Incomplete Perineal Care and Infection Control Lapse
Penalty
Summary
A deficiency occurred when a certified nursing assistant (CNA) failed to provide complete perineal care to a female resident who was always incontinent of bowel and bladder and had a history of urinary tract infection. During an observed care episode, the CNA did not fully remove all bowel movement (BM) from the resident's buttocks and anus, even after using several wipes. The CNA proceeded to place a clean brief on the resident while visible BM remained, only cleaning the area thoroughly after being prompted by the surveyor. The resident's care plan required application of barrier cream after every incontinent episode, checking and assisting with toileting every two hours, and providing perineal care after each episode. The facility's perineal care policy specified that staff should use proper hand hygiene, wear gloves, and clean from front to back, using a clean wipe for each stroke, and ensure all soiling is removed. The CNA did not adhere to these procedures, as evidenced by incomplete cleaning and failure to perform hand hygiene after glove removal. Interviews with the CNA and facility leadership confirmed that the CNA was aware of the correct procedures and the importance of thorough cleaning to prevent infection and skin breakdown. However, the CNA did not follow the established policy during the observed care, and the administrator acknowledged unfamiliarity with the policy due to being new to the facility.