Failure to Implement Infection Control Measures for Suspected Scabies
Penalty
Summary
The facility failed to implement appropriate infection control measures for three residents following a physician's order to rule out scabies. Specifically, after a physician ordered a skin scraping for one resident to test for scabies, the resident was not placed on contact isolation as required by facility policy. Observations confirmed that there was no contact isolation signage or personal protective equipment (PPE) available at the resident's door, and both the Infection Preventionist and Director of Nursing acknowledged that contact isolation should have been initiated when the order was given. Additionally, the facility did not ensure that skin monitoring was performed and documented for three residents after a physician ordered such monitoring. Review of the Treatment Administration Records (TAR) and progress notes revealed that skin monitoring was not started until two days after the physician's order, resulting in a gap in monitoring and documentation. Nursing staff confirmed that this delay occurred and acknowledged that it could lead to a delay in care. The facility's policies and procedures require the initiation of transmission-based precautions and timely documentation of infection surveillance data. However, these protocols were not followed in this instance, as evidenced by the lack of contact isolation and delayed skin monitoring for the affected residents. The failures were confirmed through interviews with staff and review of medical records and facility policies.