bandage to the resident's leg. Interviews revealed that the Wound Care Nurse was initially unaware or had forgotten that the resident was on enhanced barrier precautions, despite prior training and the presence of a posted sign. The facility's Infection Preventionist and DON confirmed that all staff were expected to follow infection control procedures, including wearing gowns and gloves for residents on enhanced barrier precautions. The facility's policy required the use of gowns and gloves during high-contact care activities for residents with chronic wounds, which was not followed in this instance.